Predictive role of nasal functionality tests in the evaluation of patients before nocturnal polysomnographic recording

Obstructive sleep apnoea syndrome is a disease characterized by a collapse of the pharyngeal airway resulting in repeated episodes of airflow cessation, oxygen desaturation, and sleep disruption. It is a common disorder affecting at least 2-4% of the adult population. The role of nasal resistance in the pathogenesis of sleep disordered breathing and sleep apnoea has not been completely clarified. Aim of the present study was to establish whether nasal resistance and nasal volumes, measured by means of Active Anterior Rhinomanometry and Acoustic Rhinometry together with Muco-Ciliary Transport time play a positive predictive role in the evaluation of Obstructive sleep apnoea syndrome patients before running a nocturnal polysomnographic recording. A retrospective study was performed analysing 223 patients referred for suspected Obstructive sleep apnoea syndrome. All patients were submitted to complete otorhinolaryngological evaluation and underwent nocturnal polysomnography. On the basis of polysomnographic data analysis, the apnoea-hypopnoea index and snoring index, patients were classified into two groups: Group 1 (110/223 patients) with a diagnosis of mild-moderate Obstructive sleep apnoea syndrome (apnoea-hypopnoea index < 30) and Group 2 (113/223 patients) affected by snoring without associated hypoxaemia/hypercapnia. A control group of 76 subjects, not complaining of sleep disorders and free from nasal symptoms was also selected. The results showed, in all the snoring and Obstructive sleep apnoea syndrome patients, total nasal resistance and increased Muco-Ciliary Transport time compared to standard values. Furthermore, the apnoea-hypopnoea index was significantly higher in patients with higher nasal resistence and significantly different between the groups. These results allow us to propose the simultaneous evaluation of nasal functions by Active Anterior Rhinomanometry, Acoustic Rhinometry, and Muco-Ciliary Transport time in the selection of patients undergoing polysomnography

Nuclear loads and nuclear shielding performance of EU DEMO divertor: A comparative neutronics evaluation of two interim design options

In a demonstrational fusion power plant (DEMO), divertor is supposed to protect vacuum vessel and superconducting magnets against neutron flux in the bottom region of the vessel. The vessel is subject to a strict design limit in irradiation damage dose and the magnets in nuclear heating power, respectively. Thus, the DEMO divertor must have the capability to protect sufficiently the vessel and the magnets against neutron flux being substantially stronger than in ITER.In this paper, a first systematic neutronics study for the European DEMO divertor is reported. Results of the extensive assessment of key nuclear loading features (nuclear heating, irradiation damage & helium production) are presented for two optional concepts, namely, dome and shielding liner including minor geometrical variants. The shielding performance of the two competing design options is discussed together with the case of a bare cassette (no shielding), particularly in terms of damage dose compared with the design limits specified for the European DEMO.It was found that both the dome and shielding liner were able to significantly reduce the nuclear loads in the cassette body and the vessel. The maximum damage dose at the end of the lifetime remained subcritical for the cassette body for both cases whereas it exceeded the limit for the vessel under the dome, but only locally on the surface underneath the pumping duct. But, the damage could be reduced below the limit for the vessel by increasing the size of the dome or by deploying the shielding liner. The most critical feature was the excessive damage occurring in the own body of the shielding components where the maximum damage dose in the steel heat sink of the dome and the shielding liner far exceeded the design limit at the end of the lifetime

Evaluation of temporomandibular disorders before and after orthognathic surgery: therapeutic considerations on a sample of 76 patients

Temporomandibular disorders may be associated with dental and facial malformations. The aim of this study is to record the prevalence of TMDs in patients scheduled for orthognathic surgery, reporting the development of TMDs and symptoms during the entire period of the treatment, and demonstrating the benefits of a team effort on this population. MATERIALS AND METHODS: Assessment of temporomandibular status was performed using the RDC/TMD criteria at T0 (prior to orthodontic therapy), T1 (3 months after the surgery), and T2 post-therapeutic cycle (6 to 12 months postoperatively). A total of 76 participants were included in the study; all the patients underwent surgical treatment: 12 had bilateral sagittal split osteotomy, 6 with condylar position devices; 64 had Le Fort I + bilateral sagittal split osteotomy, and 15 with condylar position devices. Results were evaluated with a paired-sample t-test and segmentation analysis. RESULTS: Forty-seven patients were affected by TMDs. At T0, 25 patients experienced TMJ pain, 27 had muscular pain, 31 suffered headaches, 42 had disc dislocation with reduction, and 5 were affected by disc dislocation without reduction. Thirty-five patients had occlusal signs of parafunctions, 8 reported tinnitus, and 7 dizziness. At T1, TMJ pain changed from 33.3% to 4.44%, muscular pain changed from 35.5% to 11.1%, headaches improved from 40% to 6.67%, and disc dislocation from 55.2% to 17.7%. Segmentation analysis highlighted improvement after therapy; 57 patients were considered recovered, 14 improved, none were considered stable, whereas 5 patients demonstrated some worsening, 3 of whom had not presented disc dislocation before surgery. At T2, 71 patients were considered completely recovered or improved. CONCLUSIONS: Our data indicates beyond any doubt that both functional status and pain levels related to TMDs can be significantly improved with a multi-disciplinary approach. We concluded that surgeon's intervention need to be modified in the presence of presurgical TMDs