Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg), diastolic BP (72 ± 4 vs 67 ± 2 mmHg), HR (67 ± 4 vs 57 ± 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep) and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI

Feature selection for automatic analysis of emotional response based on nonlinear speech modeling suitable for diagnosis of Alzheimer׳s disease

Alzheimer׳s disease (AD) is the most common type of dementia among the elderly. This work is part of a larger study that aims to identify novel technologies and biomarkers or features for the early detection of AD and its degree of severity. The diagnosis is made by analyzing several biomarkers and conducting a variety of tests (although only a post-mortem examination of the patients’ brain tissue is considered to provide definitive confirmation). Non-invasive intelligent diagnosis techniques would be a very valuable diagnostic aid. This paper concerns the Automatic Analysis of Emotional Response (AAER) in spontaneous speech based on classical and new emotional speech features: Emotional Temperature (ET) and fractal dimension (FD). This is a pre-clinical study aiming to validate tests and biomarkers for future diagnostic use. The method has the great advantage of being non-invasive, low cost, and without any side effects. The AAER shows very promising results for the definition of features useful in the early diagnosis of AD

Feature selection for spontaneous speech analysis to aid in Alzheimer’s disease diagnosis: A fractal dimension approach

Alzheimer’s disease (AD) is the most prevalent form of degenerative dementia; it has a high socio-economic impact in Westerncountries. The purpose of our project is to contribute to earlier diagnosis of AD and allow better estimates of its severity by usingautomatic analysis performed through new biomarkers extracted through non-invasive intelligent methods. The method selectedis based on speech biomarkers derived from the analysis of spontaneous speech (SS). Thus the main goal of the present work isfeature search in SS, aiming at pre-clinical evaluation whose results can be used to select appropriate tests for AD diagnosis. Thefeature set employed in our earlier work offered some hopeful conclusions but failed to capture the nonlinear dynamics of speechthat are present in the speech waveforms. The extra information provided by the nonlinear features could be especially useful whentraining data is limited. In this work, the fractal dimension (FD) of the observed time series is combined with linear parameters inthe feature vector in order to enhance the performance of the original system while controlling the computational cost.© 2014 Elsevier Ltd. All rights reserved

La sarcoïdose rhinosinusienne

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Physiopathologie du syndrome d’apnées-hypopnées obstructives du sommeil

Introduction : L’étude de la physiopathologie du syndrome d’apnées-hypopnées obstructives du sommeil (SAHOS) est indispensable pour comprendre ses modalités diagnostiques et thérapeutiques. Matériels et Méthodes : Une revue de la littérature a été effectuée sur les données spécifiques à l’homme. Résultats : Deux aspects sont impliqués : d’une part, les mécanismes concourant à l’obstruction intermittente des voies aérifères supérieures (VAS) au cours du sommeil ; d’autre part, ses conséquences que sont les troubles neurocognitifs, la maladie cardiovasculaire et la dérégulation métabolique. Discussion : L’obstruction des VAS peut être expliquée par des conditions anatomiques, mécaniques et neurofonctionnelles, en particulier le rétrocontrôle proprioceptif et chimique de l’activité neuromusculaire des VAS. La compréhension de l’impact du SAHOS a bénéficié des notions nouvelles de stress oxydant, d’inflammation systémique de bas grade, de la découverte d’agents sensibles à l’hypoxie et du rôle des cytokines. À l’origine de cette cascade d’événements : l’hypoxie intermittente chronique

Les nouvelles chimiothérapies dans les cancers des voies aérodigestives supérieures (thérapie génique, thérapie cellulaire, thérapie ciblée)

Les cancers des voies aérodigestives supérieures représentent la sixième forme de cancer en France et à travers le monde. Les formes localement évoluées ne sont accessibles à une guérison que dans un 1/3 des cas après l association d une chimiothérapie à la radiothérapie et parfois à la chirurgie. Bien que ces dernières années aient vu des progrès importants dans le traitement de ces cancers en termes de radiothérapie et de chirurgie avec de nouvelles techniques de reconstruction, l espérance de vie de ces patients a peu évolué depuis 30 ans. L effort actuel se fait notamment sur le développement de nouvelles chimiothérapies issues des dernières connaissances des étapes de la cancérogenèse à l échelle moléculaire. Les bio-marqueurs péjoratifs récemment découverts offrent une nouvelle cible de traitements. Ainsi, la p53, les récepteurs à activité tyrosine kinase (EGFR, VEGFR) et ses voies de signalisation sont au coeur de l intérêt des nouvelles thérapies. Les résultats acquis par les thérapies ciblées (notamment par le cetuximab) et la faisabilité potentielle de la thérapie génique sont autant de succès encourageants, permettant de favoriser la poursuite des efforts dans ces voies. La thérapie cellulaire a également sa place, notamment dans le traitement spécifique des cancers liés au papillomavirus humain. Les stratégies d utilisation de ces biothérapies en développement sont pour la plupart en cours d évaluation pour mettre en évidence les combinaisons les plus efficaces. Les associations entre molécules standards et nouvelles, entre biothérapie et radiothérapie sont prometteuses mais augmentent la toxicité des traitements chez des patients ayant un terrain affaibli. La prise en charge nutritionnelle et la mise en place de protocoles plus personnalisés pourraient dans quelques années s accompagner d une amélioration en termes de survie globale et sans récidive.The head and neck squamous cells carcinoma represent the sixth form of cancer in France and worldwide. The forms are available locally advanced with a cure that in a third of cases after the combination of chemotherapy with radiotherapy and sometimes surgery. Although recent years have seen important progress in the treatment of these cancers in terms of radiotherapy and surgery with new reconstruction techniques, the life expectancy of these patients has changed little in 30 years. The current effort is made including the development of new chemotherapy from recent knowledge of the stages of carcinogenesis at the molecular level. The pejorative recently discovered biomarkers offer a novel target of treatment. Thus, p53, the tyrosine kinase receptor (EGFR, VEGFR) and its signaling pathways are the targets of new therapies. The results achieved by the targeted therapies (including cetuximab) and the potential feasibility of gene therapy are all encouraging success, to encourage further efforts in these pathways. The cell therapy also takes place, particularly in the treatment of specific cancers linked to human papillomavirus. Strategies for using these biotherapeutics in development are for the most current evaluation to highlight the most effective combinations. The associations between new and standard molecules, biotherapy and radiotherapy are among promising but increase toxicity of treatments in patients with a weakened field. The nutritional management and implementation of protocols could be more personalized in a few years accompanied by an improvement in overall survival and relapse free.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg), diastolic BP (72 ± 4 vs 67 ± 2 mmHg), HR (67 ± 4 vs 57 ± 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep) and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI