Obstructive sleep apnea (OSA) is a common disorder characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. Treatment of OSA is important because untreated patients have potential adverse clinical outcomes, such as excessive daytime sleepiness, metabolic dysfunction, cardiovascular disease, and mortality. Therefore, OSA should be considered as a chronic disease that requires long-term and multidisciplinary care. Positive airway pressure (PAP) therapy is the mainstay of treatment for OSA in adults. Alternative therapies include oral appliance, behavioral modification, and upper airway surgery. The treatment of OSA in adults is reviewed here with focus on PAP therapy.
Adult* ; Apnea ; Arousal ; Cardiovascular Diseases ; Chronic Disease ; Complementary Therapies ; Humans ; Mortality ; Sleep Apnea, Obstructive*

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with event-related potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with event-related potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy with bimodal onset age distribution. The age of onset is between 5-18 yr in juvenile DM and 45-64 yr in adult DM. DM has a distinct clinical manifestation characterized by proximal muscle weakness, skin rash, extramuscular manifestations (joint contracture, dysphagia, cardiac disturbances, pulmonary symptoms, subcutaneous calcifications), and associated disorders (connective tissue disease, systemic autoimmune diseases, malignancy). The pathogenesis of juvenile and adult DM is presumably similar but there are important differences in some of the clinical manifestations, associated disorders, and outcomes. In this study, we investigated the clinical characteristics and outcomes of 16 patients with juvenile DM and 48 with adult DM. This study recognizes distinctive characteristics of juvenile DM such as higher frequency of neck muscle involvement, subcutaneous calcifications, and better outcomes.
Adolescent ; Adult ; Age of Onset ; Aged ; Anti-Inflammatory Agents/therapeutic use ; Calcification, Physiologic ; Dermatomyositis/*diagnosis/mortality/therapy ; Exanthema/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Muscle Weakness/diagnosis ; Prednisolone/therapeutic use ; Prognosis ; Severity of Illness Index ; Survival Rate

No abstract available.
Hemorrhage ; Hypotension, Orthostatic ; Pons

An increasing number of neuronal autoantibodies which target cell surface or synaptic proteins have been discovered over the last decade. Autoimmune encephalitis refers to this new category of autoimmune-mediated neurological disorders, which involve the central nervous system. Recent studies have established that autoimmune encephalitis is now the major cause of encephalitis, which was previously considered to be encephalitis of an unknown etiology. Moreover, the fact that autoimmune encephalitis is potentially treatable with immunomodulating therapy has changed the paradigm for the diagnosis and treatment of acute encephalitis syndrome. We herein review the pathophysiology, clinical manifestations, diagnosis, and treatment of autoimmune encephalitis with a focus on corticosteroid therapy as the first-line immunotherapy. In addition, regarding the diagnostic approach, we emphasize the differentiation between autoimmune and infectious encephalitis, because this distinction is not necessarily clear-cut in real clinical practice and should be considered when determining the initiation and type of immunotherapy.
Autoantibodies ; Autoimmune Diseases of the Nervous System ; Central Nervous System ; Diagnosis ; Encephalitis ; Glucocorticoids ; Immunotherapy ; Infectious Encephalitis ; Nervous System Diseases ; Neurons

Background: and Purpose Japanese encephalitis (JE) is caused by the JE virus of the Flaviviridae family and is spread by mosquito bites, and no specific antiviral treatment for it exists. Here we describe the clinical presentations, laboratory findings, clinical outcomes, and adverse events after combination treatment of immunoglobulin, ribavirin, and interferon-α2b administered to patients with JE. Methods: Data were collected and reviewed from a prospective cohort of encephalitis patients admitted to Seoul National University Hospital between August 1, 2010 and October 31, 2019.We reviewed the medical records of the patients diagnosed with JE and treated either with supportive care only or with combination treatment of intravenous immunoglobulin, oral ribavirin, and subcutaneous interferon-α2b. Results: Eleven patients were diagnosed with laboratory-confirmed JE based on the diagnosis criteria of JE. The median age was 61 years, and five patients were male. Eight patients were treated with the combination therapy, while three patients received supportive management only. Four of the eight patients (50%) treated with the combination therapy showed partial recovery, while one patient (12.5%) showed complete recovery. Two patients experienced hemolytic anemia related to ribavirin and febrile reaction to immunoglobulin, respectively. Among the three patients who received supportive management only, one (33.3%) showed partial recovery and the other two (67.7%) did not show improvement. Conclusions Combination treatment of immunoglobulin, ribavirin, and interferon-α2b was found to be tolerable in JE in this study. Further studies of appropriate designs and involving larger numbers of patients are warranted to explore the efficacy of this combination therapy.

Background: and Purpose Japanese encephalitis (JE) is caused by the JE virus of the Flaviviridae family and is spread by mosquito bites, and no specific antiviral treatment for it exists. Here we describe the clinical presentations, laboratory findings, clinical outcomes, and adverse events after combination treatment of immunoglobulin, ribavirin, and interferon-α2b administered to patients with JE. Methods: Data were collected and reviewed from a prospective cohort of encephalitis patients admitted to Seoul National University Hospital between August 1, 2010 and October 31, 2019.We reviewed the medical records of the patients diagnosed with JE and treated either with supportive care only or with combination treatment of intravenous immunoglobulin, oral ribavirin, and subcutaneous interferon-α2b. Results: Eleven patients were diagnosed with laboratory-confirmed JE based on the diagnosis criteria of JE. The median age was 61 years, and five patients were male. Eight patients were treated with the combination therapy, while three patients received supportive management only. Four of the eight patients (50%) treated with the combination therapy showed partial recovery, while one patient (12.5%) showed complete recovery. Two patients experienced hemolytic anemia related to ribavirin and febrile reaction to immunoglobulin, respectively. Among the three patients who received supportive management only, one (33.3%) showed partial recovery and the other two (67.7%) did not show improvement. Conclusions Combination treatment of immunoglobulin, ribavirin, and interferon-α2b was found to be tolerable in JE in this study. Further studies of appropriate designs and involving larger numbers of patients are warranted to explore the efficacy of this combination therapy.