Outcomes of coronary artery bypass grafting (CABG) in patients with OSA-COPD overlap syndrome versus COPD alone: an analysis of US Nationwide Inpatient Sample.

BACKGROUND: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are associated with unfavorable outcomes following coronary artery bypass grafting (CABG). The purpose of this study was to compare in-hospital outcomes of patients with COPD alone versus OSA-COPD overlap after CABG. METHODS: Data of adults ≥ 18 years old with COPD who received elective CABG between 2005 and 2018 were extracted from the US Nationwide Inpatient Sample (NIS). Patients were divided into two groups: with OSA-COPD overlap and COPD alone. Propensity score matching (PSM) was employed to balance the between-group characteristics. Logistic and linear regression analyses determined the associations between study variables and inpatient outcomes. RESULTS: After PSM, data of 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed. After adjustment, OSA-COPD overlap was associated with a significantly increased risk of overall postoperative complications (adjusted odd ratio [aOR] = 1.12, 95% confidence interval [CI]: 95% CI: 1.01-1.24), respiratory failure/prolonged mechanical ventilation (aOR = 1.27, 95%CI: 1.14-1.41), and non-routine discharge (aOR = 1.16, 95%CI: 1.03-1.29), and AKI (aOR = 1.14, 95% CI: 1.00-1.29). Patients with OSA-COPD overlap had a lower risk of in-hospital mortality (adjusted odd ratio [aOR] = 0.53, 95% CI: 0.35-0.81) than those with COPD only. Pneumonia or postoperative atrial fibrillation (AF) risks were not significantly different between the 2 groups. Stratified analyses revealed that, compared to COPD alone, OSA-COPD overlap was associated with increased respiratory failure/prolonged mechanical ventilation risks among patients ≥ 60 years, and both obese and non-obese subgroups. In addition, OSA-COPD overlap was associated with increased risk of AKI among the older and obese subgroups. CONCLUSION: In US adults who undergo CABG, compared to COPD alone, those with OSA-COPD are at higher risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation, but a lower in-hospital mortality. No increased risk of AF was noted.

Design and analysis of a K-band low-phase-noise phase-locked loop with subharmonically injection-locked technique.

In this paper, we present design and analysis of a K-band (18 to 26.5 GHz) low-phase-noise phase-locked loop (PLL) with the subharmonically injection-locked (SIL) technique. The phase noise of the PLL with subharmonic injection is investigated, and a modified phase noise model of the PLL with SIL technique is proposed. The theoretical calculations agree with the experimental results. Moreover, the phase noise of the PLL can be improved with the subharmonic injection. To achieve K-band operation with low dc power consumption, a divide-by-3 injection-locked frequency divider (ILFD) is used as a frequency prescaler. The measured phase noise of the PLL without injection is -110 dBc/Hz at 1 MHz offset at the operation frequency of 23.08 GHz. With the subharmonic injection, the measured phase noises at 1 MHz offset are -127, -127, and -119 dBc/Hz for the subharmonic injection number NINJ = 2, 3, and 4, respectively. Moreover, the performance of the proposed PLL with and without SIL technique can be compared with the reported advanced CMOS PLLs.

Simultaneous measurement of refractive index and thickness of birefringent wave plates.

A nondestructive measurement system based on a position sensing detector (PSD) and a laser interferometer for determining the thickness and refractive indices of birefringent optical wave plates has been developed. Unlike previous methods presented in the literature, the proposed metrology system allows the refractive index and thickness properties of the optical plate to be measured simultaneously. The experimental results obtained for the e-light and o-light refractive indices of a commercially available birefringent optical wave plate with refractive indices of n(o)=1.542972 and n(e)=1.552033 are found to be accurate to within 0.004132 and 0.000229, respectively. Furthermore, the experimentally derived value of the wave plate thickness deviates by no more than 0.9 microm from the analytically derived value of 453.95 microm. Overall, the experimental results confirm that the proposed metrology system provides a simple yet highly accurate means of obtaining simultaneous measurements of the refractive indices and thickness of birefringent optical wave plates.