Initial Adherence to Autotitrating Positive Airway Pressure Therapy: Influence of Upper Airway Narrowing

ObjectivesThere is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing.MethodsThe patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups.ResultsAmong 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups.ConclusionAHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI

VEGFR2 but not VEGFR3 governs integrity and remodeling of thyroid angiofollicular unit in normal state and during goitrogenesis

Thyroid gland vasculature has a distinguishable characteristic of endothelial fenestrae, a critical component for proper molecular transport. However, the signaling pathway that critically governs the maintenance of thyroid vascular integrity, including endothelial fenestrae, is poorly understood. Here, we found profound and distinct expression of follicular epithelial VEGF-A and vascular VEGFR2 that were precisely regulated by circulating thyrotropin, while there were no meaningful expression of angiopoietin-Tie2 system in the thyroid gland. Our genetic depletion experiments revealed that VEGFR2, but not VEGFR3, is indispensable for maintenance of thyroid vascular integrity. Notably, blockade of VEGF-A or VEGFR2 not only abrogated vascular remodeling but also inhibited follicular hypertrophy, which led to the reduction of thyroid weights during goitrogenesis. Importantly, VEGFR2 blockade alone was sufficient to cause a reduction of endothelial fenestrae with decreases in thyrotropin-responsive genes in goitrogen-fed thyroids. Collectively, these findings establish follicular VEGF-Avascular VEGFR2 axis as a main regulator for thyrotropindependent thyroid angiofollicular remodeling and goitrogenesis.Peer reviewe

VEGF-A regulated by progesterone governs uterine angiogenesis and vascular remodelling during pregnancy

Peer reviewe

A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate

ObjectivesThe erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS).MethodsThis retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients.ResultsThe mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO2 below 90% and the ESR level in the obese group (BMI ≥25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables.ConclusionThe duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease

Surgical Extent for Oral Cancer: Emphasis on a Cut-Off Value for the Resection Margin Status: A Narrative Literature Review

The optimal cut-off point of the resection margin was recently debated in oral cancer. To evaluate the current evidence of the dynamic criteria of the resection margin, a review of the available literature was performed. Studies were sourced from PubMed and EMBASE by searching for the keywords “mouth neoplasm”, “oral cancer”, “oral cavity cancer”, “oral squamous cell carcinoma”, “tongue cancer”, “margins of excision”, “surgical margin” and “resection margin”. We found approximately 998 articles on PubMed and 2227 articles on EMBASE. A total of 3225 articles was identified, and 2763 of those were left after removing the duplicates. By applying advanced filters about the relevance of the subjects, these were narrowed down to 111 articles. After the final exclusion, 42 full-text articles were reviewed. The universal cut-off criteria of 5 mm used for determining the resection margin status has been debated due to recent studies evaluating the impact of different margin criteria on patient prognosis. Of note, the degree of the microscopic extension from the gross tumor border correlates with tumor dimensions. Therefore, a relatively narrow safety margin can be justified in early-stage oral cancer without the additional risk of recurrence, while a wide safety margin might be required for advanced-stage oral cancer. This review suggests a surgical strategy to adjust the criteria for risk grouping and adjuvant treatments, according to individual tumor dimensions or characteristics. In the future, it might be possible to establish individual tumor-specific surgical margins and risk stratification during or after surgery. However, the results should be interpreted with caution because there is no strong evidence (e.g., prospective randomized controlled studies) yet to support the conclusions. Our study is meaningful in suggesting future research directions and discussions

Controlled Aspect Ratios of Gold Nanorods in Reduction-Limited Conditions

Aspect ratios of gold nanorods have been finely modified in reduction-limited conditions via two electrochemical ways: by changing the amount of a growth solution containing small gold clusters in the presence of already prepared gold nanorods as seeds or by changing electrolysis time in the presence or absence of a silver plate. While the atomic molar ratio of gold in the growth solution to gold in the seed solution is critical in the former method, the relative molar ratio of gold ions to silver ions in the electrolytic solution is important in the latter way for the control of the aspect ratios of gold nanorods. The aspect ratios of gold nanorods decrease with an increase of electrolysis time in the absence of a silver plate, but they increase with an increase of electrolysis time in the presence of a silver plate

One-Pot and Template-Free Fabrication of ZnS·(ethylenediamine)_0.5 Hybrid Nanobelts

A template-free and one-pot solvothermal process has been developed for the facile synthesis of ZnS·(en)_0.5 (en = ethylenediamine) hybrid nanobelts having diverse length-to-width (aspect) ratios. While typical hybrid nanobelts synthesized at 180 °C for 6 h have an average width of 130 nm, a mean thickness of 55 nm, and an average length of 16 μm, their aspect ratios have been varied by adjusting solvent volume ratios of hydrazine monohydrate (hm) to en. A sufficient amount of sulfide from the reduction of sulfur by hm has been found to be essential for the efficient anisotropic one-dimensional growth of highly crystalline ZnS·(en)_0.5 hybrid nanobelts. The photoluminescence spectra of ZnS·(en)_0.5 hybrid nanostructures exhibit three bands located at 327, 415–430, and 587–654 nm, which are assigned to band-edge emission, trap sites-related emission, and anion-vacancy emission, respectively. The mean lifetime of photoluminescence having three decay components of 30, 170, and 2700 ps decreases with the volume ratio of hm to en due to the decrease of defect sites with the increase of the aspect ratios of ZnS·(en)_0.5 hybrid nanobelts. Compared with bare-ZnS nanobelts prepared by the hydrothermal treatment of ZnS·(en)_0.5 hybrid nanobelts, hybrid ones have shown enhanced optical properties that would give them potential for optoelectronic devices

Long-term outcomes of intraoral submandibular stone removal in children as compared with adults

To investigate the long-term outcomes of intraoral submandibular stone removal in children as compared with those in adult patients. Retrospective clinical review. We retrospectively analyzed the medical records of 17 children and 48 adult patients who had undergone intraoral stone removal for submandibular sialolithiasis and followed up for more than 24 months. The mean durations of follow-up were 43.4 months and 49.4 months for children and adults, respectively. The long-term outcomes were compared between the two age groups. Intraoral submandibular stone removal achieved the status of "symptom-free" in 82.4% of child and 83.3% of adult patients. Recurrence in the affected gland was not found in any children but was found in two adult patients (4.2%). In pediatric patients with calculi around the hilum, a higher incidence (50%) of having long-term complaints was noted as compared with cases with calculi in the proximal and distal duct (P = .029). However, this difference was not evident in adult patients. Intraoral removal of submandibular stones is an effective treatment option with an acceptable long-term outcome for children. Nevertheless, in cases with calculi around the hilum, a careful surgical approach is required

Technical feasibility of radiomics signature analyses for improving detection of occult tonsillar cancer

Abstract Diagnosis of occult palatine tonsil squamous cell carcinoma (SCC) using conventional magnetic resonance imaging (MRI) is difficult in patients with cervical nodal metastasis from an unknown primary site at presentation. We aimed to establish a radiomics approach based on MRI features extracted from the volume of interest in these patients. An Elastic Net model was developed to differentiate between normal palatine tonsils and occult palatine tonsil SCC. The diagnostic performances of the model with radiomics features extracted from T1-weighted image (WI), T2WI, contrast-enhanced T1WI, and an apparent diffusion coefficient (ADC) map had area under the receiver operating characteristic (AUROC) curve values of 0.831, 0.840, 0.781, and 0.807, respectively, for differential diagnosis. The model with features from the ADC alone showed the highest sensitivity of 90.0%, while the model with features from T1WI + T2WI + contrast-enhanced T1WI showed the highest AUROC of 0.853. The added sensitivity of the radiomics feature analysis were 34.6% over that of conventional MRI to detect occult palatine tonsil SCC. Therefore, we concluded that adding radiomics feature analysis to MRI may improve the detection sensitivity for occult palatine tonsil SCC in patients with a cervical nodal metastasis from cancer of an unknown primary site