Factors Related to Sleep Time Underestimation in Obstructive Sleep Apnea: Retrospective Study Based on Polysomnographic Data

BACKGROUND: The perception of sleep time in obstructive sleep apnea (OSA) is not well understood, some studies have reported that subjects with OSA have abnormal sleep perception. We hypothesized that the severity of OSA would affect the sleep perception of patients with OSA and investigated the associated factors that affect the sleep perception in OSA. METHODS: Four hundred and sixty eight subjects with OSA were included in present study. Subjects with OSA were divided, depending upon their sleep perception. The first group included individuals who underestimated their time spent sleeping, the second group included those who did not underestimate their sleep time. The underestimation of sleep time is defined as the perceived total sleep time being less than 80% of that measured in polysomnography (PSG). All participants were analyzed their demographics, PSG parameter and questionnaires such as Beck Depression Inventory, Epworth Sleepiness Scale. RESULTS: Of 468 participants, 179 (38.2%) subjects were included in the group that underestimating sleep. Gender (female, odds ratio [OR]=2.01, 95% confidence interval [CI]=1.25–3.22), depression (OR=1.75, 95% CI=1.03–2.97) and proportion of slow wave sleep (OR=0.98, 95% CI=0.96–0.99) were related to the underestimation of sleep. CONCLUSIONS: The underestimation of sleep in OSA is not directly related to OSA severity. Gender, psychiatric disorder, and sleep architecture are associated with the underestimating sleep in OSA.

Simvastatin inhibits sphingosylphosphorylcholine-induced differentiation of human mesenchymal stem cells into smooth muscle cells

Sphingosylphosphorylcholine (SPC) induces differentiation of human adipose tissue-derived mesenchymal stem cells (hASCs) into smooth muscle-like cells expressing alpha-smooth muscle actin (alpha-SMA) via transforming growth factor-beta1/Smad2- and RhoA/Rho kinase-dependent mechanisms. 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have been known to have beneficial effects in the treatment of cardiovascular diseases. In the present study, we examined the effects of simvastatin on the SPC-induced alpha-SMA expression and Smad2 phosphorylation in hASCs. Simvastatin inhibited the SPC-induced alpha-SMA expression and sustained phosphorylation of Smad2 in hASCs. SPC treatment caused RhoA activation via a simvastatin-sensitive mechanism. The SPC-induced alpha-SMA expression and Smad2 phosphorylation were abrogated by pretreatment of the cells with the Rho kinase inhibitor Y27632 or overexpression of a dominant negative RhoA mutant. Furthermore, SPC induced secretion of TGF-beta1 and pretreatment with either Y27632 or simvastatin inhibited the SPC-induced TGF-beta1 secretion. These results suggest that simvastatin inhibits SPC-induced differentiation of hASCs into smooth muscle cells by attenuating the RhoA/Rho kinase-dependent activation of autocrine TGF-beta1/Smad2 signaling pathway.

Synovial fluid of patients with rheumatoid arthritis induces alpha-smooth muscle actin in human adipose tissue-derived mesenchymal stem cells through a TGF-beta1-dependent mechanism

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. Transforming growth factor-beta1 (TGF-beta1) is a secreted protein that promotes differentiation of synovial fibroblasts to alpha-smooth muscle actin (alpha-SMA)-positive myofibroblasts to repair the damaged joints. Synovial fluid from patients with RA (RA-SF) induced expression of alpha-SMA in human adipose tissue-derived mesenchymal stem cells (hASCs). RA-SF-induced alpha-SMA expression was abrogated by immunodepletion of TGF-beta1 from RA-SF with anti-TGF-beta1 antibody. Furthermore, pretreatment of hASCs with the TGF-beta type I receptor inhibitor SB431542 or lentiviral small hairpin RNA-mediated silencing of TGF-beta type I receptor expression in hASCs blocked RA-SF-induced alpha-SMA expression. Small interfering RNA-mediated silencing of Smad2 or adenoviral overexpression of Smad7 (an inhibitory Smad isoform) completely inhibited RA-SF-stimulated alpha-SMA expression. These results suggest that TGF-beta1 plays a pivotal role in RA-SF-induced differentiation of hASCs to alpha-SMA-positive cells.

Fatigue and Quality of Life of Korean Cancer Inpatients / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to identify the relationship between fatigue and quality of life (QOL) of Korean cancer inpatients. METHODS: The data were collected from May to August 2007. Study subjects were recruited at D, Y and A university hospitals in Daegu and Kyungpook, Korea. The research instruments utilized in this study were fatigue (FACT-F) and quality of life (FACT-G) in Korean version 4. Data were analyzed with descriptive statistics, t-test, ANOVA, and Pearson correlation using SPSS Win 12.0 program. RESULTS: Fatigue of subjects showed a significant difference according to the type of treatment, change in weight, performance status, exercise, and sleep. The QOL of subjects showed a significant difference according to the purpose of treatment, change in weight, performance status, exercise, and sleep. The mean score of fatigue was 22.48 and the mean score of QOL was 55.52. The fatigue was negatively related to QOL, physical well-being, emotional well-being, and functional well-being. CONCLUSION: The results suggest the needs for intervention in order to reduce fatigue and to improve QOL of cancer inpatients.

Risk Factors of Breast Cancer / 종양간호학회지

PURPOSE: The purpose of this study was secondary analysis to explore about risk factors with breast cancer on a basis of primary literature. METHODS: This study was searched articles by using CINAHL, MEDLINE, Riss4u, Internet website regarding breast cancer. This study searched for the journal published in Korea and foreign countries from 2000 to 2008, about risk factors of breast cancer. This study was reviewed 42 articles (5 experimental study, 35 survey, 1 qualitative study, 1 report) suitable for the research objectives. RESULTS: Magnitude of risk breast cancer (++) was age, geographic region, family history, mutations in BRCA1, BRCA2 genes and in other penetrance genes, radiation, history of benign breast disease, late age of menopause, early age of menarch, nulliparity and older age at first birth, high mammographic breast density, high insulin-like growth factor 1 level. Magnitude of risk factor (+) was hormone replacement therapy, oral contraceptives use, obesity, tall stature, alcohol consumption, high prolactin level, high saturated fat and well-done meat intake, polymorphisms in low penetrance gene, high socioeconomic status. CONCLUSION: A breast cancer screening protocol according to magnitude of risk factors is needed for disease prevention. The nurses need to educate and counsel women with risk factors of breast cancer.

A case of lethal kwashiorkor caused by feeding only with cereal grains / 소아과

Kwashiorkor is a syndrome of severe protein malnutrition, which manifests itself in hypoalbuminemia, diarrhea, dermatitis, and edema. It can be life-threatening due to associated immune deficiency and an increased susceptibility to infections. Kwashiorkor should be treated early with nutritional support and the control of infection. Dilated cardiomyopathy may develop during the treatment and in such cases a poor prognosis is expected. Kwashiorkor has been known as a common disease of poor countries. To date, in fact, there has been no report of kwashiorkor leading to death in technically advanced countries. We here report a fatal case of a baby girl admitted with kwashiorkor. She had been fed only with cereal grain mixed with juice, without any protein supplement, for 2 months. This diet was deficient not because of poverty, but due to the illiteracy of her parents. The patient suffered from diarrhea, whole body edema, hypothermia, and dermatitis. Laboratory findings revealed an immune-deficient state featuring leukopenia and decreased immunoglobulin. Blood and urine cultures revealed Alcaligenes Xylosoxidans growth. The patient was fed frequent small amounts of protein-containing formula and intravenous albumin and micronutrients were administered for nutritional support. She was also treated with intravenous immunoglobulin and antibiotics in order to control infection. Nevertheless, she developed dilated cardiomyopathy and multi-organ failure and died. We review this case in light of the literature.