Introduction: Derangement of systemic and mucosal immunity, which are the integral components of the immune system, increases the risk of septic complications in patients postoperatively. The aims of this study were to investigate the integrity of systemic immunity as well as the mucosal immune system in patients with pancreatic cancer (PC), chronic pancreatitis (CP) and obstructive jaundice (OJ).Method: Healthy controls, as well as four groups of patients were studied. These included; jaundiced patients with PC, jaundiced patients secondary to benign disease (choledocholithiasis), non-jaundiced patients with PC and non-jaundiced patients with CP. The study evaluated the nutritional status including anthropometric measurements and the serum proteins: retinal binding protein (RBP), transferrin (TRF) and prealbumin (PALB). This study also evaluated systemic immunity in terms of total lymphocyte count, lymphocyte subsets (CD4+, CD8+, CD25+and CD56+), tumour necrosis factor alpha (TNF- alpha), interleukin-1alpha (IL-1 alpha) and complement components; and mucosal immunity in terms of CD3+, CD4+, CD8+, CD20+, CD57+, CD68+ and mast cells. Results: 78 patients were recruited (including 39 males) as follows: normal controls (n=17), benign OJ (n=9), patients with PC with jaundice (n=23), non-jaundiced patients with PC (n=20) and CP (n=9). Circulating CD25+ and CD4+ were significantly lower in the PC group whereas CD8+ showed increased levels in the same patients with a significant decrease in OJ patients when compared with controls. Circulating CD56+ showed no statistically significant difference between all four groups. In addition, IL-1 and TNF-alpha showed no statistically significant difference in all groups when compared with the control group. Also, C3 and CH50 showed significantly raised levels in PC with jaundice when compared with the control group. On the other hand mucosal lymphocyte subsets showed no statistically significant difference among all groups in comparison with the control group. As for prealbumin and transferrin, both showed significantly low levels in OJ, PC with jaundice and with PC when compared to healthy controls. Survival analysis for both PC groups was carried out and showed no difference in terms of age, however PC patients who survived over 13 months showed increased levels of prealbumin as well as low levels of CH50.Conclusion: Patients with PC both with and without jaundice showed some signs of altered and dysfunctional systemic immunity as well as a reduction in serum proteins. These findings may have implications on the disease progression and postoperative complications. This may warrant therapeutic interventions to restore nutrition and improve immunity before major surgical intervention is planned which could result in improving prognosis.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) in children, as defined by the American Thoracic Society, is a disorder of breathing during sleep characterized by prolonged partial airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. Objective: This study aimed to investigate retrospectively the prevalence of OSAS among children aged 6 to 12 years old, evaluated through polysomnography and sleep questionnaires between 2011 and 2012, analyzing severity, symptoms and associated risk factors. Methods: We evaluated 63 children referred to the Sleep Laboratory of the Dell Childrenâs Hospital in Austin, Texas (USA) with suspition of Sleep Disordered Breathing. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 8,8 Â1,9 years old, and 55,6% of the children were male. Children without OSAS accounted for 30,2% of the sample. The OSAS observed in the remainder was mild in 49,2%, moderate in 11,1% and severe in 9,5%. Gender and age were not associated with OSAS. Hispanic and African-American children were at higher risk for OSAS. Twenty two hispanic children presented OSAS ( 88%) and ten African-american children presented OSAS (83,3%). In children with OSAS, the most common symptoms were: snoring (86%), periodic limb movements (64,3%), arousals during sleep (60,5%) and restless sleep (58,1%). Excessive daytime sleepiness was reported in only 33,3% of the patients. Bruxism was more prevalent among the patients without OSAS (52,6%) than in the patients with OSAS (31%). Overweight children were at higher risk for OSAS. Conclusions: Overweight children are at a higher risk for developing OSAS. Hispanic and African American children presented a higher risk for developing OSAS. Age and gender were not associated to the diagnose of OSAS. Bruxism was more prevalent among the children who did not present OSAS. / IntroduÃÃo: Em crianÃas, a SÃndrome da Apneia Obstrutiva do Sono (SAOS) à um distÃrbio respiratÃrio caracterizado por obstruÃÃo parcial prolongada e/ou episÃdios intermitentes de obstruÃÃo completa da via aÃrea superior, que interrompe a ventilaÃÃo normal e o padrÃo normal de sono. Objetivo: Este trabalho buscou investigar a prevalÃncia de SAOS entre crianÃas de seis a doze anos de idade, avaliadas por meio de polissonografia e questionÃrio sobre o sono, no perÃodo de 2011 a 2012, avaliando gravidade, sintomatologia e fatores de risco associados. MÃtodos: Foram estudadas 63 crianÃas encaminhadas ao LaboratÃrio do Sono do Dell Childrenâs Hospital em Austin, Texas (EUA) com suspeita de Transtornos RespiratÃrios do Sono. Os pais preencheram um questionÃrio sobre o sono, jà rotineiramente utilizado como padrÃo para todos os pacientes encaminhados para polissonografia no Dell Childrenâs Hospital (ApÃndice A). Em seguida, as crianÃas foram submetidas ao exame polissonogrÃfico. Resultados: A idade mÃdia foi de 8,8Â1,9 anos, sendo 55,6% das crianÃas do sexo masculino. NÃo apneicos corresponderam a 30,2% dos investigados. SÃndrome da Apneia Obstrutiva do Sono em grau leve ocorreu em 49,2%, moderado em 11,1% e grave em 9,5%. NÃo foi encontrada diferenÃa entre a incidÃncia de SAOS entre meninos e meninas. Observou-se uma associaÃÃo estatisticamente significante entre raÃa e presenÃa/ausÃncia de SAOS, sendo que as crianÃas negras e hispÃnicas apresentaram maior risco de SAOS do que as crianÃas brancas. Entre os hispÃnicos, 88% dos pacientes apresentaram SAOS (n=22); nos negros 83,3% (n=10) e nos brancos 46,7% (n=7). Dentre as crianÃas diagnosticadas com SAOS, os sintomas mais frequentes foram: ronco (86%) movimentos periÃdicos de membros (64,3%), despertares durante o sono (60,5%) e sono agitado (58,1%). SonolÃncia excessiva foi relatada apenas em 33,3% dos casos. O bruxismo foi relatado com maior frequÃncia no grupo sem SAOS (52,6%) do que no grupo de pacientes com diagnÃstico de SAOS (31%). CrianÃas com sobrepeso apresentaram maior risco de desenvolver SAOS (100%) (Testes Qui quadrado e exato de Fisher). ConclusÃes: Sobrepeso à um fator de risco para SAOS. CrianÃas da raÃa hispÃnica e negra apresentaram maior risco a SAOS. Sexo e idade nÃo se associaram a SAOS. O bruxismo foi mais frequentemente relatado por pacientes que nÃo demonstraram SAOS.

Obstructive sleep apnoea (OSA) is characterised by repetitive reductions or pauses in breathing during sleep due to upper airway narrowing or closure. Due to disruption to normal sleep patterns, many patients with OSA suffer from increased daytime sleepiness. Epidemiological studies have established a link between OSA and driver fatigue and accidents, generally showing a two to seven times increased risk of road traffic accidents in non-commercial drivers with OSA. There is emerging evidence that commercial drivers have a higher prevalence of OSA than the general population, being predominately male, middle-aged and overweight, three important risk factors for OSA. However, little is known about the relationship between OSA and driver sleepiness in commercial drivers, whether road accidents are increased in commercial drivers with OSA, and whether OSA interacts with other fatigue promoting factors, such as sleep deprivation, to further escalate road accident risk. One thousand randomly selected commercial drivers were surveyed in the field. In addition, 61 randomly selected NSW commercial drivers had in hospital sleep studies and daytime performance testing, including a PC based driving simulator task. The prevalence of OSA, defined as Respiratory Disturbance Index (RDI) < 10, was approximately 50% in NSW commercial drivers. Approximately one quarter of the drivers reported pathological daytime sleepiness, and 12-14% had both OSA and pathological daytime sleepiness. A diagnosis of OSA was the most important factor predicting excessive daytime sleepiness in these drivers: OSA was more important than 15 other work-related, lifestyle and medical factors that could be expected to promote, or be associated with, daytime sleepiness. Drivers with sleep apnoea syndrome (both OSA and pathological daytime sleepiness) had an increased driving accident risk, using driving simulator and daytime performance testing as proxy measures for accident risk. These results demonstrate the importance of OSA as a cause of driver fatigue in commercial drivers and suggest that all commercial drivers should be screened for the presence of sleep apnoea syndrome in order to potentially reduce road accident risk through treatment. A separate, but related body of work examined the combined effects of mild OSA and other fatigue promoting factors (sleep deprivation and circadian influences) on driving performance. Twenty nine subjects, consisting of a group with mild OSA and a group of non-OSA controls, were tested on several occasions throughout the night and day using an intensive performance battery, under both baseline conditions and after a period of 36 hours of total sleep deprivation. The results suggest that drivers with mild OSA are not different to the control group in their response to sleep deprivation or time of day influences. However, the subjects with mild OSA were less aware of their impairment due to sleep deprivation, which is of concern if drivers with OSA are relying on their subjective awareness of fatigue to make decisions about when to stop driving. A final perspective on OSA and driver fatigue is provided through a clinical case series of seven fall-asleep fatality associated MVA�s associated with unrecognised or under-treated sleep disorders. As well as demonstrating the day to day potential for devastating road accidents due, at least in part, to un-recognised or untreated sleep disorders, these cases also serve to highlight some of the current medico-legal controversies and difficulties in this area of driver fatigue. In conclusion, this body of work has provided novel information about the epidemiology and implications of OSA in commercial drivers, and about how OSA interacts with other fatigue promoting factors. Finally, it has explored some of the medico-legal issues that relate to sleep disorders and driver fatigue. As well as providing much needed information in the area of driver fatigue, at the same time this work raises many more questions and suggests areas of future research. For instance, such research should examine the relationship between objective accident rates and OSA/sleep apnoea syndrome in commercial drivers, the interaction between mild sleep apnoea syndrome and other fatigue risk factors, and driver perception of sleepiness prior to sleep onset in drivers with sleep disorders.

No description available.

The purpose of this study was to compare power output and ventilatory measurements between the steep ramp test (SR) and both the 30-second Wingate anaerobic (WAT) and standard cardiopulmonary exercise tests (CPET) in chronic obstructive pulmonary disease (COPD). 11 patients (7 males and 4 females) underwent spirometry, a CPET, WAT and SR test. Repeated measures ANOVA was used to compare the differences between the peak work rate of the CPET (CPET_peak), SR (SR_peak), and the average power of the WAT (W_avg). The W_avg was higher than the SR_peak, which was higher than the CPET (231.2 ± 113.4, 156.8 ± 67.9, 65.9 ± 35.9, p>0.05 respectively). There were no differences found between the tests at end-exercise for inspiratory reserve volume (IRV), ventilation (V_E), and end-expiratory lung volume (EELV). Tidal volume (V_T) was also compared between the tests as a percentage of the inspiratory capacity (IC) remaining at end-exercise and no differences were found. The similarity between the ventilatory measures indicates a similar level of constraint, despite the large difference in work rates achieved, in all 3 tests. This shows that a standard CPET underestimates leg power in COPD patients, and the WAT and SR may be better indicators of leg muscle power and anaerobic type exercise.

The purpose of this study was to compare power output and ventilatory measurements between the steep ramp test (SR) and both the 30-second Wingate anaerobic (WAT) and standard cardiopulmonary exercise tests (CPET) in chronic obstructive pulmonary disease (COPD). 11 patients (7 males and 4 females) underwent spirometry, a CPET, WAT and SR test. Repeated measures ANOVA was used to compare the differences between the peak work rate of the CPET (CPET_peak), SR (SR_peak), and the average power of the WAT (W_avg). The W_avg was higher than the SR_peak, which was higher than the CPET (231.2 ± 113.4, 156.8 ± 67.9, 65.9 ± 35.9, p>0.05 respectively). There were no differences found between the tests at end-exercise for inspiratory reserve volume (IRV), ventilation (V_E), and end-expiratory lung volume (EELV). Tidal volume (V_T) was also compared between the tests as a percentage of the inspiratory capacity (IC) remaining at end-exercise and no differences were found. The similarity between the ventilatory measures indicates a similar level of constraint, despite the large difference in work rates achieved, in all 3 tests. This shows that a standard CPET underestimates leg power in COPD patients, and the WAT and SR may be better indicators of leg muscle power and anaerobic type exercise.

SAS has became an increasingly important public-health problem since 1970. It can adversely affect neurocognitive, cardiovascular, respiratory diseases and can also cause behavior disorder. Moreover, up to 90% of these cases are obstructive sleep apnea (OSA). Presently, Polysomnography is considered as the gold standard for diagnosing sleep apnea syndrome (SAS). However, Polysomnography-based sleep studies are expensive and time-consuming because they require overnight evaluation in sleep laboratories with dedicated systems and attending personnel. In this study, based on the nocturnal oxygen saturation (SpO2) signals, this work develops a method to classify patients with different levels of respiratory disturbance index (RDI) values. To achieve this goal, this study uses neural network in conjunction with different sets of feature variables to perform classification.

No description available.

The physiological signals of human are very important for the diagnosis of diseases. There are two different applications of physiological signals in this study. One is using oxyhemoglobin saturation to diagnose the obstructive sleep apnea hypopnea syndrome (OSAS); the other is to determine the association between dermatoglyphics and schizophrenia by using fingerprint asymmetry measures. The objective of the first part is to comprehensively evaluate the capablity and reliability of the previously proposed oxyhemoglobin indices derived automatically for predicting the severity of OSAS. Patients with a diagnosis of OSAS by standard polysomnography were recruited from China Medical University Hospital Sleep Center. The result revealed that when AHI cutoff value was set to 30/h, ODI achieves 87.8% sensitivity and 96.6% specificity. Another important finding is that, for both apnea and hypopnea, probability of oxyhemoglobin desaturation increases with increases of body mass index (BMI) and neck circumference (NC). Early detection and intervention strategies for schizophrenia are receiving increasingly more attention. Dermatoglyphic patterns have been hypothesized to be indirect measures for early abnormal developmental processes that can lead to later psychiatric disorders such as schizophrenia. However, previous results have been inconsistent in trying to establish the association between dermatoglyphics and schizophrenia. The goal of second part of this work is to try to resolve this problem by borrowing well developed techniques from the field of fingerprint matching. Fingerprint images were acquired digitally from 40 schizophrenic patients and 51 normal individuals. Based on these images, the sample means of the proposed measures consistently identified the patient group as having a higher degree of asymmetry than the control group.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2005. / Titre provenant de l'écran-titre. Bibliogr. f. 71-72.