High Human Papillomavirus DNA loads in Inflammatory Middle Ear Diseases

Background. Previous studies reported human papillomaviruses (HPVs) in middle ear tumors, whereas these viruses have been poorly investigated in chronic inflammatory middle ear diseases. The purpose of this study was to investigate HPVs in non-tumor middle ear diseases, including chronic otitis media (COM). Methods. COM specimens (n=52), including chronic suppurative otitis media (CSOM) (n=38) and cholesteatoma (COMC) (n=14), as well as normal middle ear specimens (NME) (n=56) were analyzed. HPV DNA sequences and DNA loads were analyzed by quantitative PCR. HPV genotyping was performed by direct sequencing of the amplimers. Results. HPV DNA was detected in 23% (12/52) of COM and in 30.4% (17/56) NME (p>0.05). Specifically, HPV DNA sequences were revealed in 26.3% (10/38) of CSOM and in 14.3% (2/14) COMC (p>.05). Interestingly, the HPV DNA load was higher in COMC (mean 7.47 copy/cell) than in CSOM (mean 1.02 copy/cell), and NME (mean 1.18 copy/cell) (P=.03 and P=.017 versus CSOM and NME, respectively). HPV16 and HPV18 were the main genotypes detected in COMC, CSOM and NME. Conclusions. This data indicates that HPV-positive CSOM and COMC are generally associated with higher viral DNA loads as compared to NME. In addition, for the first time, HPVs were detected in normal middle ear mucosa specimens. This result suggests that NME is an additional epithelial tissue that can be HPV infected

Functional Organization and Restoration of the Brain Motor-Execution Network After Stroke and Rehabilitation

Multiple cortical areas of the human brain motor system interact coherently in the low frequency range (\u3c0.1 Hz), even in the absence of explicit tasks. Following stroke, cortical interactions are functionally disturbed. How these interactions are affected and how the functional organization is regained from rehabilitative treatments as people begin to recover motor behaviors has not been systematically studied. We recorded the intrinsic functional magnetic resonance imaging (fMRI) signals from 30 participants: 17 young healthy controls and 13 aged stroke survivors. Stroke participants underwent mental practice (MP) or both mental practice and physical therapy (MP+PT) within 14–51 days following stroke. We investigated the network activity of five core areas in the motor-execution network, consisting of the left primary motor area (LM1), the right primary motor area (RM1), the left pre-motor cortex (LPMC), the right pre-motor cortex (RPMC) and the supplementary motor area (SMA). We discovered that (i) the network activity dominated in the frequency range 0.06–0.08 Hz for all the regions, and for both able-bodied and stroke participants (ii) the causal information flow between the regions: LM1 and SMA, RPMC and SMA, RPMC and LM1, SMA and RM1, SMA and LPMC, was reduced significantly for stroke survivors (iii) the flow did not increase significantly after MP alone and (iv) the flow among the regions during MP+PT increased significantly. We also found that sensation and motor scores were significantly higher and correlated with directed functional connectivity measures when the stroke-survivors underwent MP+PT but not MP alone. The findings provide evidence that a combination of mental practice and physical therapy can be an effective means of treatment for stroke survivors to recover or regain the strength of motor behaviors, and that the spectra of causal information flow can be used as a reliable biomarker for evaluating rehabilitation in stroke survivors

Chronic Inflammatory Disease and Osteopathy: A Systematic Review

<div><p>Background</p><p>Chronic inflammatory diseases (CID) are globally highly prevalent and characterized by severe pathological medical conditions. Several trials were conducted aiming at measuring the effects of manipulative therapies on patients affected by CID. The purpose of this review was to explore the extent to which osteopathic manipulative treatment (OMT) can be benefi-cial in medical conditions also classified as CID.</p><p>Methods</p><p>This review included any type of experimental study which enrolled sub-jects with CID comparing OMT with any type of control procedure. The search was conducted on eight databases in January 2014 using a pragmatic literature search approach. Two independent re-viewers conducted study selection and data extraction for each study. The risk of bias was evaluated according to the Cochrane methods. Heterogeneity was assessed and meta-analysis performed where possible.</p><p>Results</p><p>10 studies met the inclusion criteria for this review enrolling 386 subjects. The search identified six RCTs, one laboratory study, one cross-over pilot studies, one observation-al study and one case control pilot study. Results suggest a potential effect of osteopathic medicine on patients with medical pathologies associated with CID (in particular Chronic Obstructive Pul-monary Disease (COPD), Irritable Bowel Syndrome, Asthma and Peripheral Arterial Disease) com-pared to no treatment or sham therapy although data remain elusive. Moreover one study showed possible effects on arthritis rat model. Meta-analysis was performed for COPD studies only show-ing no effect of any type of OMT applied versus control. No major side effects were reported by those receiving OMT.</p><p>Conclusion</p><p>The present systematic review showed inconsistent data on the effect of OMT in the treatment of medical conditions potentially associated with CID, however the OMT appears to be a safe approach. Further more robust trials are needed to determine the direction and magnitude of the effect of OMT and to generalize favorable results.</p></div

Forest plot of comparisons, OMT for COPD parameters.

<p>Outcomes: A, forced expiratory volume in the first second (FEV1); B, forced vital capacity (FVC) and C, residual volume (RV). CI, confidence interval; SD, standard deviation.</p

Overview of included studies of osteopathic manipulative treatment for chronic inflammatory diseases.

<p>OMT: osteopathic manipulative treatment; PEF: Peak Expiratory Flow; COPD: Chronic Obstructive Pulmonary Disease; PR: Pulmonary Rehabilitation; 6MWT: 6-minutes Walking Test; FMV: Flow Mediated Vasodilation; IBS: Irritable Bowel Syndrome; QoL: Quality of Life; ABPI: Ankle/Brachial Pressure Index; RCT: Randomized Controlled Trial</p><p>Overview of included studies of osteopathic manipulative treatment for chronic inflammatory diseases.</p

Overview of main findings and side effects of included studies.

<p>OMT: Osteopathic Manipulative Treatment; SD: Standard Deviation; PEF: Peak Expiratory Flow; ANCOVA: Analysis of Covariance; FEF: Forced Expiratory Flow; RV: Residual Volume; TLC: Total Lung Capacity; IC: Inspiratory Capacity; TLP: Thoracic Lymphatic Pump; FVC: Forced Vital Capacity; MVV: Maximal Voluntary Volume; 6MWD: 6-minute walking Distance; PR: Pulmonary Rehabilitation; ABPI: Ankle/Brachial Pressure Index; CPT: Claudication Pain Time; TWT: Total Walking Time; FMV: Flow Mediated Vasodilation; sICAM: Soluble Intercellular adhesion molecule; sVCAM: Soluble Vascular Cell Adhesion Molecule; IL-6: Human Interleukin-6; IBS: Irritable Bowel Syndrome. As a secondary outcome authors measured the thoracic compliance. OMT groups significantly increased respiratory motion when compared to sham intervention groups. The mean change in upper and lower thoracic excursion was statistically significant between groups (Tables <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121327#pone.0121327.t001" target="_blank">1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121327#pone.0121327.t002" target="_blank">2</a>).</p><p>Guiney et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121327#pone.0121327.ref022" target="_blank">22</a>] enrolled 140 asthmatic children (range 5–17 y) and randomly assigned to OMT group and sham control group. The main outcome was the baseline variation of PEF before and after treatment. Results demonstrated that OMT group significantly increase PEF rates compared to control (PEF_OMT: 13.0 (27.4); PEF_sham: 0.3 (35.5)). Within group analysis demonstrated that the OMT group moved from 7 L to 19 L/minute, whilst the control group did not change (10 L/minute) (Tables <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121327#pone.0121327.t001" target="_blank">1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121327#pone.0121327.t002" target="_blank">2</a>).</p><p>Overview of main findings and side effects of included studies.</p

Flow chart of the study selection.

<p>Flow chart of the study selection.</p

Sleep position and obstructive sleep apnea (OSA): Do we know how we sleep? A new explorative sleeping questionnaire

Purpose: Positional obstructive sleep apnea (POSA) has been defined as a difference of 50% or more in Apnea-Hypopnea Index (AHI) between supine and non-supine position. Sleep position is fundamental in the evaluation of obstructive sleep apnea syndrome (OSAS) severity but most tools used in the diagnosis of OSAS are not free from potential bias in the&nbsp;evaluation of usual sleep positions. The aim of this investigation was to evaluate a novel sleep questionnaire with the purpose of exploring sleep habits and evaluating if sleep assessment can identify the usual body position assumed for sleep. Materials and methods: The questionnaire was administered to patients recruited from October to November 2018. Questions concerned sleeping positions and conditions that could influence sleeping positions. Patients who had previously undergone polysomnography (PSG) were asked how they slept during the study night. Whenever present during the examination, the patient's bed partner was also asked about the patient's usual body positions during sleep. Results: Of 315 patients (211 men) enrolled, 35% were affected by OSAS and 69% of patients with OSAS&nbsp;had POSA. POSA was more prevalent among men (75%) compared to women (43%). The new questionnaire provided a discordant result from PSG recordings about sleeping positions and revealed a difference between usual sleeping position and the position during PSG recording. Reported sleep quality was much worse on PSG than at home suggesting that the "first night effect" is real and may lead to over-estimation of POSA cases. Conclusions: Information about sleeping positions is fundamental to the assessment of OSAS severity. Knowledge gained from the new questionnaire as described may represent a&nbsp;valuable addendum to develop a&nbsp;more detailed polygraphic report. Such a&nbsp;tool may be used in practice with the aim of better identifying patients with true positional OSAS. Such patients may benefit from targeted positional therapy

Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO2 LASER, transoral robotic surgery, or the microdebrider

Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology

Purpose: This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). Methods: The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. Results: The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9&nbsp;years, with an average Body Mass Index (BMI) of 25.6&nbsp;kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. Conclusions: Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary