Efficacy of oral appliance therapy in patients following uvulopalatopharyngoplasty failure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/1/lio2256.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/2/lio2256_am.pd

Friedman tongue position and cone beam computed tomography in patients with obstructive sleep apnea

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139112/1/lio292.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139112/2/lio292_am.pd

Association of Cortisol and the Metabolic Syndrome in Korean Men and Women

Obesity and the metabolic syndrome are closely related and have become increasingly prevalent in Korea. The cardiovascular disease (CVD) risk factors comprising the metabolic syndrome have previously been associated with increased hypothalamic-pituitary-adrenal axis (HPAA) activity, but the associations have not been extensively examined in non-Caucasian populations. The aim of the present study was to investigate the relationships between cortisol, adiposity and the metabolic syndrome in a Korean population. A total of 1,881 adults participated in the study between January 2001 and February 2008. Sociodemographic data were assessed by questionnaires. Body composition, clinic blood pressures as well as metabolic variables including glucose, insulin, and lipid profile were assessed and analyzed in relation to cortisol levels. Mean age of the participants was 58.7 ± 10.8 yr. Higher levels of cortisol was associated with elevated blood pressure, fasting glucose and total cholesterol in men, and between cortisol and systolic blood pressure, fasting glucose and total cholesterol in women. There was an increased risk for the metabolic syndrome associated with higher cortisol levels in both men (P < 0.001) and women (P = 0.040) adjusting for age and body mass index. Higher cortisol levels are associated with several CVD risk factors and the metabolic syndrome, independent of overall of adiposity level, in Korean men and women

Impact of the COVID-19 Pandemic on the Clinical Learning Environment: Addressing Identified Gaps and Seizing Opportunities

The clinical learning environment (CLE) encompasses the learner’s personal characteristics and experiences, social relationships, organizational culture, and the institution’s physical and virtual infrastructure. During the COVID-19 pandemic, all four of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post–COVID-19 world

The Relation of Serum Arginine Levels with Serum Arginase and Nitric Oxide Synthase Activity in Patients with Breast Cancer

Introduction: There is a significant disparity between metabolism in normal individuals and cancer patients which have resulted in metabolism based diagnosis. Several types of tumours have abnormalities in arginine and arginine metabolic enzymes. It is now becoming apparent that the two key enzymes of arginine metabolism: arginase and Nitric Oxide Synthase (NOS) in mammals play key roles in regulation of most aspects of arginine metabolism in cancer. Aim: To evaluate arginine levels, arginase and nitric oxide synthase activity from serum of breast cancer patients of different stages and healthy controls and to find out the diagnostic use of these parameters for early breast cancer detection. Materials and Methods: Fifty histopathologically proved cases of breast cancer of any stage (Stage I to Stage IV) in the age group of 35-70 years and 25 age and sex matched healthy controls were recruited for this prospective case control study. Intravenous blood sample was obtained to evaluate study parameters. Serum arginine levels were estimated by Sakaguchi method, serum arginase activity was estimated by Roman and Ray method while serum NOS activity was measured by Cortas and Wakid method. Results: The results of this study showed significant decrease in serum arginine levels and significant increase in the activities of serum arginase and NOS in patients of all stages when compared with controls (p<0.01). Serum arginine levels further decreased (p<0.05) and activity of serum arginase (p<0.01) and of serum nitric oxide synthase (p<0.05) was found to be significantly increased in final stage (Stage III+IV) patients when compared with patients of initial stage (Stage I+II). Conclusion: Complex interrelationship exists between the two important arginine metabolic pathways: arginase and NOS which may profoundly influence tumour growth and biology. The estimation of these parameters can give additional insight regarding disease progression

Craniofacial Growth Series Volume 54

Obstructive sleep apnea (OSA) is a relatively common disorder characterized by the repeated collapse of the upper airway, resulting in sleep fragmentation and episodic hypoxemia. The consequences of untreated sleep apnea can be significant and include increased risk of cardiovascular events (e.g., heart attack, stroke), decreased quality of life and motor vehicle accidents. It is estimated that over 80% of individuals who have sleep apnea do not know that they have this medical problem, emphasizing the need for greater awareness among both clinicians and the lay population. OSA has a complex multi-factorial etiology and is more common in older adults who are overweight, but it can affect individuals of any age and body type. Even children, especially those with enlarged tonsillar or constricted nasopharyngeal tissues, may have OSA. It requires long- term management; lifestyle changes, positive airway pressure, oral appliances and/or surgery can be used treat sleep apnea successfully once the condition is diagnosed. The Moyers Symposium has had a long history of dealing with interdisciplinary topics and the 44th Annual Moyers Symposium was no exception. We brought together ten healthcare providers in both medicine and dentistry who have expertise in sleep-disordered breathing to discuss the diagnosis and treatment of OSA patients, considering in detail the multiple treatment approaches that are available. Some of the attendees also may have discovered that this condition was relevant personally, as the signs, symptoms and history of OSA were presented during the meeting. The 44th Annual Moyers Symposium was held at The University of Michigan on Saturday and Sunday, March 4-5, 2017. The interdisciplinary audience was large, with approximately 550 individuals in attendance. The annual Presymposium meeting (aka the 42nd Annual International Conference on Craniofacial Research) was held on Friday March 2, 2017 in the 4th Floor Amphitheater of the Horace H. Rackham School of Graduate Studies Building. Thirteen of the 16 papers presented by an international group of investigators were focused specifically on the topic of the 2017 Moyers Symposium. Many of the Presymposium papers are included as chapters in this volume. As in previous years, the Symposium honored the late Dr. Robert Edison Moyers, Professor Emeritus of Dentistry and Fellow Emeritus and Founding Director of the Center for Human Growth and Development at The University of Michigan. This meeting was co-sponsored by the School of Dentistry and the Center for Human Growth and Development. First, I would like to thank my co-editor of this volume, Anita V. Shelgikar, MD, for her tireless work in helping us plan and execute the 2017 Moyers Symposium. Anita was instrumental in identifying out- standing speakers in sleep medicine to participate, as well as delivering the keynote 21st Annual Robert E. Moyers Memorial Lecture entitled Sleep Apnea: What Is It and Why Should We Care? She then demon- strated excellent editing skills in critiquing chapters from both medical and dental disciplines, making many suggestions that have clarified and improved each chapter. Her participation was integral from beginning to end both for the Symposium and the subsequent volume. We continue to recognize the enormous contribution of Kris De Koster, Associate Editor of the Craniofacial Growth Series, for her efforts on this book. For the past ten years, Kris has facilitated the publication of this annual volume through her interactions with the authors, editing, manipulating a variety of figure formats and formatting the layout of the book. It is always a challenge for us to produce such a volume in the time frame prior to the next Symposium; Kris has a stellar record of producing a high-quality book within this limited period. In addition, we recognize the work of Kathy Ribbens who provided assistance in the final format- ting the book for publication. We also thank the contributors for sending us their material in a timely fashion. We acknowledge and thank Dr. Nan Hatch, Chair of the Depart- ment of Orthodontics and Pediatric Dentistry, for providing the financial resources to underwrite partially the publication of this book. We also must thank Dr. Brenda Volling, the Director of the Center for Human Growth and Development, for the continued financial and moral sup- port of the Moyers Symposium provided by the Center for the last 44 years. We are fortunate to work with the staff from the Office of Continuing Dental Education, who organize and run the Presymposium and Symposium. Michelle Jones, Karel Barton and Elizabeth Fee managed both meetings in an exceptionally smooth and efficient fashion. We all are very pleased that the 44th Moyers Symposium was so successful. The topic obviously was of heightened clinical relevance to clinicians and researchers in both medicine and dentistry. The chapters within this volume are written with both the clinician and patients in mind, so that we all can benefit from sharing our knowledge provided from a variety of perspectives. James A. McNamara, Jr. Editor-in-Chief, Craniofacial Growth Series The University of Michigan Ann Arbor, Michigan December 2017UM Center for Human Growth and DevelopmentUM Department of Orthodontics and Pediatric Dentistryhttps://deepblue.lib.umich.edu/bitstream/2027.42/146772/1/Moyers Proceedings Symp 2017 Sleep Apnea.pdf53Description of Moyers Proceedings Symp 2017 Sleep Apnea.pdf : Proceedings of the 44th Annual Moyers Symposiu

Respiratory cycle-related EEG changes: Response to CPAP

Study Objectives: Respiratory cycle-related EEG changes (RCREC) quantify statistically significant synchrony between respiratory cycles and EEG spectral power, vary to some extent with work of breathing, and may help to predict sleepiness in patients with obstructive sleep apnea. This study was designed to assess the acute response of RCREC to relief of upper airway obstruction by positive airway pressure (PAP). Design: Comparison of RCREC between baseline diagnostic polysomnograms and PAP titration studies. Setting: Accredited academic sleep disorders center. Patients: Fifty adults referred for suspected sleep disordered breathing. Interventions: For each recording, the RCREC in specific physiologic EEG frequency ranges were computed as previously described for the last 3 h of sleep not occupied by apneic events. Results: The sample included 27 women; mean age was 47 ± 11 (SD) years; and median respiratory disturbance index at baseline was 24 (inter-quartile range 15-43). Decrements in RCREC, from baseline to PAP titration, reached 43%, 24%, 14%, 22%, and 31% for delta (P = 0.0004), theta (P = 0.01), alpha (P = 0.10), sigma (P = 0.08), and beta (P = 0.01) EEG frequency ranges, respectively. Within each specific sleep stage, these reductions from baseline to PAP studies in synchrony between EEG power and respiratory cycles still reached significance (P \u3c 0.05) for one or more EEG frequency ranges and for all frequency ranges during REM sleep. Conclusions: RCREC tends to diminish acutely with alleviation of upper airway obstruction by PAP. These data in combination with previous observations support the hypothesis that RCREC reflect numerous, subtle, brief, but consequential inspiratory microarousals