Background—: Despite the adverse cardiovascular consequences of obstructive sleep apnea, the majority of patients remain undiagnosed. To explore an efficient ECG-based screening tool for obstructive sleep apnea, we examined the usefulness of automated detection of cyclic variation of heart rate (CVHR) in a large-scale controlled clinical setting. Methods and Results—: We developed an algorithm of autocorrelated wave detection with adaptive threshold (ACAT). The algorithm was optimized with 63 sleep studies in a training cohort, and its performance was confirmed with 70 sleep studies of the Physionet Apnea-ECG database. We then applied the algorithm to ECGs extracted from all-night polysomnograms in 862 consecutive subjects referred for diagnostic sleep study. The number of CVHR per hour (the CVHR index) closely correlated ( r =0.84) with the apnea-hypopnea index, although the absolute agreement with the apnea-hypopnea index was modest (the upper and lower limits of agreement, 21 per hour and −19 per hour) with periodic leg movement causing most of the disagreement ( P <0.001). The CVHR index showed a good performance in identifying the patients with an apnea-hypopnea index ≥15 per hour (area under the receiver-operating characteristic curve, 0.913; 83% sensitivity and 88% specificity, with the predetermined cutoff threshold of CVHR index ≥15 per hour). The classification performance was unaffected by older age (≥65 years) or cardiac autonomic dysfunction (SD of normal-to-normal R-R intervals over the entire length of recording <65 ms; area under the receiver-operating characteristic curve, 0.915 and 0.911, respectively). Conclusions—: The automated detection of CVHR with the ACAT algorithm provides a powerful ECG-based screening tool for moderate-to-severe obstructive sleep apnea, even in older subjects and in those with cardiac autonomic dysfunction.

Purpose: Gliomas are common tumors of the central nervous system, and the majority of patients with gliomas have a poor prognosis. The prediction of prognosis is very important in selecting treatment. In the present study, we retrospectively examined the immunohistochemical staining of cleaved caspase-3 (CC3), an activated form of caspase-3 that acts as a lethal protease at the most distal stage of the apoptosis pathway, in gliomas, and the correlation between the prognosis of patients and caspase-3 activation to find useful prognostic indicators. Experimental Design: Immunohistochemical staining of CC3 was done in 65 patients with gliomas. The percentage of CC3 staining-positive cells was defined as the CC3 immunoreactivity score (IRS). Survival analysis between CC3 IRS of glioma patients and survival time was carried out using the Kaplan-Meier method with the log-rank test and the Cox proportional hazards regression model. Results: CC3 IRS was statistically analyzed to designate the best provisional cutoff point, and when detected in >10% of glioma cells, it was considered positive. The Kaplan-Meier method with the log-rank test revealed that patients with CC3 IRS-positive tumors had significantly greater survival than those with CC3 IRS-negative tumors among three grades, 2, 3, and 4 (P = 0.0061), and within grade 3 of anaplastic astrocytoma (P = 0.0458). After adjustment for known clinical prognostic factors, such as age, WHO grade, and performance status, the hazard ratio for CC3 IRS-positive was 0.39 with 95% confidence interval between 0.19 and 0.85 (P = 0.0187). Within high grades, including grades 3 and 4, the hazard ratio was 0.40 with 95% confidence interval between 0.20 and 0.86 (P = 0.0192). Conclusions: CC3 IRS could be useful as a good prognostic indicator for glioma patients.

We examined the effect of ambient temperature, air pressure and air pollutants on daily emergency admissions by identifying the cause of admission for each type of stroke and cardiovascular disease using generalized linear Poisson regression models allowing for overdispersion, and controlling for seasonal and inter-annual variations, days of the week and public holidays, levels of influenza and respiratory syncytial viruses. Every 1°C decrease in mean temperature was associated with an increase in the daily number of emergency admissions by 7.83% (95% CI 2.06–13.25) for acute coronary syndrome (ACS) and heart failure, by 35.57% (95% CI 15.59–59.02) for intracerebral haemorrhage (ICH) and by 11.71% (95% CI 4.1–19.89) for cerebral infarction. An increase of emergency admissions due to ICH (3.25% (95% CI 0.94–5.51)), heart failure (3.56% (95% CI 1.09–5.96)) was observed at every 1 hPa decrease in air pressure from the previous days. We found stronger detrimental effect of cold on stroke than cardiovascular disease.

Uptake of Cadmium in Meals from the Digestive Tract of Young Non‐smoking Japanese Female Volunteers: Yuriko Kikuchi, et al. Department of Preventive Medicine and Public Health, School of Medicine, Keio UniversityObjectives: To estimate rates of cadmium (Cd) uptake from the digestive tract and changes in Cd in biological specimens after intake of Cd mainly in rice.Methods: Twenty‐five young non‐smoking Japanese female volunteers (20–23 in age) were recruited and a 20‐d experimental study was conducted. With polished rice containing 0.004 ppm and 0.340 ppm of Cd, Meal L and Meal H were prepared. Approximately 12% of total Cd in Meal L and 92% of total Cd in Meal H originated in rice. The volunteers ate Meal L for 11 d to achieve a stable intake‐output balance of Cd. Fifteen of the 25 volunteers ate Meal H on the 12^th day (Group D1), and the remaining 10 ate Meal H on the 12^th, 13^th and 14^th day (Group D3). All 25 subjects then resumed the consumption of Meal L to the end of the study (20^th day). All meals, feces and urine were collected during the study, and Cd intake from the daily meals (Cd‐I), Cd in feces (Cd‐F) and Cd in urine (Cd‐U) were determined. For measurement of Cd in blood (Cd‐B), venous blood was collected from all volunteers on the day before the study and again on the 12^th and 20^th day; venous blood was also collected from 4–8 volunteers at additional time points.Results: Mean Cd‐I was 4.51 µg/d (range: 1.85–6.93) or 48.48 µg/d (range: 27.98–56.27) when they ate Meal L or Meal H. Cd‐F and Cd‐B exhibited faster responses to the change in Cd‐I than did Cd‐U. The Cd_uptake rate, defined as (1‐Cd‐F_excess /Cd‐I_excess) (Fig. 1), was 47.2% (range: –9.4–83.3%) in Group D1 and 36.6% (range: –9.2– 73.5%) in Group D3, and the Cd_balance rate, defined as (1‐Cd‐F_output /Cd‐I_intake), was 23.9% (range: –4.0–37.7%) in Group D1 and 23.7% (range: –8.2–56.9%) in Group D3.Conclusions: Cd‐F and Cd‐B are better biological monitoring parameters for assessing change in Cd‐I than Cd‐U. The Cd_uptake and Cd_balance rates appeared to be higher than those in previous papers when ingested Cd mainly originated in rice.

Background and objective:  The SD‐101 is a non‐restrictive, sheet‐like medical device with an array of pressure sensors, to detect sleep‐disordered breathing by sensing gravitational alterations in the body corresponding to respiratory movements. This study evaluated the accuracy of the SD‐101 for screening sleep apnoea‐hypopnoea syndrome (SAHS) by comparison with polysomnography.Methods:  Nocturnal polysomnography and SD‐101 monitoring were conducted simultaneously and compared in 201 patients with suspected SAHS (suspected SAHS group) and 165 male employees of a transport company (screening group).Results:  Polysomnography revealed an AHI of <5, 5 ≤ AHI < 15, 15 ≤ AHI < 30, 30 ≤ AHI < 60 and AHI ≥ 60 events/h in 39, 35, 38, 68 and 21 subjects in the suspected SAHS group and 103, 34, 12, 12 and four subjects in the screening group, respectively. Central SAHS and obstructive SAHS were subsequently diagnosed in 11 (5.5%) and 135 (67.2%) of subjects in the suspected SAHS group and five (3.0%) and 39 (23.6%) of subjects in the screening group, respectively. Significant correlations were apparent between AHI and the respiratory disturbance index (RDI) measured with the SD‐101 in both the suspected SAHS group (r = 0.88) and screening group (r = 0.92). Receiver operating characteristic curve analysis revealed 89.5% sensitivity and 85.8% specificity in identifying SAHS, using an RDI of 14.0 events/h.Conclusions:  These findings suggest that the SD‐101 is a useful device for screening SAHS.