Chung Hsiao Municipal Hospital

SummaryUntil now, no study has directly network meta‐analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta‐analyse the impact of three kinds of nasal interfaces with both network meta‐analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea–hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta‐analysis was conducted using multivariate random‐effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random‐effects meta‐analysis. Twenty‐nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea–hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea–hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta‐regression identified that lower pretreatment apnea–hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea–hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration.

Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). The impact of the mask type on the efficacy and acceptance of CPAP is inconclusive. The present study aimed to compare the effects and compliance of oronasal and nasal mask by the meta-analysis of the existing trials. Studies were retrieved from PubMed, EMBASE, and CENTRAL up to August 2016. The literature was reviewed by two independent authors. The mean difference of residual apnea-hypopnea index (AHI), therapeutic pressure, usage hour, and preference between oronasal and nasal mask was quantified. The pooled effect was analyzed with random-effect generic inverse variance and the heterogeneity was assessed with I2. From 6070 articles, 13 studies comprising 4000 subjects were included for the meta-analysis. The number of recruited subjects was different and the recruited trials were heterogeneous for all four outcomes. The 寫Newcastle-Ottawa scale showed that two studies (120 subjects) enrolling participants inadequately response to oronasal CPAP were biased. Compared to nasal masks, the oronasal masks had higher residual AHI for 5.5/hour (95% CI 2.3–8.8, p<0.001, I2 94%, 676 subjects), higher therapeutic pressure for 1 cmH2O (0–2.1, p=0.05, I2 76%, 534 subjects), and shorter usage per night for 0.8 hour (-1.06 - -0.54, p<0.001, I2 25%, 1364 subjects), and less preferred (odds ratio 0.05, 95% CI 0–0.6, p=0.02, 153 subjects). The subgroup analysis of 11 unbiased trials (3880 subjects) gave the same results for all four outcomes. Subgroup analysis of 5 randomized control trials (RCT) (176 subjects) had similar results except that therapeutic pressure was similar between two masks (p=0.97). The present studies showed that oronasal masks were associated with higher residual AHI, higher therapeutic pressure, shorter usage, and less preference compared to nasal masks. This study was supported by National Taiwan University (NTU) Hospital (105-S2998), Ministry of Science and Technology (103-2314-B-002-139-MY3), and NTU (NTU-ERP-105R8951-1).

For a healthy environment for hot spring recreation, this study discussed the diffusion in the bathroom of hydrogen sulfide gas from hot sulfur springs for an improvement of this harmful situation. Based on empirical measurements and then comparing the results with CFD simulation, the analysis exposed the distribution status of indoor hydrogen sulfide and its diffusion behavior. Results indicate that sulfur springs produce high levels of hydrogen sulfide that are hazardous. And the high concentrations can be improved under ideal ventilation, which was determined by the air exchange rate, flow field efficiency, turbulence and vortex phenomena.

Coronary artery (CA) anatomy of anatomically corrected malposition of the great arteries (ACM) has not been well elucidated. We studied the CA pattern and their association with the aortopulmonary rotation (APR). CA anatomy and APR of ACM were identified by image or surgical intervention. The degree of APR was defined by the pattern of the aortic sinus of Valsalva on the lateral angiogram or computed tomography (CT). Four CA types were presented in 10 patients and literatures. Six patients had the same CA type as the usual pattern in transposition of the great arteries (type 1); and two had left anterior descending (LAD) from the left-hand facing sinus that also gave rise to the right CA (RCA) (type 0). One patient had LAD from the left-hand facing sinus while RCA and circumflex artery from the right-hand facing sinus (type 10); and single CA from the anterior left-hand sinus (type 3c) was identified in another. APR was left anterior in type 1 and more lateral in types 0 and 3c; and left posterior in type 10 (p=0.001). The usual pulmonary trans-annular incision can only be performed in case of type 10 CA after posterior APR (10%, 1/10). In the majority (90%, 9/10 with the CA type 1, 0, and 3c), the RCA is in front of the pulmonary annulus, and the atrioventricular groove patch plasty posterior to the RCA had to be adopted for a trans-annular patch. The observed CA pattern was correlated with APR. APR identified by the aortic sinus pattern could implicate the CA patterns and the surgical options in ACM.

In this series of Uterine Cervical Cancers 1955-1958, the five-year survival rate for adenocarcinotna was lower than that for epidermoid carcinoma. The survival rate was about equal in both when the lymph nodes were free of tumour cells whereas in the presence of lymph node metastasis the survival rate for adenocarcinoma was much lower. The incidence of lymph node metastases was also higher with adenocarcinoma. From a review of the literature and our personal experience the authors feel that the present forms of treatment are ineffective for adenocarcinoma of the cervix and propose that future treatment should be: Surgery followed by chemotherapy for adenocarcinoma and chemotherapy and/or irradiation followed by surgery for small cell carcinoma.

The aim of this study was to investigate the efficiency of adenoviral-mediated transfer of the interleukin (IL)-10 gene for inhibition of experimental autoimmune anterior uveitis, a rat model of human acute anterior uveitis. Uveitis was induced in the Lewis rat by simultaneous injection of melanin-associated antigen intraperitoneally (i.p.) and into the left footpad. The animals were treated by systemic administration of adenoviral construct expressing IL-10 (Ad-IL-10) or Ad-Mock carrying no cytokine transgene. A significant reduction in ocular inflammation was noted for rats that received one or two divided i.p. administrations of Ad-IL-10 (one 10 x 10(9) and two 5 x 10(9) particles of adenoviral construct, respectively), as judged by reduced clinical scores and decreased leukocyte infiltration in the anterior chamber and confirmed by histological examinations, relative to control animals. Systemic Ad-IL-10, treatment also revealed a higher serum level of IL-10, compared to the controls. The results suggest that systemic adenovirus-mediated IL-10 gene therapy has an anti-inflammatory effect on immune-mediated ocular inflammation and that this approach may be promising for the treatment of acute anterior uveitis.

This study tested whether FC-77, a perfluorochemical, inhibits inflammatory responses in lipopolysaccharide (LPS) stimulated RAW 264.7 macrophages. The possible anti-inflammatory mechanisms involved were also investigated. RAW 264.7 macrophages were simultaneously incubated with pure FC-77 at final volume of 10% or 30% (v/v) and LPS (1 microg/ml) for 12 or 24 h on a mechanical shaker. In some tests FC-77 was added after cells stimulated by LPS for 12 h. Then the levels of prostaglandin E2(PGE2), tumor necrosis factor alpha (TNF-alpha), and interleukins (IL)-1beta, -6), and -10 were measured in medium. Alterations in cyclooxygenase (COX) 2 expression and nuclear transcription factor (NF) kappaB activation in cells were also evaluated. Pre- or posttreatment with FC-77 dose-dependently reduced the LPS-induced TNF-alpha, IL-1beta, and IL-6 formation and enhanced IL-10 production compared to LPS-stimulated alone cells. FC-77 also attenuated the LPS-induced PGE2 formation accompanied by suppressing COX-2 expression, the degradation of cytosolic inhibitor of kappaB-alpha and NF-kappaB activation. FC-77 inhibits inflammatory responses in LPS-stimulated macrophages by a mechanism that involves the attenuation of NF-kappaB dependent induction of COX-2/PGE2 pathway and the pro- /anti-inflammatory cytokine ratio.