A Study of the Effect of Tensor Tympani Release in Myringoplasty on Post Operative Middle Ear Compliance

OBJECTIVES: To evaluate the changes in post operative middle ear compliance after myringoplasty with release of the tensor tympani tendon in patients with dry large central perforations. DESIGN: Experimental ; randomized control study. DURATION AND SETTING: This study was conducted in the Department of ENT, Coimbatore Medical College Hospital from February 2010 to October 2011. METHODOLOGY: A total of 50 patients with unilateral tubotympanic type of CSOM, having large central perforations, dry for at least 3 months with medialised handle of malleus were selected after ruling out Eustachian tube dysfunction. Out of them, 25 each were designated into control and study groups. Myringoplasty was done in the routine manner in the control group ; the tensor tympani was released during myringoplasty in the study group. Patients were reviewed periodically and at the end of the third month, were compared in terms of graft take, subjective hearing improvement, post-operative air bone gap, graft mobility, medialisation and post operative tympanometry. RESULTS: Graft success rates were approximately similar in boyh groups(92% & 88%).The mean post operative air bone gap (16.45dB and 14.45Db in control and study groups)showed no significant difference, but patients belonging to study group reported better subjective hearing improvement. The proportion of A, AS, and B curves on postoperative tympanometry was 9%,22% and 68 % in the control group , while in the study group it was 15%,68% and 20 % respectively showing a significant change in post operative compliance among both, The proportions of patients with graft medialisation and immobile graft were higher in the control group. (medialisation rates : 45 % in controls, 15% in study patients.Graft mobility : 32 %controls and 75% study group). CONCLUSION: Tensor tympani tendon release in patients with medialised malleus handle has a definitive role in establishing post operative middle ear compliance in the range of normalcy , ensuring efficient middle ear function. Further studies are needed to evaluate its long term effects before it can be routinely adopted

Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms †.

Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. However, the ECG recordings must be manually reviewed, which is time-consuming and costly. Our aims were to: (i) evaluate the manual review workload; and (ii) evaluate strategies to reduce the workload. In total, 2141 older adults were asked to record their ECG four times per day for 1-4 weeks in the SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) Feasibility Study, producing 162,515 recordings. Patients with AF were identified by: (i) an algorithm classifying recordings based on signal quality (high or low) and heart rhythm; (ii) a nurse reviewing recordings to correct algorithm misclassifications; and (iii) two cardiologists independently reviewing recordings from patients with any evidence of rhythm abnormality. It was estimated that 30,165 reviews were required (20,155 by the nurse, and 5005 by each cardiologist). The total number of reviews could be reduced to 24,561 if low-quality recordings were excluded from review; 18,573 by only reviewing ECGs falling under certain pathological classifications; and 18,144 by only reviewing ECGs displaying an irregularly irregular rhythm for the entire recording. The number of AF patients identified would not fall considerably: from 54 to 54, 54 and 53, respectively. In conclusion, simple approaches may help feasibly reduce the manual workload by 38.4% whilst still identifying the same number of patients with undiagnosed, clinically relevant AF

Gamma-Linolenic and Stearidonic Acids Are Required for Basal Immunity in Caenorhabditis elegans through Their Effects on p38 MAP Kinase Activity

Polyunsaturated fatty acids (PUFAs) form a class of essential micronutrients that play a vital role in development, cardiovascular health, and immunity. The influence of lipids on the immune response is both complex and diverse, with multiple studies pointing to the beneficial effects of long-chain fatty acids in immunity. However, the mechanisms through which PUFAs modulate innate immunity and the effects of PUFA deficiencies on innate immune functions remain to be clarified. Using the Caenorhabditis elegans–Pseudomonas aeruginosa host–pathogen system, we present genetic evidence that a Δ6-desaturase FAT-3, through its two 18-carbon products—gamma-linolenic acid (GLA, 18:3n6) and stearidonic acid (SDA, 18:4n3), but not the 20-carbon PUFAs arachidonic acid (AA, 20:4n6) and eicosapentaenoic acid (EPA, 20:5n3)—is required for basal innate immunity in vivo. Deficiencies in GLA and SDA result in increased susceptibility to bacterial infection, which is associated with reduced basal expression of a number of immune-specific genes—including spp-1, lys-7, and lys-2—that encode antimicrobial peptides. GLA and SDA are required to maintain basal activity of the p38 MAP kinase pathway, which plays important roles in protecting metazoan animals from infections and oxidative stress. Transcriptional and functional analyses of fat-3–regulated genes revealed that fat-3 is required in the intestine to regulate the expression of infection- and stress-response genes, and that distinct sets of genes are specifically required for immune function and oxidative stress response. Our study thus uncovers a mechanism by which these 18-carbon PUFAs affect basal innate immune function and, consequently, the ability of an organism to defend itself against bacterial infections. The conservation of p38 MAP kinase signaling in both stress and immune responses further encourages exploring the function of GLA and SDA in humans

Recent advances and perspectives on starch nanocomposites for packaging applications

Starch nanocomposites are popular and abundant materials in packaging sectors. The aim of this work is to review some of the most popular starch nanocomposite systems that have been used nowadays. Due to a wide range of applicable reinforcements, nanocomposite systems are investigated based on nanofiller type such as nanoclays, polysaccharides and carbonaceous nanofillers. Furthermore, the structures of starch and material preparation methods for their nanocomposites are also mentioned in this review. It is clearly presented that mechanical, thermal and barrier properties of plasticised starch can be improved with well-dispersed nanofillers in starch nanocomposites

Characterising RR Intervals in Atrial Fibrillation Detected Through Screening

Atrial fibrillation (AF) is known to be characterised by increased RR interval variability. However, the characteristics of RR intervals in AF detected through screening have not been extensively studied. The aim of this study was to characterise RR intervals in AF detected in screening of older, community dwelling adults. RR interval characteristics were extracted from 2, 709 ECGs from the SAFER AF Screening Programme, consisting of 671 ECGs exhibiting AF, and 2,038 non-AF ECGs. The characteristics included measures of the mean RR interval, the variability in RR intervals, and the proportion of successive RR intervals differing by at least 50ms (pNN50). All characteristics differed significantly between AF and non-AF ECGs. pNN50 provided the highest performance for discriminating between AF and non-AF, with an AUROC of 96%. In AF the majority of successive RR intervals differed by more than 50ms, although there was large variation in the level of RR interval variability between AF ECGs. This study contributes to furthering our understanding of RR interval characteristics in AF. In the future this could form the basis of an algorithm to automatically identify ECGs exhibiting AF with potential applications in AF screening.</p

Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms

Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. However, the ECG recordings must be manually reviewed, which is time-consuming and costly. Our aims were to: (i) evaluate the manual review workload; and (ii) evaluate strategies to reduce the workload. In total, 2141 older adults were asked to record their ECG four times per day for 1–4 weeks in the SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) Feasibility Study, producing 162,515 recordings. Patients with AF were identified by: (i) an algorithm classifying recordings based on signal quality (high or low) and heart rhythm; (ii) a nurse reviewing recordings to correct algorithm misclassifications; and (iii) two cardiologists independently reviewing recordings from patients with any evidence of rhythm abnormality. It was estimated that 30,165 reviews were required (20,155 by the nurse, and 5005 by each cardiologist). The total number of reviews could be reduced to 24,561 if low-quality recordings were excluded from review; 18,573 by only reviewing ECGs falling under certain pathological classifications; and 18,144 by only reviewing ECGs displaying an irregularly irregular rhythm for the entire recording. The number of AF patients identified would not fall considerably: from 54 to 54, 54 and 53, respectively. In conclusion, simple approaches may help feasibly reduce the manual workload by 38.4% whilst still identifying the same number of patients with undiagnosed, clinically relevant AF

Reliability of single-lead electrocardiogram interpretation to detect atrial 1 fibrillation: insights from the SAFER feasibility study

Background and Aims Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single lead ECGs, and to identify factors influencing agreement. Methods In a population-based AF screening study, adults aged ≥65 years old recorded four single-lead ECGs per day for 1-4 weeks using a handheld ECG recorder. ECGs showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen’s kappa (). Results Out of 2,141 participants and 162,515 ECGs, only 1,843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: = 0.42 (95% CI, 0.32 – 0.52) at participant-level; and = 0.51 (0.46 – 0.56) at ECG-level. At participant-level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG-level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF. Conclusion Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses