Αρχειοθήκη ιστολογίου

Κυριακή 21 Φεβρουαρίου 2021

Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients

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Objectives/Hypothesis

Oral appliances (OAs) are a treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). The main objective of the study was to determine the predictive factors of OA efficacy. The secondary objective was to measure the efficacy rates and determine OAs' tolerance and dropout.

Study Design

Retrospective study.

Methods

Efficacy results of the OAs based on the apnea hypopnea index (AHI) reduction, complications, and dropout rates were retrospectively collected from 347 patients with a moderate to severe OSAHS treated by a retention OA. The procedure was entirely performed by otolaryngologists.

Results

The AHI with OA was more significantly reduced in patients with a higher initial AHI and a higher initial body mass index but reduction was not related to age and not proportional to the degree of mandibular advancement. The 50% AHI reduction rate after OA was 65.2%, the AHI ≤5/hr rate after OA was 26.1%, and the <50% AHI reduction and residual AHI > 10/hr rate was 50.1%. The OA significantly reduced the mean AHI (−14.9/hr, P < .0001). In 7.8% of patients, the AHI increased with OA. Seven patients (1.5%) experienced adverse effects. Thirty‐seven (7.8%) patients stopped using OA mainly because of its ineffectiveness. Advancement can be considered beyond the initial maximal advancement. It can be effective sometimes; however, increasing advancement did not significantly reduce AHI.

Conclusions

OA is an effective and well‐tolerated treatment for moderate to severe OSAHS. This treatment was effective for reduction of the AHI ≥50% in two‐thirds of cases studied and it should be considered in more cases.

Level of Evidence

4. Laryngoscope, 2021

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Stem and progenitor cells in sebaceous gland development, homeostasis and pathologies

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Abstract

Sebaceous glands (SGs), typically associated with hair follicles, are critical for the homeostasis and function of mammalian skin. The main physiological function of SGs is the production and holocrine secretion of sebum to lubricate and protect the skin. Defective SGs have been linked to a variety of skin disorders, including acne, seborrheic dermatitis and formation of sebaceous tumours. Thus, a better understanding how SGs are formed and maintained is important to unravel the underlying molecular and cellular mechanisms of SG pathologies and to find better and effective therapies.

Over the last two decades, research has come a long way from the initial identification of skin epithelial stem cells to the isolation and functional characterisation of multiple stem cell pools as well as a better understanding of their unique and complex activities that drive skin homeostasis and operate in skin pathologies. Here, we discuss recent progress in unravelling cellular mechanisms underlying SG development, homeostasis and sebaceous tumour formation and assess the role of stem and progenitor cells in controlling SG physiology and disease processes. The development of elegant in vivo imaging as well as various in vitro and ex vivo stem cell and SG tissue models will advance mechanistic studies on SG function and allow drug screening and testing for efficient and successful targeting SG pathologies.

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Stress‐associated ectopic differentiation of melanocyte stem cells and ORS amelanotic melanocytes in an ex vivo human hair follicle model

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Abstract

Hair graying depends on the altered presence and functionality of hair follicle melanocytes. Melanocyte stem cells (MelSCs) reside in the bulge of hair follicles and give rise to migrating and differentiating progeny during the anagen phase. Aging, genotoxic stress, redox stress, and multiple behavior‐associated acute stressors have been seen to induce hair graying by depleting the MelSC pool, a phenomenon which is accompanied by ectopic pigmentation of these cells, followed by their depletion from the stem cell niche. This aberrant differentiation produces a state from which a return to stem cell‐like quiescence appears to be lost. The cellular features of stress‐induced hair graying have been extensively studied in murine models. Here we describe a method to assess and quantify human hair follicle MelSC differentiation by measuring ectopically pigmented MelSCs in isolated human hair follicles exposed to specific stress signal mediators. Ionizing radiation, hydrogen peroxid e, and noradrenaline have been shown to cause hair graying in mice. We demonstrate here that isolated, ex vivo cultured human hair follicles exposed to these treatments display similar ectopic pigmentation within the bulge area which is accompanied by induction of differentiated melanocytic markers. This study suggests that as in murine models, stress signaling induces closely matching phenotypic changes in human hair follicles which can be monitored and studied as a surrogate model for early steps in human hair graying.

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Epigenetic and metabolic regulation of epidermal homeostasis

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Abstract

Continuous exposure of the skin to environmental, mechanical, and chemical stress necessitates constant self‐renewal of the epidermis to maintain its barrier function. This self‐renewal ability is attributed to epidermal stem cells (EPSCs), which are long‐lived, multipotent cells located in the basal layer of the epidermis. Epidermal homeostasis – coordinated proliferation and differentiation of EPSCs – relies on fine‐tuned adaptations in gene expression which in turn are tightly associated with specific epigenetic signatures and metabolic requirements. In this review, we will briefly summarize basic concepts of EPSC biology and epigenetic regulation with relevance to epidermal homeostasis. We will highlight the intricate interplay between mitochondrial energy metabolism and epigenetic events – including miRNA‐mediated mechanisms – and discuss how the loss of epigenetic regulation and epidermal homeostasis manifests in skin disease. Discussion of inherited epider molysis bullosa (EB) and disorders of cornification will focus on evidence for epigenetic deregulation and failure in epidermal homeostasis, including stem cell exhaustion and signs of premature aging. We reason that the epigenetic and metabolic component of epidermal homeostasis is significant and warrants close attention. Charting epigenetic and metabolic complexities also represents an important step in the development of future systemic interventions aimed at restoring epidermal homeostasis and ameliorating disease burden in severe skin conditions.

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Histopathological study on neuroapoptotic alterations induced by etomidate in rat hippocampus.

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Via histochem

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Histopathological study on neuroapoptotic alterations induced by etomidate in rat hippocampus.

Acta Histochem. 2021 Feb 16;123(3):151693

Authors: Alipour M, Asl MK, Khordad E, Alipour F, Raoofi A, Ebrahimzadeh-Bideskan A, Ebrahimi V

Abstract
In human, there is substantial neurogenesis in the hippocampus that is implicated in memory formation and learning. These new-born neurons can be affected by neuropathological conditions. Anesthesia and surgical procedures are associated with postoperative cognitive changes particularly, impaired memory and learning. Therefore, the aim of this study was to evaluate the possible neurodegenerative effects of etomidate in rat hippocampus. Thirty male Wistar rats weighing 250 ± 30 g were randomly divided into 3 groups: 1) Etomidate group; four times 20 mg intraperitoneal injection with 1-h intervals, 2) Control group; the equal volume of normal saline, and 3) Normal group; without any intervention. 6 h after the last injection, the brains were removed and processed according to routine histological methods. TUNEL assay and toluidine blue staining were performed to evaluate neuro-histopathological changes in different regions of hippocampus. Our results showed that the number of TUNEL positive cells and dark neurons (DNs) in etomidate group were significantly higher in the CA1, CA2, CA3, and dentate gyrus (DG) of hippocampus compared with the control and normal groups (p < 0.05). While, there was no significant difference between the various regions of hippocampus in control and normal groups. Our findings showed that etomidate can increase apoptotic cells and dark neurons induction in different regions of hippocampus mainly in DG.

PMID: 33601320 [PubMed - as supplied by publisher]

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Neuroendocrine neoplasms of the middle ear: Unpredictable tumor behavior and tendency for recurrence

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Abstract

Background

Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare temporal bone tumors. This study evaluates its clinical behavior and therapy outcome.

Method

Retrospective case review in a tertiary referral center evaluating histopathology, immunohistochemistry, treatment, and outcome.

Results

Nine patients were diagnosed with MEANT. One patient presented with locally invasive tumor and underwent extensive en‐bloc tumor resection with adjuvant radiotherapy. Seven of eight patients with locally non‐aggressive tumor confined to the tympanomastoid space underwent tumor resection. Two patients were disease‐free, five presented recurrence, even after apparent successful surgery. All tumors showed neuroendocrine features. Histopathology and immunohistochemistry did not yield prognostic tumor characteristics.

Conclusion

MEANTs are rare tumors with uncertain biological behavior and subsequent unpredictable clinical course. The preferred treatment is complete surgical tumor resection. They have a high tendency for recurrence, irrespective of negative intermediary surgery. As of yet, there are no prognostic biomarkers, including histopathology and immunohistochemistry.

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Nomograms for predicting survival outcomes in intensity‐modulated radiotherapy era of nasopharyngeal carcinoma: A study based on Epstein–Barr virus DNA biological responses

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Abstract

Background

Treatment of nasopharyngeal carcinoma (NPC) is evolving toward Intensity‐modulated radiotherapy (IMRT) era, which requires patient‐specific reestimation of survival outcomes in modern health care.

Methods

A total of 488 detectable pre‐treatment Epstein–Barr virus (EBV) DNA patients (stage II‐IVa) treated with induction chemotherapy (IC) and IMRT were examined (training set, n = 325; validation set, n = 163).

Results

Concurrent chemotherapy (CC) was still an independent prognosticator for overall survival (OS) and progression‐free survival (PFS). Both nomograms included age, T classification, N classification, post‐IC EBV DNA, and CC. Predictions correlated well with observed 3‐/5‐year OS and PFS. The concordance index was 0.776 (95% confidence interval (CI) 0.69–0.86) for OS and 0.742 (95% CI 0.65–0.83) for PFS in the validation cohort. The nomograms can successfully classify patients into low‐ and high‐risk groups.

Conclusion

The validated nomograms provided useful prediction of OS and PFS for detectable pre‐treatment EBV DNA patients with NPC in IMRT era.

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Outcomes and prognostic factors of major salivary gland tumors treated with proton beam radiation therapy

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Abstract

Background

Proton beam radiation therapy (PBRT) has dosimetric advantages compared to photon radiation therapy for the treatment of major salivary gland tumors (MSGTs).

Methods

Patients with non‐metastatic MSGTs treated at a single proton therapy center from October 2013 to October 2018 were retrospectively reviewed.

Results

Sixty‐eight patients with MSGTs were included and the most common site and histology were the parotid gland (75.0%) and adenoid cystic carcinoma (22.1%), respectively. The 3‐year rates of locoregional control, progression‐free survival, and overall survival were 95.1% (95% CI: 89.9%‐100.0%), 80.7% (70.2%‐92.7%), and 96.1% (95% CI: 90.9%‐100.0%), respectively.

Conclusion

In a large cohort of MSGTs treated with PBRT, the rates of locoregional control were high in short‐term follow‐up and treatment was well tolerated.

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Theoretical Screening and Experimental Synthesis of Ultrahigh-Iodine Capture Covalent Organic Frameworks.

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Theoretical Screening and Experimental Synthesis of Ultrahigh-Iodine Capture Covalent Organic Frameworks.

ACS Appl Mater Interfaces. 2021 Feb 18;:

Authors: Song S, Shi Y, Liu N, Liu F

Abstract
Radioactive materials of nuclear waste would be hazardous to human health such as the reproductive and metabolic system. How to design a radioactive material adsorbent quickly and efficiently is still a great challenge. In this study, a strategy for the efficient design of a high-potential radioactive iodine uptake adsorbent by theoretical screening is proposed. The following experiments which use covalent organic frameworks (COFs) as demonstration have great agreement with the theoretical screening prediction. Three screened COFs show ultrahigh iodine adsorption, which reaches up to 6.4 g/g (640% in mass) in vapor and 99.9 mg/g in solution, owing to the pore size and the functional groups in COFs.

PMID: 33599122 [PubMed - as supplied by publisher]

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[Radiological incident: public health countermeasures].

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[Radiological incident: public health countermeasures].

G Ital Med Lav Ergon. 2020 Dec;42(4):272-276

Authors: De Luca G

Abstract
SUMMARY: Several measures in a response to a nuclear or radiological emergency have in common the aim of protecting human life and health, among these: to save lives; to avoid or to minimize severe deterministic effects; to provide fist aid, critical medical treatment and to manage the treatment of radiation injuries; to reduce the risk of stochastic effects. In the phase of the urgent response (the first hours or few days from the declaration of the emergency) mitigatory actions have to be taken by the operating personnel of a nuclear facility to prevent the escalation of the emergency and mitigate the consequences of radioactive releases and exposure; along with these, urgent protective actions have to be implemented. Examples of urgent protective actions are: sheltering, evacuation of people residing near the plant and iodine thyroid blocking (ITB): these actions can be also precautionary if taken before or immediately after the beginning of the radioactive release. In the second phase of the emergency (the early response phase) which can last days or weeks, early protective actions, like relocation, restrictions on the food chain and on water supply etc., should be taken. The mitigatory and protective actions should be part of a general protective strategy of the population, based on generic criteria and generic guidance values for restricting exposure of the emergency workers and of the general population.

PMID: 33600654 [PubMed - in process]

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Basivertebral foramina of true vertebrae: morphometry, topography and clinical considerations.

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Basivertebral foramina of true vertebrae: morphometry, topography and clinical considerations.

Surg Radiol Anat. 2021 Feb 17;:

Authors: Tzika M, Paraskevas GK, Piagkou M, Papatolios AK, Natsis K

Abstract
PURPOSE: Basivertebral foramina (BVF) are openings of the posterior wall of vertebral body (VB) that lead to basivertebral canals (BVC), where homonymous neurovascular bundle courses. BVF and BVC are implicated with spinal fractures, vertebral augmentation and basivertebral nerve radiofrequency ablation. Despite their essential clinical impact, knowledge of BVF precise anatomy is scarce. The current study describes in detail the BVF typical morphological and topographical anatomy, morphometry and variants.
METHODS: In total, 1561 dried true vertebrae of 70 Greek spines of known gender and age were examined. BVF number, location, shape and size (in foramina > 1 mm), BVF distance from VB rims and pedicles, as well as VB morphometry (diameters, heights and distance between pedicles) were studied. Ten spines were re-examined by computed tomography and BVC depth and shape were recorded. Correlations and differences were statistically analyzed.
RESULTS: C1 lack BVF (3.4%). One BVF was found in 45.1%, two in 36.9%, three in 3.8% and four BVF in 0.6%. Multiple small (< 1 mm) foramina were observed in 10.1%. Asymmetry was detected in 12.3%. C2 and T10-L1 presented typical pattern, whereas C3 and T2 had the greatest variability. BVF were significantly closer to the upper rim in C2 and T10-L4 and to the lower rim in C7-T4, T6-T8 and L5. The mean BVC depth was 12-21.8% of the VB anteroposterior diameter.
CONCLUSION: BVF number, shape, size and topography are described, in detail, per vertebral level. The provided morphological classification and the created cumulative BVF topographic graphs should assist in clinical practice and surgery.

PMID: 33598754 [PubMed - as supplied by publisher]

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Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool.

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Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool.

Eur Arch Otorhinolaryngol. 2021 Feb 19;:

Authors: Frendø M, Frithioff A, Konge L, Foghsgaard S, Mikkelsen PT, Sørensen MS, Cayé-Thomasen P, Andersen SAW

Abstract
PURPOSE: To develop and gather validity evidence for a novel tool for assessment of cochlear implant (CI) surgery, including virtual reality CI surgery training.
METHODS: Prospective study gathering validity evidence according to Messick's framework. Four experts developed the CI Surgery Assessment Tool (CISAT). A total of 35 true novices (medical students), trained novices (residents) and CI surgeons performed two CI-procedures each in the Visible Ear Simulator, which were rated by three blinded experts. Classical test theory and generalizability theory were used for reliability analysis.
RESULTS: The CISAT significantly discriminated between the three groups (p < 0.001). The generalizability coefficient was 0.76 and most of the score variance (53.3%) was attributable to the participant and only 6.8% to the raters. When exploring a standard setting for CI surgery, the contrasting groups method suggested a pass/fail score of 36.0 points (out of 55), but since the trained novices performed above this, we propose using the mean CI surgeon performance score (45.3 points).
CONCLUSION: Validity evidence for simulation-based assessment of CI performance supports the CISAT. Together with the standard setting, the CISAT might be used to monitor progress in competency-based training of CI surgery and to determine when the trainee can advance to further training.

PMID: 33604749 [PubMed - as supplied by publisher]

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