Systemic lupus erythematosus (SLE) is an autoimmune disease of uncertain etiology that affects multiple tissues and organs. Arsenic trioxide (ATO) has been used in lupus-prone mice with a regulatory effect on immune abnormality. Tetra-arsenic tetra-sulfide (As4S4), a traditional Chinese medicine, is effective on acute promyelocytic leukemia with mild side effects than ATO. In this study, a pilot study was performed to investigate the effects and the mechanism of As4S4 on the lupus-prone BXSB mice. Improvement of monocytosis (p<0.05) in spleen and decreased serum interleukin-6 (IL-6) (p=0.0277) were observed with As4S4 treatment. As4S4-treated mice exhibited amelioration of skin, liver and renal disease with mild side effects. Histological analysis revealed that As4S4 suppressed immune complex deposition, mesangial proliferation and inflammatory cell infiltration in kidney and liver. Our study support that As4S4 selectively suppresses cutaneous lupus and nephritis in BXSB mice and might be a potential treatment for SLE.

Study Objectives: Population based estimates of obstructive sleep apnea (OSA) frequency and health impact are incomplete. The aim of this study was to determine the prevalence of risk factors for physician and sleep study diagnosed OSA among individuals in a state-based surveillance program Methods: Using questions inserted into the 2016 (n = 5,564) and 2017 (n = 10,884) South Carolina Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, we analyzed the prevalence of physician diagnosed OSA and associated comorbidities. The validated STOP-BANG questionnaire without neck circumference (STOP-BAG) defined populations at moderate risk (score 3-4) and high risk (score 5-7). Statistical analysis using weighted prevalence and means and their 95% confidence intervals (CI) thus reflect population estimates of disease burden. Results: The population-based prevalence of physician diagnosed OSA in South Carolina was 9.7% (95% CI: 9.0-10.4). However, the populations with moderate risk (18.5%, 95% CI: 17.3-19.8) and high risk (25.5%, 95% CI: 23.9-27.1) for OSA, as determined by the STOP-BAG questionnaire, were much higher. Compared to those at low risk for OSA, those at high risk were more often diagnosed with coronary heart disease, stroke, asthma, skin cancer, other cancers, chronic obstructive pulmonary disease, arthritis, depression, kidney disease, and diabetes (all P < .001). Conclusions: OSA is common and strongly associated with major comorbidities. As such, this public health crisis warrants more diagnostic and therapeutic attention. The STOP-BAG questionnaire provides a public health platform to monitor this disease.

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The epidemiology of obstructive sleep apnea (OSA) in the USA has primarily been determined by health system data or local surveillance. The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional state-administered, national health survey conducted in a large number of adults annually. Heretofore, it has never been used to help define the epidemiology of OSA. The BRFSS is unique compared to health system data in that the patient's perspective of disease burden and additional sociodemographic characteristics are assessed. METHODS: We incorporated the following question in two states' (South Carolina and Kentucky) 2017 BRFSS: "Has a doctor ever diagnosed you with a condition called obstructive sleep apnea (also known as OSA) based on a sleep study?" We present data from one state's BRFSS (South Carolina-SC). Using more than 90 survey questions of socio-demographics, risk factors, chronic conditions, and health impairments, we defined the prevalence, health characteristics, and disease burden of adults with physician-diagnosed OSA and compared these to adults without OSA. In the 2017 SC BRFSS survey data (n ¼11,311), those who responded, "don't know/not sure," "refused," or dropped out of the survey before being asked the question were excluded. Survey analysis procedures were used in SAS 9.4 (SAS Inc., Cary, NC) to account for the complex weighting and sampling of BRFSS. To compare the demographic and health behavior/outcome distributions between those with OSA and without OSA, weighted prevalence and mean estimates, along with their 95% confidence intervals (CIs) and chi-square tests for categorial variables, were obtained. RESULTS: Among the 10,884 adults, the prevalence of physician diagnosed OSA in SC in 2017 was 9.7% (95% CI 9.0-10.4). Socioeconomic characteristics associated with a high prevalence of OSA were male gender, high BMI, and a marital status of married, divorced or widowed compared to single. When comparing adults with and without OSA, those with OSA were more likely former smokers. The prevalence of ever being diagnosed with hypertension, coronary heart disease, stroke, asthma, skin cancer, other cancer, COPD, arthritis, depression, kidney disease, diabetes were all higher in OSA diagnosed individuals. Health impairments more likely to be reported in adults with OSA were difficulty concentrating or remembering, difficulty walking or climbing stairs, and fair-poor general health, number of days in the past month where their physical or mental health was "not good," and number of days where their physical or mental health kept them from their normal activities. CONCLUSIONS: The BRFSS provides significant insight into the prevalence and burden of OSA in the general adult population CLINICAL IMPLICATIONS: This study could be used to increase awareness of OSA and its health-related impact.