Clinical and anatomical characteristics associated with obstructive sleep apnea severity in children

Purpose: To determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy. Methods: The authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses. Results: The mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p = 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements. Conclusions: The clinical criteria and craniofacial characteristics evaluated did not influence the disease severity

Unexpected hypoxia-dependent erythropoietin secretion during experimental conditions not affecting tissue oxygen supply/demand ratio

Unexpected hypoxia-dependent erythropoietin secretion during experimental conditions not affecting tissue oxygen supply/demand ratio. Although a great deal of evidence supports the hypothesis that plasma erythropoietin (EPO) levels of mammals are related to the oxygen supply to the tissues relative to their oxygen needs, several observations millitate against its inherent simplicity. This study presents our results obtained from in vivo experiments that suggest that hypoxia-dependent EPO production can be altered by conditions which apparently do not modify the tissue oxygen supply/demand ratio. Hypoxia-dependent EPO production rate (EPO-PR), derived from plasma EPO titers and plasma EPO half-lives, were estimated in both transfused-polycythemic and normocy-themic mouse models subjected to different treatments. From calculations of the o2 carrying capacity of blood and body o2 consumption, it was assumed that the tissue supply/demand ratios were similar in both experimental and control mice of the same model at the time of induction of EPO production. The following observations were worth noting: (1) EPO-PRs in transfused polycythemic mice whose erythropoietic rates were stimulated by intermittent exposure to hypobaria (0·5 atm, 18 hr/day × 3 weeks), phenylhydrazine administration (40 mg/kg at weekly intervals × 3 weeks) or repeated rh-EPO injections (1500 U/kg 3 times a week × 3 weeks) before transfusion were more than five times higher than in comparabily polycythemic mice whose erythropoietic rates were not stimulated previously; and (2) EPO-PR in response to hypobaric hypoxia was 2·08 times normal in normocythemic mice with cyclophosphamide (100 mg/kg) induced depression of erythropoiesis, and 0·33 times normal in normocythemic mice with rh-EPO (400 U/kg × 2) induced enhancement of erythropoiesis. Although the results obtained in polycythemic mice are difficult to explain, those from normocythemic mice suggest the existence of a feedback mechanism between EPO-responsive cells and EPO-producing cells. Both demonstrate the existence of experimental conditions in which modulation of the hypoxia-dependent expression of the EPO gene appears to occur. This modulation would be dependent on factors other than oxygen

The impact of ventral oral graft bulbar urethroplasty on sexual life

Objective: To evaluate the pre- and postoperative aspects of sexual life (SL) in patients with bulbar urethral stricture who underwent ventral oral graft urethroplasty. Methods: Between 2009 and 2010, 52 men (mean age 36 years) were enrolled in our prospective study to ascertain sexual disorders before and after surgery. The validated Male Sexual Health Questionnaire-Long Form (MSHQ-LF) was completed pre- and postoperatively; the unvalidated but adapted Post-Urethroplasty Sexual Questionnaire (PUSQ) was completed postoperatively. Data were compared using the non parametric Wilcoxon test. Results: Before urethroplasty, most of the patients reported sexual disorders, in particular reduced ejaculatory stream (85%); many of them (35%) feared the risk of a postoperative worsening in the quality of SL. After urethroplasty, nobody reported a worsened erection, while most of the patients noticed a significant improvement in erection, ejaculation, relationship with their partner, sexual activity, and desire. Modifications in the scrotoperineal sensitivity were reported by 42% and 15% noticed esthetic changes without impact on SL. All patients reported an improvement in quality of life (QOL) and were satisfied with the outcome of urethroplasty. Conclusion: Urethral stricture disease may be responsible for sexual disorders that have a significant impact upon SL. Patients confessed a marked anxiety tackling urethroplasty and declared that one of their deepest fears regarded a potential further deterioration in the quality of SL. At short-term follow-up, the minimally invasive ventral graft urethroplasty does not cause sexual complications, apart from the post-ejaculation dribbling. On the contrary, this technique showed to restore SL in all its aspects

Hypoxia-Stimulated Erythropoietin Secretion in Mice with Different Types of Induced Polycythemia: The Posthypoxic Enigma

Abstract Erythropoietin (EPO) is a hormone that is part of a feedback system that adjust the volume of the red cell mass (RCM) to tissue oxygen demands. Increased plasma EPO concentration (pcEPO) accompanies reduced oxygen supply or increased demands, whereas low levels of pcEPO are observed with increased oxygen supply or reduced demands. Therefore, the increment of RCM induced by transfusion (HT mouse) will enhance oxygen supply to tissues and depress EPO secretion when they are subjected to hypobaric hypoxia (HH, a potent stimulus for EPO secretion). When mice made polycythemic by sustained exposure to HH (PH mouse) are re-exposed to the stimulus after a brief period at sea level condition, they react synthesizing EPO as do normocythemic mice. This study was designed to compare HH-stimulated EPO production in mice in which polycythemia was induced by different maneuvers (exposure to HH [6350 m]) for 2 wks, transfusion of homologous erythrocytes (0.8 ml of packed erythrocytes ip), sustained exposure to air containing 0.06% CO, sustained administration of rHu-EPO (5.5 IU day/2wk) and repeated injections of phenylhydrazyne (60 mg/Kg/3 wk) followed by transfusion. After treatments were completed, all animals were exposed to 337 mmHg for 6 h. Blood collected by cardiac puncture and pcEPO measured by immunoassay (R&D systems). pcEPO was significantly elevated in normocythemic and PH mice in relation to non-exposed controls, whereas pcEPO was not increased in response to HH in the remaining groups. In another experiment, mice were exposed for 2 wk to different simulated altitudes (0, 2500, 3600, 4600, 5500 and 7300 m). They were re-exposed to HH for 6 hr. Linear regression analysis between the variable X (simulated high altitude) and the variable Y (pcEPO) showed a slope of 563.4 ± 116.1 pg/1000m and an r 2 = 0.887. Data indicate that the enhancement of EPO secretion in response to the hypoxic challenge in polycythemic mice only occurs in mice that have been previously exposed to hypoxia. However, the operating mechanism of hypoxia in this state of EPO hypersecretion remains as an open question

What Happens to MnO2 When It Comes in Contact with Zn2+? An Electrochemical Study in Aid of Zn/MnO2-Based Rechargeable Batteries

In the science and technology of electrochemical energy storage, different allotropes of MnO2, fabricated with a variety of methods, are assembled into electrodes, playing the role of cathode or oxygen reduction reaction (ORR) electrocatalyst. Often, MnO2-based cathodes are combined with Zn anodes into different types of batteries, resulting in contact between MnO2 and its electrochemical reaction products, and Zn2+. Awareness is growing that this interaction adversely affects the functional performance of MnO2, but no definitive understanding has been reached for this issue. This study contributes, through electrochemical measurements accompanied by microscopy and Raman spectroscopy, to a better understanding of the way the electrochemical behavior of two technologically representative types of manganese dioxide - hydrothermally grown α-MnO2 and electrodeposited γ-MnO2 (EDM) - is degraded when these materials are exposed to neutral and alkaline aqueous solutions, containing Zn2+. Specifically, we highlighted different types of irreversible changes in electrochemical response, which can be interpreted with phase-formation processes. Such changes result in the deactivation of α-MnO2 as ORR electrocatalyst, and of both α-MnO2 and EDM as zinc-ion battery (ZIB) cathodes. The electroactivity of EDM for ZIB operation can be restored if Mn2+ is added to the neutral electrolyte, because a phase, active in discharge, is electrodeposited during charging

Microalbuminuria and sRAGE in High-Risk Hypertensive Patients Treated with Nifedipine/Telmisartan Combination Treatment: A Substudy of TALENT

Some antihypertensive drugs have also renoprotective and anti-inflammatory properties that go beyond their effect on blood pressure. It has been suggested that microalbuminuria and glomerular filtration rate (GFR) are associated with circulating levels of the soluble form of the receptor, sRAGE (soluble receptor for advanced glycation ends-products). In the present analysis, we used data from the TALENT study to evaluate soluble receptor for advanced glycation end-products (sRAGE) plasma levels in patients with hypertension and high-cardiovascular risk-treated nifedipine and telmisartan in combination. Treatment with nifedipine-telmisartan significantly decreased mean systolic and diastolic ambulatory blood pressure and resulted in a significant increase in sRAGE plasma concentrations after 24 weeks of therapy. We concluded that in hypertensive patients with early-stage renal disease, sRAGE concentrations are not influenced by either microalbuminuria or GFR. Long-term treatment with a combination of nifedipine-telmisartan may have a beneficial effect increasing sRAGE plasma levels, thus exerting an atheroprotective and anti-inflammatory activity

Chromosomal control of non-gliadin proteins from the 70% ethanol extract of wheat endosperm

The non-gliadin fraction of the 70% ethanol extracts of compensated nulli-tetrasomics and ditelosomics of Triticum aestivum cv. Chinese Spring has been analyzed by combined electrofocusing and electrophoresis. Seventeen of the 21 protein map components of the euploid have been ascribed to eight chromosomes: 4A, 3BS, 6BS, 7BS, 3D, 4D, 5D and 7DS. The relationship of the different map components with other proteins previously associated with the same chromosomes is discusse

Disposable versus reusable ureteroscopes. A prospective multicenter randomized comparison

Introduction: To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing RIRS, with specific reference to post-operative complications and infection rates. Materials and methods: Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results: The patients’ demographics, stones features and preoperative urine cultures were comparable between the groups. The SFRs were not significantly different (86,6% and 90,0% for group A and group B respectively, p = 0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p = 0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infections rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p < 0.05). Conclusions: The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes

Ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP): outcomes on a large cohort

Purpose: To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. Methods: A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student\u2019s t test, Chi-square test and logistic regression analysis. Results: Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 \ub1 4.47 vs 16.7 \ub1 2.9 (p = 0.419) and 17.7 \ub1 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 \ub1 7.24 vs 5.8 \ub1 4.3 (p = 0.032) and 3.9 \ub1 4.1 (p = 0.029) at 3 and 6 months. Conclusion: ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men