Nasal pathologies in patients with obstructive sleep apnoea

Nasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway to aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSAS patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swellin

Aspects of Common Eider Nesting Ecology in Labrador

The status, distribution, and nesting ecology of common eiders (Somateria mollissima) breeding in Labrador are not well known. This study is an initial effort to improve understanding of the nesting ecology of eiders on the Labrador coast, a zone of intergradation between the northern (S. m. borealis) and American (S. m. dresseri) subspecies of common eider. During 1998 and 1999, 187 islands were surveyed for nesting eiders at four sites (from north to south: Nain, Hopedale, Makkovik, St. Peter’s Bay) along 750 km of the coast. Nest initiation dates (calculated by candling eggs) ranged over a four- to five-week period and were positively associated with latitude: the earliest mean initiation date (5 June) was in St. Peter’s Bay in the south and the latest (27 June) at Nain in the north. Mean clutch size ranged from 3.5 to 4.2 and varied by area and year; eiders nesting in Nain had the smallest clutches. In 1999, the highest nest density (49.8 nests/ha) was observed in Nain and the lowest (3.9 nests/ha) in Makkovik. In some cases, we used boat surveys to assess eider presence and absence and found it to be a reliable method; this search technique could be beneficial to researchers working in remote locations where operational costs are high.On connaît mal le statut, la distribution et l’écologie de nidification de l’eider à duvet (Somateria mollissima) qui se reproduit au Labrador. Cette étude représente un premier pas vers une meilleure compréhension de l’écologie de nidification de l’eider sur la côte du Labrador, une zone de chevauchement entre la sous-espèce du nord (S. m. borealis) et celle américaine (S. m. dresseri) de l’eider à duvet. Durant 1998 et 1999, on a cherché des eiders nicheurs dans 187 îlots à quatre endroits (du nord au sud: Nain, Hopedale, Makkovik, baie de St. Peter’s) répartis sur 750 km de rivage. Les dates du début de la couvaison (calculées en mirant les oeufs) s’étalaient sur une période de quatre à cinq semaines et étaient associées positivement à la latitude: c’est dans la baie de St. Peter’s dans le sud qu’on a observé la date moyenne du début de la couvaison la plus précoce (5 juin), et à Nain dans le nord, la plus tardive (27 juin). La taille moyenne de la couvée allait de 3,5 à 4,2 et variait selon l’endroit et l’année; les eiders qui nichaient à Nain avaient les plus petites couvées. En 1999, la plus forte densité de nids (49,8 nids/ha) a été observée à Nain et la plus faible (3,9 nids/ha), à Makkovik. Dans certains cas, on a utilisé des relevés effectués à partir d’embarcations pour établir la présence et l’absence d’eiders, méthode qui s’est avérée fiable; cette technique de recherche pourrait être bénéfique aux chercheurs travaillant dans des lieux éloignés où les coûts d’opération sont élevés

Management of idiopathic epistaxis in adults: what's new? [Il trattamento dell’epistassi idiopatica nell’adulto: cosa c’è di nuovo?]

L’epistassi è uno dei disturbi più comuni per il quale il paziente si rivolge spesso al pronto soccorso. Questa revisione della letteratura sipropone di valutare sistematicamente e criticamente gli studi scientifici riguardo il trattamento dell’epistassi idiopatica al fine di ottenere utili spunti per la pratica clinica. La ricerca è stata eseguita nei database elettronici: PubMed, Embase, Cochrane e Central. I criteri di inclusione sono stati: studi clinici controllati retrospettivi o prospettici o randomizzati o studi su modelli animali che includevano i risultati nella gestione dell’epistassi idiopatica. Sono stati individuati 23 articoli che soddisfano i criteri di inclusione. Il tamponamento nasale rappresenta ancora l’approccio di prima linea all’epistassi, anche se è evidente dalla letteratura che sia il meno efficace ma il più associato a ricoveri ospedalieri di maggior durata rispetto alla chirurgia endoscopica basata sull’elettrocoagulazione. In conclusione appare sempre più evidente che la cauterizzazione dovrebbe essere l’approccio di prima linea per l’alto tasso di costo-efficacia e il basso rischio di complicanze. Tuttavia, ulteriori ricerche urgenti sono necessarie per validare l’efficacia dei nuovi biomateriali nel trattamento dell’epistassi.Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twentythree articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials

LiNbO3 integrated system for opto-microfluidic sensing

International audience; In this work, we realized and tested an integrated opto-microfluidics platform entirely made on lithium niobate (LiNbO3) crystals, able to detect the single droplet passage and estimate its size without the need of any imaging processing. It is based on the coupling of a self-aligned integrated optical stage, made of an array of optical waveguides, to a microfluidic circuit such as a T-junction or Cross-junction engraved in the same substrate. The platform presented high quality performances in terms of optical triggering, reproducibility and stability in time, allowing in real-time data analysis. The comparison with standard approaches using microscopes and fast camera imagining acquisition and relative post-processing, showed an increased capability better than 50%. The demonstrated feasibility of integration of these two stages will allow the realization of a Lab-On-a-Chip on a monolithic substrate of lithium niobate, exploiting its multiple applications for manipulation of droplets

Miniaturized data loggers and computer programming improve seabird risk and damage assessments for marine oil spills in Atlantic Canada

Obtaining useful information on marine birds that can aid in oil spill (and other hydrocarbon release) risk and damage assessments in offshore environments is challenging. Technological innovations in miniaturization have allowed archival data loggers to be deployed successfully on marine birds vulnerable to hydrocarbons on water. A number of species, including murres (both Common, Uria aalge, and Thick-billed, U. lomvia) have been tracked using geolocation devices in eastern Canada, increasing our knowledge of the seasonality and colony-specific nature of their susceptibility to oil on water in offshore hydrocarbon production areas and major shipping lanes. Archival data tags are starting to resolve questions around behaviour of vulnerable seabirds at small spatial scales relevant to oil spill impact modelling, specifically to determine the duration and frequency at which birds fly at sea. Advances in data capture methods using voice activated software have eased the burden on seabird observers who are collecting increasingly more detailed information on seabirds during ship-board and aerial transects. Computer programs that integrate seabird density and bird behaviour have been constructed, all with a goal of creating more credible seabird oil spill risk and damage assessments. In this paper, we discuss how each of these technological and computing innovations can help define critical inputs into seabird risk and damage assessments, and when combined, can provide a more realistic understanding of the impacts to seabirds from any hydrocarbon release

Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP)

Negli ultimi anni si è diffusa lopinione che la chirurgia multilivello nel trattamento della sindrome delle apnee ostruttive garantisca risultati pià soddisfacenti. Lobiettivo del nostro lavoro è quello di confrontare tre tecniche palatali associate alla TORS: luvulopalatofaringoplastica (UPPP), lexpansion sphincter pharyngoplasy (ESP) e la barbed repositioning pharingoplasty (BRP). Trenta pazienti, trattati con TORS, tonsillectomia e settoturbinoplastica e chirurgia palatale sono stati retrospettivamente studiati. I seguenti valori pre e post-operatori sono stati presi in considerazione: AHI, ESS, VAS per la valutazione del dolore, tempi operatori palatali, data di dimissione e complicanze (tipi ed incidenza). Sia la BRP che lESP hanno garantito dei valori postoperatorio di AHI inferiori rispetto allUPPP con un maggior tasso di successo chirurgico. Dallaltra parte non è stato possibile dimostrare una superiorità della BRP sullESP. I tempi operatori più lunghi sono stati registrati nel gruppo ESP mentre i più brevi sono stati riscontrati nel gruppo BRP. Riassumendo, ESP e BRP sono risultate più efficaci dellUPPP in un setting robotico multilivello. Inoltre, essendo una tecnica rapida, di facile apprendimento e dal basso tasso di complicanze, la BRP si presenta come una valida opzione chirurgica nel trattamento dellOSAS

Phenomenological theory of the 3 Kelvin phase in Sr2RuO4

We model the 3K-phase of Sr2RuO4 with Ru-metal inclusion as interface state with locally enhanced transition temperatures. The resulting 3K-phase must have a different pairing symmetry than the bulk phase of Sr2RuO4, because the symmetry at the interface is lower than in the bulk. It is invariant under time reversal and a second transition, in general, above the onset of bulk superconductivity is expected where time reversal symmetry is broken. The nucleation of the 3K-phase exhibits a ``capillary effect'' which can lead to frustration phenomena for the superconducting states on different Ru-inclusions. Furthermore, the phase structure of the pair wave function gives rise to zero-energy quasiparticle states which would be visible in quasiparticle tunneling spectra. Additional characteristic properties are associated with the upper critical field Hc2. The 3K-phase has a weaker anisotropy of Hc2 between the inplane and z-axis orientation than the bulk superconducting phase. This is connected with the more isotropic nature Ru-metal which yields a stronger orbital depairing effect for the inplane magnetic field than in the strongly layered Sr$_2RuO4. An anomalous temperature dependence for the z-axis critical field is found due to the coupling of the magnetic field to the order parameter texture at the interface. Various other experiments are discussed and new measurements are suggested.Comment: 10 pages, 5 figure

Trans-oral robotic surgery for the management of oropharyngeal carcinomas: A 9-year institutional experience

Trans-oral robotic surgery (TORS) has changed surgical management of patients with oropharyngeal squamous cell carcinomas (OPSCC). In this study we present surgical and oncologic outcomes of patients with oropharyngeal squamous cell carcinomas, treated using TORS, with and without an adjuvant therapy. Sixty patients with oropharyngeal squamous cell carcinomas treated with TORS between January 2008 and December 2017 have been retrospectively evaluated considering clinicopathologic features, disease characteristics, adjuvant treatments and oncological outcomes. TORS was performed for OPSCC to the base of tongue in 41.7%, tonsils in 46.7%, soft palate and posterior pharyngeal wall in 3.3% and 5%, respectively. Neck dissection was performed in 43.3% of patients. Management strategies included surgery alone in 30%, TORS and adjuvant radiotherapy in 33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year overall survival of the total group was 77.6%, the 5-year disease-free survival rate was 85.2%, and the 5-year local recurrence-free survival rate was 90.6%. Finally, in selected patients TORS appears to yield similar oncologic outcomes and functional outcomes to traditional techniques and non-operative treatment with a possible benefit on long-term quality of life. The future offers exciting opportunities to combine TORS and radiotherapy in unique ways. However, further research is urgently needed to clarify the indications for adjuvant therapy following TORS resections

Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation

La decannulazione è sempre stata considerata una procedura con un certo grado di rischio, specie nei pazienti con ridotti diametri delle via aeree, come nel caso della sindrome delle apnee ostruttive (OSA). Presentiamo 4 casi nei quali la chirurgia robotica transorale (TORS) ha permesso un appropriato management di pazienti tracheotomizzati da divers mesi. Gli obiettivi del nostro lavoro sono: 1. Dimostrare come il team otorinolaringoiatrico possa favorire il riconoscimento di pazienti ad alto rischio di decannulazione inefficace e 2. Evidenziare il ruolo nella TORS nel trattamento dellipertrofia della base della lingua, responsabile dellostruzione delle vie aeree superiori. Dalla nostra esperienza la TORS appare una tecnica efficace nella decannulazione di pazienti affetti da ipertrofia della base della lingua e da epiglottide flottante

Effects of confinement and surface enhancement on superconductivity

Within the Ginzburg-Landau approach a theoretical study is performed of the effects of confinement on the transition to superconductivity for type-I and type-II materials with surface enhancement. The superconducting order parameter is characterized by a negative surface extrapolation length $b$. This leads to an increase of the critical field $H_{c3}$ and to a surface critical temperature in zero field, $T_{cs}$, which exceeds the bulk $T_c$. When the sample is {\em mesoscopic} of linear size $L$ the surface induces superconductivity in the interior for $T T_{cs}$. In analogy with adsorbed fluids, superconductivity in thin films of type-I materials is akin to {\em capillary condensation} and competes with the interface delocalization or "wetting" transition. The finite-size scaling properties of capillary condensation in superconductors are scrutinized in the limit that the ratio of magnetic penetration depth to superconducting coherence length, $\kappa \equiv \lambda/\xi$, goes to zero, using analytic calculations. While standard finite-size scaling holds for the transition in non-zero magnetic field $H$, an anomalous critical-point shift is found for H=0. The increase of $T_c$ for H=0 is calculated for mesoscopic films, cylindrical wires, and spherical grains of type-I and type-II materials. Surface curvature is shown to induce a significant increase of $T_c$, characterized by a shift $T_c(R)-T_c(\infty)$ inversely proportional to the radius $R$.Comment: 37 pages, 5 figures, accepted for PR