293 research outputs found
Content comparison of health-related quality of life instruments for obstructive sleep apnea
No full textBackground and purpose: Due to the increasing importance of quality of life assessments in obstructive sleep apnea (OSA) patients and due to an increased use of the International Classification of Functioning, Disability and Health (ICF), for comparative purposes it is essential to understand the relationship between health-related quality of life (HRQOL) instruments and the ICF. The purpose of this study was to compare the content covered by OSA-specific instruments using the ICF.Patients and methods: OSA-specific instruments were identified, including the Calgary Sleep Apnea Quality of Life Index, the Functional Outcomes of Sleep Questionnaire, the Obstructive Sleep Apnea Patient-Oriented Severity Index, and the Quebec Sleep Questionnaire, and linked to the ICF by six health professionals according to standardized guidelines. The degree of agreement between health professionals was calculated by means of the kappa statistic.Results: A total of 308 concepts were identified and linked to 78 different ICF categories; 35 categories of the component body function, one category of the component body structure, 38 categories of the component activities and participation, and four categories of the component environmental factors. Only contents within the chapters mental functions, mobility and social life were addressed by all instruments. Forty-seven categories were covered by only one instrument.Conclusion: The ICF proved highly useful for the comparison of HRQOL instruments. This analysis may help researchers and clinicians to choose the most appropriate HRQOL instrument for a specific purpose as well as help to compare study outcomes of studies using different instruments for HRQOL assessment
Childhood narcolepsy with cataplexy: comparison between post-H1N1 vaccination and sporadic cases.
No full textWe aimed to compare post-Pandemrix vaccination (postvaccine) childhood narcolepsy with cataplexy (NC) vs. sporadic pre-H1N1 pandemic (pre-H1N1) cases.Clinical, anthropometric, polysomnographic, and cerebrospinal hypocretin 1 (hcrt-1) measurements were collected together with the video recordings of cataplexy in 27 Finnish patients with NC onset after H1N1 Pandemrix vaccination (mean age, 12±4 years; 52\% boys) and 42 Italian NC patients with NC onset before the H1N1 pandemic (mean age, 11±3 years; 48\% boys). All subjects carried the HLA-DQB1*0602 allele.Postvaccine subjects were older at NC onset (12±3 vs. 9±3 years; P=.008) and displayed a shorter mean sleep latency in multiple sleep latency tests (MSLT) (2.3±2.2 vs. 3.7±2.9 min; P=.026) compared to pre-H1N1 cases. Anthropometric, clinical (core NC symptoms), hcrt-1 deficiency, and polysomnographic data did not differ among groups, but higher disrupted nocturnal sleep was observed in postvaccine subjects. Comparison of cataplexy features at video assessment showed an overlapping picture with the exception for hyperkinetic movements which appeared to be more evident in pre-H1N1 subjects.The clinical picture of childhood NC was similar in postvaccine and pre-H1N1 children
Misdiagnosis of narcolepsy caused by a false-positive orexin-A/hypocretin-1 enzyme immune assay
No full text<p>The diagnosis of narcolepsy is based on clinical history, sleep studies, and, in some cases, cerebrospinal fluid orexin-A/hypocretin-1 measurement. The gold standard for orexin measurement is the radioimmunoassay but other commercial kits are also available, such as the enzyme immune assay (EIA). The specificity of orexin EIA in humans is unknown. We report four cases where orexin levels were measured by EIA and resulted in false positives and the misdiagnosis of narcolepsy. Therefore, orexin EIA measurement should be strongly discouraged in a clinical setting. CITATION: Sarkanen T, Sved G, Juujärvi M, Alakuijala A, Partinen M. Misdiagnosis of narcolepsy caused by a false-positive orexin-A/hypocretin-1 enzyme immune assay. J Clin Sleep Med. 2022;18(8):2075-2078.</p>Peer reviewe
Narcolepsy as an autoimmune disease: the role of H1N1 infection and vaccination.
No full textNarcolepsy is a sleep disorder characterised by loss of hypothalamic hypocretin (orexin) neurons. The prevalence of narcolepsy is about 30 per 100 000 people, and typical age at onset is 12-16 years. Narcolepsy is strongly associated with the HLA-DQB1*06:02 genotype, and has been thought of as an immune-mediated disease. Other risk genes, such as T-cell-receptor α chain and purinergic receptor subtype 2Y11, are also implicated. Interest in narcolepsy has increased since the epidemiological observations that H1N1 infection and vaccination are potential triggering factors, and an increase in the incidence of narcolepsy after the pandemic AS03 adjuvanted H1N1 vaccination in 2010 from Sweden and Finland supports the immune-mediated pathogenesis. Epidemiological observations from studies in China also suggest a role for H1N1 virus infections as a trigger for narcolepsy. Although the pathological mechanisms are unknown, an H1N1 virus-derived antigen might be the trigger
Part 1. International Classification of Functioning, Disability and Health (ICF) Core Sets for persons with sleep disorders: results of the consensus process integrating evidence from preparatory studies
No full textBackground/objectives. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and universally accepted framework to classify changes in functioning related to health conditions. Comprehensive and Brief Core Sets have been defined for various disorders but not for sleep disorders. Such a Core Set would greatly enhance the techniques available to describe the impact of sleep disorders on patients. The overarching purpose of this paper is to report on phase 1 of the international and World Health Organization (WHO) endorsed consensus process in identifying ICF Core Sets for sleep disorders.Methods. A formal decision-making and consensus process which integrated evidence gathered from preparatory studies was carried out. Relevant ICF categories were selected by a sample of international experts from different backgrounds using the nominal group technique.Results. Twenty-six experts from 22 countries and different professional backgrounds attended the consensus conference. Altogether 120 second- or third-level ICF categories were included in the Comprehensive ICF Core Set with the following ICF component split: 49 categories from body functions, 8 from body structures, 31 from activities and participation and 32 from environmental factors. The Brief ICF Core Set included a total of 15 second-level categories: 5 body functions (sleep, energy and drive, attention, consciousness, respiration functions); 3 body structures (brain, respiratory system, pharynx); 4 activities and participation (focusing attention, driving, handling stress and other psychological demands, carrying out daily routine); and 3 environmental factors (immediate family; health services, systems, and policies; and health professionals).Conclusion. A formal consensus process integrating evidence and expert opinion led to the first version of the ICF Core Sets for persons with sleep disorders. Further validation of the Core Set is needed
Litiumioniakkumateriaalien liuotus sulfaatti- ja kloridiliuoksissa hydrometallurgisen kierrätyksen osana
No full textAs a result of the worldwide attempt to phase out fossil fuels and implement cleaner technologies, batteries are becoming increasingly important. One of the most obvious effects of this green transition in everyday life has been the rapid increase in the number of electric vehicles (EVs) over the past few years. Li-ion batteries used in EVs contain high concentrations of valuable materials, many of which are classified as critical. To ensure the circulation of these materials back to reuse after End-of-Life (EoL), efficient recycling is necessary.
The most commonly used battery recycling processes are hydrometallurgical and pyrohydrometallurgical. This thesis studies the leaching step of the hydrometallurgical recycling route. Leaching experiments were performed in sulfate and chloride media, using both pure commercial battery cathode chemicals and industrially processed battery waste – black mass – originating from EoL batteries. This allowed for the investigation of both fundamental phenomena associated with cathode materials leaching as well as holistic process considerations related to the presence of other battery components.
During the leaching of pure cathode chemicals, Mn was observed to precipitate out of sulfate media at temperatures T ≥ 70 °C in the absence of external reductants. This precipitation was inhibited in chloride-containing lixiviants, where Cl2 gas was formed instead. Moreover, a system utilizing the reductive properties of soluble cuprous chloride complex species was found to be efficient for battery cathode materials leaching, reaching over 90% Co and Li yields under relatively mild conditions (1 M H2SO4, 0.2 M NaCl, 30 °C, 2 h). Nonetheless, observations on the use of real industrial black mass in a similar system raised questions about the compatibility of chloridecontaining lixiviants, as the reactor overflowed due to rapid gas evolution.
In studies involving industrial black mass, the reductive properties of Cu were found to be improved in response to an increased solution iron concentration – up to 0.4 g/L Fe – whereas Al reductive properties were only improved as the temperature was increased. Furthermore, Cu was found to be overall a more efficient reductant in terms of electron efficiency when compared with Al. In the presence of both Cu and Al, copper was also found to temporarily cement on Al particle surfaces and redissolve as leaching progressed.
Furthermore, Design of Experiments (DoE) methodology was used in combination with regression modeling to derive equations that can predict leaching yields based on input parameters – temperature, solution Fe concentration, Cu amount, and H2O2 amount. This analysis revealed solution Fe concentration and feed Cu amount as more impactful variables in terms of cathode material reduction when compared with the commonly used hydrogen peroxide. This finding was attributed to the various side-reactions associated with H2O2.
Existing literature on LIB cathode material and industrial black mass leaching has largely focused on the development of novel leaching systems by the investigation of alternative reductants to H2O2 while often neglecting the role of various metallic components found within industrial black masses. This thesis contributes to the field by providing a detailed comparison of sulfate and chloride media leaching efficiencies, elucidating the capability of soluble cuprous complexes to catalyze the leaching system, and investigating the reductive efficiencies of current collector metals Cu and Al and the role of soluble Fe as an electron transporter between these metals and battery cathode materials. The research presented in this thesis will help future researchers and industrial operators by providing detailed information about the performance of various leaching media and the reductive efficiency of metallic fractions found within industrial black mass.Maailmanlaajuiset pyrkimykset fossiilisista polttoaineista puhtaampiin teknologioihin siirtymiseksi ovat kasvattaneet akkujen merkitystä huomattavasti, mikä on arkielämässä näkynyt erityisesti viime vuosina kasvaneena sähköautojen määränä. Sähköautojen litiumioniakut sisältävät suurina pitoisuuksina arvokkaita metalleja, joista monet on määritelty kriittisiksi. Tehokas kierrätys on välttämätöntä näiden materiaalien saamiseksi takaisin käyttöön niiden elinkaaren lopussa.
Yleisimmin käytetyt akkukierrätysprosessit ovat hydrometallurginen ja pyrohydrometallurginen, joista tämä väitöskirja tutkii hydrometallurgisen prosessin liuotusvaihetta. Liuotuskokeita suoritettiin sulfaatti- ja kloridiliuoksissa käyttäen raaka-aineena niin puhtaita kaupallisia akkukatodikemikaaleja kuin teollisesti prosessoitua akkujätettäkin (musta massa). Nämä raaka-ainevalinnat mahdollistivat sekä puhtaiden katodikemikaalien liuotukseen liittyvien ilmiöiden tutkimisen että muiden akuissa esiintyvien materiaalien liuotusprosessissa aikaansaamien vaikutusten havainnoinnin.
Puhtaiden katodikemikaalien liuotuksessa mangaanin huomattiin saostuvan liuoksesta lämpötiloissa T ≥ 70 °C ilman lisättyjä pelkistimiä. Vastaavaa saostumista ei havaittu kloridipitoisissa liuoksissa, jotka sen sijaan reagoivat muodostaen kloorikaasua. Lisäksi väitöskirjassa tutkittu liukoisten kuprokloridikompleksien pelkistävää vaikutusta hyödyntävä liuotussysteemi todettiin tehokkaaksi akkukatodimateriaalien liuotuksessa. Systeemin avulla saavutettiin yli 90 % Co ja Li saannot suhteellisen miedoissa olosuhteissa (1 M H2SO4, 0.2 M NaCl, 30 °C, 2 h). Kokemukset teollisen mustan massan käytöstä raaka-aineena vastaavassa systeemissä herättivät kuitenkin huolta kloridipitoisten liuosten ja mustan massan yhteensopivuudesta reaktioon liittyvän voimakkaan kaasunkehityksen ja vaahdonmuodostuksen vuoksi.
Teollisen mustan massan liuotukseen keskittyvissä tutkimuksissa kuparin pelkistysominaisuuksien havaittiin tehostuvan liuoksen rautapitoisuuden kasvaessa 0.4 g/L Fe asti, kun taas alumiinin pelkistävä vaikutus voimistui ainoastaan lämpötilan noustessa. Lisäksi kuparin havaittiin olevan alumiinia tehokkaampi pelkistin suhteessa näiden metallien luovuttamien elektronien määrään. Kuparin huomattiin myös sementoituvan alumiinikappaleiden pinnalle ja liukenevan uudelleen liuotusprosessin edetessä.
Työssä käytettiin lisäksi Design of Experiments (DoE) -metodologiaa yhdessä regressiomallinnuksen kanssa. Näin saatiin johdettua akkumetallien liuotussaantoja ennustavat yhtälöt perustuen seuraaviin liuotusparametreihin – lämpötila, liuoksen rautapitoisuus sekä kuparin ja vetyperoksidin määrät. Regressioanalyysi osoitti liuoksen rautapitoisuuden ja kuparin määrän olevan katodimateriaalin pelkistymisen kannalta merkittävämpiä tekijöitä kuin usein käytetty H2O2, minkä epäiltiin johtuvan useista vetyperoksidiin liittyvistä sivureaktioista.
Aikaisempi akkumateriaalien ja teollisen mustan massan liuotukseen liittyvä kirjallisuus on keskittynyt pitkälti uusien liuotussysteemien kehittämiseen tutkimalla vaihtoehtoisia pelkistimiä vetyperoksidille, mutta teollisen akkujätteen sisältämät metalliset fraktiot ovat tyypillisesti jääneet vähälle huomiolle. Tämä väitöskirja tuottaa uutta tietoa kyseiseltä tieteenalalta tarjoamalla yksityiskohtaisen vertailun sulfaatti- ja kloridiliuoksien liuotustehokkuuksien välillä, esittelemällä uuden kuprokloridikomplekseihin perustuvan liuotussysteemin ja tutkimalla kuparin ja alumiinin pelkistystehokkuuksia sekä liukoisen raudan roolia elektronien siirrossa näiden metallien ja akkukatodimateriaalien välillä. Tässä väitöskirjassa esitetty tutkimus hyödyttää sekä tulevaa tutkimusta että teollisia akkukierrätystoimijoita tuottamalla lisää tietoa eri liuosten liuotustehokkuudesta sekä akkujätteessä esiintyvien metallisten fraktioiden pelkistystehosta
Correction: Absence of anti-hypocretin receptor 2 autoantibodies in post pandemrix narcolepsy cases.
No full textFollowing publication of this [1] article, questions were raised about some of the reported methods and results, and about differences between the findings reported in this article and in a previous article published by another group [2]. The PLOS ONE Editors reviewed this matter, and consider that the research reported in the PLOS ONE article is scientifically valid and meets the journal’s publication criteria, but that some items require clarification and additional controls. The authors address these issues below: “As noted in [1], we were unable to replicate some findings reported by Ahmed et al. in [2]. We would like to provide some clarifications regarding some methodological differences between the two studies. First, a statement in the Discussion was inaccurate in relaying the differences between the results of peptide binding affinity to DQ0602. The statement: ‘The fact that NP 111-121 (YDKEEIRRIWR) (116I was underlined) and HCRTR2 34-45 (YDDEEFLRYLWR) did not appear to bind to DQ0602 (unlike what was reported with the Proimmune 1 array by Ahmed et al. [43]) (Fig 2, S19 Table) suggested this epitope was likely irrelevant to DQ0602-associated narcolepsy or differential vaccine risk’ should instead read: The fact that NP 111-121 (YDKEEIR RIWR) (116I was underlined) and HCRTR2 34-45 (YDDEEFLRYLWR) did not appear to bind to DQ0602 (Competition binding results S23 Table this Correction) (Of note, ‘NP109-113 116I’ of Fig 2 in [1] should be corrected to ‘NP109-123 116I’) suggested this HCRTR2 epitope was likely irrelevant to DQ0602-associated narcolepsy or differential vaccine risk. Indeed, S3 Table of Ahmed and Steinman’s Proimmune REVEAL 1 data [2] showed weak binding for RELILYDKEEIRRIWRQANNG (24.4 and 16.9 of REVEAL 1 score at first measure and post 24h, respectively), little binding for RELILYDKEEMRRIWRQANNG (1.5 and 0.5 of REVEAL 1 score at first measure and post 24h, respectively) and no binding for the HCRTR2 peptide (LNPTDYDDEEFLRYLWREYLH) (0.0 of REVEAL 1 score at both first measure and post 24h). We overlooked these small differences. Our results show little binding for RELI LYDKEEIRRIWRQANNG (92.40±2.33% of Bio-EBV binding), very weak binding for RELI LYDKEEMRRIWRQANNG (77.84±1.10% of Bio-EBV binding) and no binding for the HCRTR2 34-45 peptide (98.12±1.38% or 99.85±2.10% of Bio-EBV binding) (competition binding results S23 Table this Correction). This does not change our interpretation. Second, intrigued by the results reported by Ahmed et al. [2], we also conducted our own peptide binding studies to DQ0602 using the Proimmune REVEAL 1 binding assay (See S1 File of this Correction) and compared these results for 144 peptides with our own competition assay that uses DQ0602 monomers bound to Bio-EBV (more than 1,446 peptides have been tested using this platform). Results are shown in S12 Fig this Correction S23 Table this Correction; underlying data and analyses are provided in S2 File of this Correction. Overall, no significant correlation was found between our competition binding assay using Bio-EBV and Proimmune results (r 2 = 0.00795, p = 0.290 at 0h; r 2 = 0.00026, p = 0.848 at S12 Fig this Correction). Classifying our binders into strong (high displacement, 25% of Bio-EBV binding) or weak binders (partial displacement, 25–50% of Bio-EBV binding) in our competition assay and positive versus negative in the Proimmune assay also did not reveal any correlation using χ 2 (all p values>0.56, S2 File of this Correction). Further illustrating this, the known EBV binding epitope of DQ0602 (EBV 486-500 ) [6–8], which was used in our competition binding assay, and HA 273-287 , a strong binder in our assay (8.10±1.53% of Bio-EBV S23 Table this Correction), were found not to bind to DQ0602 using the Proimmune 1 assay (0.0 of REVEAL 1 score at both 0h and post 24h, S1 File of this Correction). This led us to conclude that the Proimmune DQ0602 binding assay was unreliable. However, as these results were peripheral to the message of our manuscript and lack of replication of the presence of anti-HCRTR2 antibodies, these were not included in our original publication
Domiciliary nasal respiratory support : first experiences in Malta
No full textNasal respiratory support is a non-invasive alternative to conventional assisted ventilation with endotracheal intubation, or the more cumbersome negative pressure ventilators. The two main types of this relatively new therapy are nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) respiratory support, which are mostly used in chronic hypoventilatory states and obstructive sleep apnoea (OSA) respectively. We have introduced these two types of respiratory support to five patients suffering from neuromuscular disorders and twenty-four patients with OSA with marked improvement in the quality of life of all patients concerned. Our experiences with these patients should hopefully lead to further development in the diagnostic and therapeutic facilities in this field in Malta.peer-reviewe
Autoantibodies against ganglioside GM3 are associated with narcolepsy-cataplexy developing after Pandemrix vaccination against 2009 pandemic H1N1 type influenza virus
No full textFollowing the mass vaccinations against pandemic influenza A/H1N1 virus in 2009, a sudden increase in juvenile onset narcolepsy with cataplexy (NC) was detected in several European countries where AS03-adjuvanted Pandemrix vaccine had been used. NC is a chronic neurological disorder characterized by excessive daytime sleepiness and cataplexy. In human NC, the hypocretin-producing neurons in the hypothalamus or the hypocretin signaling pathway are destroyed by an autoimmune reaction. Both genetic (e.g. HLA-DQB1*0602) and environmental risk factors (e.g. Pandemrix) contribute to the disease development, but the underlying and the mediating immunological mechanisms are largely unknown. Influenza virus hemagglutinin is known to bind gangliosides, which serve as host cell virus receptors. Anti-ganglioside antibodies have previously been linked to various neurological disorders, like the Guillain-Barré syndrome which may develop after infection or vaccination. Because of these links we screened sera of NC patients and controls for IgG anti-ganglioside antibodies against 11 human brain gangliosides (GM1, GM2, GM3, GM4, GD1a, GD1b, GD2, GD3, GT1a, GT1b, GQ1b) and a sulfatide by using a line blot assay. Samples from 173 children and adolescents were analyzed: 48 with Pandemrix-associated NC, 20 with NC without Pandemrix association, 57 Pandemrix-vaccinated and 48 unvaccinated healthy children. We found that patients with Pandemrix-associated NC had more frequently (14.6%) anti-GM3 antibodies than vaccinated healthy controls (3.5%) (P = 0.047). Anti-GM3 antibodies were significantly associated with HLA-DQB1*0602 (P = 0.016) both in vaccinated NC patients and controls. In general, anti-ganglioside antibodies were more frequent in vaccinated (18.1%) than in unvaccinated (7.3%) individuals (P = 0.035). Our data suggest that autoimmunity against GM3 is a feature of Pandemrix-associated NC and that autoantibodies against gangliosides were induced by Pandemrix vaccination
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