High risk for obstructive sleep apnea and risk of hypertension in military personnel: The CHIEF sleep study.

BACKGROUND: Epidemiological studies have revealed an association between obstructive sleep apnea (OSA) and hypertension in the general population, while the association in military personnel was rarely investigated. AIM: To examine the association between high risk for OSA and hypertension by phenotypes in military young adults. METHODS: A total of 746 military personnel, aged 27.9 years, were included in the cardiorespiratory fitness and health in armed forces (CHIEF)-sleep study in Taiwan in 2020. Antihypertensive medications were not used by the subjects. High risk for OSA was assessed using the Berlin Questionnaire. Hypertension was defined using the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. The cutoff levels of systolic and diastolic blood pressure (SBP and DBP) for the 2017 ACC/AHA- and JNC 7-based guidelines were 130/140 mmHg and 80/90 mmHg, respectively. Hypertension phenotypes included isolated systolic and diastolic hypertension (ISH, high SBP only and IDH, high DBP only) and combined hypertension (both high SBP and DBP). Multivariable logistic regression analysis with adjustment for demographics, lifestyle and metabolic biomarkers. RESULTS: The prevalence of high risk for OSA, JNC 7-based hypertension and 2017 ACC/AHA-based hypertension were 8.0%, 5.2% and 22.0%, respectively. Those with a high risk for OSA had a higher probability of JNC 7-based overall and combined hypertension (odds ratios (ORs) and 95% confidence intervals: 2.82 (1.07-7.42) and 7.54 (1.10-51.54), although the probabilities of ISH and IDH were unaffected by a high risk for OSA (ORs: 1.96 and 2.35, respectively, both P > 0.05). In contrast, no associations for any hypertension phenotypes were found according to the 2017 ACC/AHA criteria. CONCLUSION: A high risk for OSA was associated with severe hypertension and combined hypertension among Asian military young adults.

Identification of rare missense mutations in the glutamate ionotropic receptor AMPA type subunit genes in schizophrenia.

OBJECTIVE: The alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptors significantly regulate the synaptic transmission and functions of various synaptic receptors. This study aimed to identify single nucleotide mutations in the glutamate receptor, ionotropic, AMPA type (GRIA) gene family, which is associated with schizophrenia. METHODS: The exon regions of four genes (GRIA1, GRIA2, GRIA3, and GRIA4) encoding glutamate ionotropic receptor AMPA type proteins were resequenced in 516 patients with schizophrenia. We analyzed the protein function of the identified rare mutants via immunoblotting. RESULTS: A total of 24 coding variants were detected in the GRIA gene family, including six missense mutations, 17 synonymous mutations, and one frameshift insertion. Notably, three ultra-rare missense mutations (GRIA1p.V182A, GRIA2p.P123Q, and GRIA4p.Y491H) were not documented in the single nucleotide polymorphism database, gnomAD genomes, and 1517 healthy controls available from Taiwan BioBank. Immunoblotting revealed GRIA4p.Y491H mutant with altered protein expressions in cultured cells compared with the wild type. CONCLUSION: Our findings suggest that, in some patients affected by schizophrenia, the GRIA gene family harbors rare functional mutations, which support rare coding variants that could contribute to the genetic architecture of this illness. The in-vitro impacts of these rare pathological mutations on the pathophysiology of schizophrenia are worthy of future investigation.

Associations of decayed teeth and localized periodontitis with mental stress in young adults: CHIEF oral health study.

The associations of mental stress with decayed teeth in children and periodontitis in old-aged adults have been described. However, the associations for young adults were not clear. This study aimed to examine the associations of decayed teeth and localized periodontitis with mental stress in young adults. This study included 334 military recruiters, aged 19-45 years in Taiwan. Mental stress was assessed by the brief symptom rating scale-5 (BSRS-5), including five domains: anxiety, depression, hostility, interpersonal sensitivity and insomnia (maximum score of 20). Those with symptomatic mental stress were defined as having BSRS-5 > 5 (n = 34). Multiple linear and logistic regression models were used to determine the associations of decayed tooth numbers and periodontitis with BSRS-5, with adjustments for age, sex, education level, physical activity, body weight category and smoking status. The BSRS-5 was positively correlated with decayed tooth numbers [ß: 0.26 (95% confidence interval: 0.01-0.52)]. Those who had more than two decayed teeth [odds ratio: 3.59 (1.52-8.46)] had a higher risk of symptomatic mental stress. In contrast, the correlation between BSRS-5 and localized severer periodontitis was null. Our study recommended that decayed teeth instead of localized periodontitis, was a risk factor for mental stress in young adults.

Body Mass Index and Association of Psychological Stress with Exercise Performance in Military Members: The Cardiorespiratory Fitness and Hospitalization Events in Armed Forces (CHIEF) Study.

AIMS: To investigate the influence of body mass index (BMI) on the association between psychological stress and physical fitness. BACKGROUND: Both obesity and psychological stress reduce exercise performance. OBJECTIVE: It is unknown whether obesity may modify the relationship. METHODS: A population of 4,080 military subjects in Taiwan was divided to three groups according to the BMI ≥27.0 kg/m2 (obesity), 24.0-26.9 kg/m2 (overweight) and 18.5-23.9 kg/m2 (normal weight). Normal, slight, and great psychological stress was evaluated by the Brief Symptoms Rating Scale (BSRS-5) score ≤5, 6-9, and ≥10, respectively. Aerobic and anaerobic fitness were respectively evaluated by time for a 3000-meter run and numbers of 2-minute sit-ups and 2-minute push-ups. Analysis of covariance (ANCOVA) with adjustments for age and sex was used to determine the relationship. RESULTS: The mean time (sec) for a 3000-meter run (standard error) under slight and great stress differed from that under normal stress in the normal weight (881.0 (11.0) and 877.9 (5.8) vs. 862.2 (1.7), p=0.089 and 0.0088, respectively) and in the obesity (928.1 (16.8) and 921.8 (10.7) vs. 895.2 (1.6), p=0.054 and 0.016, respectively), while the differences were not significant in the overweight (877.1 (12.7) and 877.5 (7.1) vs. 867.1 (2.1), both p >0.5). The impacts of the BMI on 2-minute sit-ups had a similar pattern with that on a 3000-meter run whereas the impact of the BMI on 2-minute push-ups was insignificant. CONCLUSIONS: Mental stress may not affect physical fitness in overweight military personnel. The mechanism is not clear and should be further investigated.

Association of Psychological Stress with Physical Fitness in a Military Cohort: The CHIEF Study.

INTRODUCTION: Psychological stress is associated with sedentary behavior, which may impair exercise performance. The aim of our study was to examine the association between psychological stress and physical fitness in military personnel. METHOD: A military cohort of 4080 subjects in Taiwan was used for the analysis. The Brief Symptoms Rating Scale (BSRS-5) includes items of anxiety, depression, hostility, interpersonal sensitivity, and insomnia measured by a five-point Likert-type scale of 0-4. Psychological stress was defined as normal (n = 3657), slight (n = 314), and great (n = 109) by BSRS-5 score ≤5, 6-9, and ≥10, respectively. Aerobic fitness and anaerobic fitness were evaluated by the time of 3000-meter running and the numbers of 2-min sit-ups and 2-min push-ups, respectively. Multiple linear and logistic regression analyses were used to determine the relationship. RESULTS: As compared with normal stress, slight and great stress were positive dose-dependently correlated with 3000-meter running time (ß = 9.09 and 14.44; P = 0.0032 and 0.048, respectively) after adjusting for age, sex, service specialty, body mass index, systolic blood pressure, cigarette smoking, alcohol intake, hemoglobin levels, and exercise frequency. Similarly, those with slight stress were more likely to be the worst 10% performers in the 3000-meter run test relative to the normal individuals (odds ratio and 95% confidence intervals: 1.50, 1.00-2.24). By contrast, there was no relationship of psychological stress with the numbers of 2-min sit-ups and 2-min push-ups. CONCLUSIONS: Our findings suggest that the presence of higher psychological stress on military personnel may reduce their cardiorespiratory fitness but not affect the anaerobic fitness.

Netrin-1 Dampens Hypobaric Hypoxia-Induced Lung Injury in Mice.

Background: This study aimed to explore the effects of netrin-1 on hypobaric hypoxia-induced lung injury in mice. Methods: We exposed 6-8-week-old C57BL/6 mice to hypobaric stress at 340 mmHg for 30 minutes followed by 260 mmHg for different periods (6, 12, 18, and 24 hours) to observe the severity of lung injury (O2 concentration, 21%; 54.6 mmHg). The wet/dry weight ratio and protein leakage from the mouse lung were used to determine the suitable exposure time. Netrin-1 was injected into the tail vein of mice before 18-hour decompression. Inflammatory cytokines, lung injury scores, and activity of nuclear factor κB were evaluated. The expression of apoptosis-related proteins was also examined. Results: Protein concentration in the bronchoalveolar lavage fluid was significantly higher in the 18-hour group (p < 0.05). Pulmonary pathology revealed neutrophil infiltration, alveolar septum thickening, and tissue edema. Injury score and macrophage inflammatory protein 2 levels were also increased. Intrinsic apoptosis pathway was activated. Hypoxia decreased the expression of Bcl2 protein, the number of active caspase-3-stained cells, and UNC5HB receptors. Pretreatment with netrin-1 reduced protein leakage, inhibited neutrophil migration, lowered the injury score, attenuated apoptosis, and increased UNC5HB receptor expression. Conclusion: Netrin-1 dampens hypobaric hypoxia-induced lung injury by inhibiting neutrophil migration and attenuating apoptosis.

Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system.

Over the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. This review aimed to propose an anatomical nomenclature system by classifying ICB approaches into proximal and distal ones to aid future research and provide practice advisories according to recent updates. We also comprehensively discuss various aspects of this nomenclature system. Our review suggests that ultrasound-guided ICB should be categorized as an advanced technique that should be performed under supervision and dual guidance. For one-shot block, the conventional distal approach is still preferred but should be modified to follow ergonomic practice, with the arm in the proper position. For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.

Corrigendum to "Advances of Techniques in Deep Regional Blocks".

[This corrects the article DOI: 10.1155/2017/7268308.].

Seroprevalence survey of selective anti-neuronal autoantibodies in patients with first-episode schizophrenia and chronic schizophrenia.

Autoimmune encephalopathy caused by autoantibodies against neuronal cell-surface proteins in the brain is a newly discovered disease category associated with psychiatric disorders. Correct diagnosis of this condition relies on the detection of specific autoantibodies in the blood or cerebral spinal fluid in addition to the clinical presentations. The study aimed to understand the seroprevalence of selective anti-neuronal autoantibodies in our patients with schizophrenia. First, we screened for six anti-neuronal autoantibodies in an archived blood sample collected from patients with the first-episode schizophrenia. The six autoantibodies including antibodies against N-methyl-d-aspartate (NMDA) receptor, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors 1 and 2, γ-butyric acid receptor type B1 (GABARB1), leucine-rich glioma inactivated-1 (LGI1) protein, and contactin-associated protein-like 2 (CASPR2) protein. A total of 78 plasma samples (46 males and 32 females) were investigated; however, no positive case was identified. In this second study, we screened anti-NMDA receptor autoantibodies in a blood sample of 234 patients with chronic schizophrenia (133 females and 101 males) including 48 patients defined as treatment resistance. None of this sample was detected as positive. The negative findings in this study suggest that the seroprevalence of autoantibodies against neuronal surface proteins might be low in patients diagnosed with schizophrenia.

Rationale and design of the cardiorespiratory fitness and hospitalization events in armed forces study in Eastern Taiwan.

AIM: To investigate the association between cardiorespiratory fitness and hospitalization events in a cohort of large voluntary arm forces in Taiwan. METHODS: The cardiorespiratory fitness and hospitalization events in armed forces (CHIEF) is a retrospective cohort consisting of more than 4000 professional military members aged 18-50 years in Eastern Taiwan. All participants received history taking, physical examination, chest radiography, 12-lead electrocardiography, blood tests for cell counts and fasting glucose, lipid profiles, uric acid, renal function and liver function in the Hualien Armed Forces General Hospital during 2014. In addition, participants were required to undergo two indoor resistant exercise tests including 2-min push-up and 2-min sit-up, both scored by infrared sensing, and one outdoor endurance 3000-m none weight-bearing running test, the main indicator of cardiorespiratory fitness in the Military Physical Training and Testing Center in Eastern Taiwan in 2014. RESULTS: Hospitalization events for cardiovascular disease, acute kidney injury, rhabdomyolysis, severe infectious disease, acute psychiatric illness, diabetes, orthopedic surgery and mortality will be identified in the National Insurance Research Database for 10 years. CONCLUSION: CHIEF will be among the largest Eastern Asian armed forces cohort, in which physical status was strictly evaluated to follow up the hospitalization events for severe illness.