Obstructive Sleep Apnea Syndrome (OSAS) treated with orthodontic appliances in children : a new feasible approach

Obstructive Sleep Apnea Syndrome (OSAS) affects up to 4% of the paediatric population and, due to the high risk of cardio-vascular and neurological complications and negative outcomes on the developmental process associated, represents the most serious type of Sleep Disordered Breathing (SDB) and the most challenging for public health.Although the most common treatment for OSAS in childhood is Adenotonsillectomy (AT), this approach is limited by its surgical risks and by a high prevalence of recurrence or partial success, with persistence of signs and symptoms of obstructive apnea.The presence of cranio-facial abnormalities and malocclusion is considered an important risk factor for paediatric OSAS and its recurrence after AT. Children affected by OSAS often present specific oro-facial features such asnarrow maxilla, mandibular retrusion, anterior openbite, bilateral/ monolateral cross bite, that are frequently associated with dysfunctions such as oral breathing and atypical swallowing. Those alterations can represent an anatomical base which can contribute to the development of paediatric OSAS, especially in preschool child aged 3-6 years, when the hyperplasia of adenoids and tonsils is reported to be at its peak with a higher risk for obstruction. The purpose of the present research is to evaluate the possibility that an orthodontic treatment, primary aiming to the treatment of malocclusion and the related dysfunctions, can induce improvement or relief of respiratory nighttime distress, as a secondary effect. The sample consisted of 5 children affected by OSAS, 3 female and 2 male, average aged 4.5 years, who have never undergone AT or have had a recurrence of sign and symptoms 1 year after AT.All patients presented narrow maxilla, associated with monolateral/ bilateral crossbite and or anterior openbite. The patients underwent orthodontic treatment performed with an elastodontic appliance, which is a removable oral device made of PVC and widely used in children aged less than 6 years. The following variables were evaluated in each patient at the beginning (T0) and after 1 year (T2) of orthodontic treatment:occlusal parameters; Sleep Clinical Score (SCS); Night time poligraphic parameters: Snoring, Apnea/Hypopnea Index (AHI) andOswestry Disability Index (ODI).Four out of 5 patients showed high compliance to the orthodontic treatment and improved their occlusal relationship. In those patients also AHI and ODI index improved as well as the SCS score, revealing a reduction of sign and symptoms of OSAS. The only patient who did not improve his occlusal and respiratory findings also showed poor compliance to the orthodontic treatment. The study suggest that the treatment of malocclusion might produce improvements in sign and symptoms of OSAS in children aged 3-6 years and that preformed elastodontc appliances are a feasible therapeutic tool for this purpose

The progress of AAV-mediated gene therapy in neuromuscular disorders

INTRODUCTION: The well-defined genetic causes and monogenetic nature of many neuromuscular disorders, including Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA), present gene therapy as a prominent therapeutic approach. The novel variants of adeno-associated virus (AAV) can achieve satisfactory transduction efficiency of exogenous genes through the central nervous system and body-wide in skeletal muscle. AREAS COVERED: In this review, we summarize the strategies of AAV gene therapy that are currently under preclinical and clinical evaluation for the treatment of degenerative neuromuscular disorders, with a focus on diseases such as DMD and SMA. In addition to gene replacement strategy, we provide an overview of other approaches such as AAV-mediated RNA therapy and gene editing in the treatment of muscular dystrophies. EXPERT OPINION: AAV gene therapy has achieved striking therapeutic efficacy in clinical trials in infants with SMA. Promising results have also come from the preclinical studies in small and large animal models of DMD and several clinical trials are now on the way. This strategy shows great potential as a therapy for various neuromuscular disorders. Further studies are still required to confirm its long-term safety and improve the efficacy

Platelet activation and cardiovascular co-morbidities in patients with chronic obstructive pulmonary disease.

Objective: Platelet activation in COPD patients is associated with an increased risk of cardiovascular events. Aim of the study: to assess the mean platelet volume (MPV), as an index of platelet activation, in patients with COPD both when stable or during exacerbation. Research design and methods: 478 patients with COPD (75 with exacerbation) and 72 age-matched healthy controls were enrolled. Medical history, co-morbidities, medications, pulmonary function tests, MPV and blood cell count, erythrocyte sedimentation rate (ERS) and C reactive protein (CRP) were recorded. Results: MPV was higher in COPD patients than in controls (8.7 \ub1 1.1 fL and 8.4 \ub1 0.8 fL respectively, p = 0.025) and increased across the severity of the diseases as assessed by the GOLD post bronchodilator FEV1 categorized I to IV (p>0.05). MPV was higher in COPD patients during acute exacerbation as compared with stable condition (8.7 \ub1 1.0 fL and 8.9 \ub1 1.0 fL, p = 0.021). MPV 65 10.5 fL correlated with the presence of at least one co-existing cardiovascular disease (p = 0.008) . No correlation was observed between MPV and CRP or ERS in patients or in controls. An inverse significant correlation was found between platelets count and MPV in COPD patients. Conclusions: Elevated MPV is associated with lower platelet count and with cardiovascular co-morbidity in COPD patients. MPV value is higher in more severe COPD and during acute exacerbation. Present findings warrant future studies to confirm a possible clinically relevant role for platelet activation and cardiovascular risk in the population of COPD

Vilanterol trifenatate for the treatment of COPD

Introduction: Currently the treatment of chronic obstructive pulmonary disease (COPD) has limited effectiveness and there is a need to develop new drugs. International guidelines recommend the use of long-acting bronchodilators (β2 agonists and anti-cholinergics/muscarinics), inhaled steroids and associations between these drugs in the maintenance treatment of moderate-to-severe COPD. Area covered: Vilanterol trifenate is a new once-daily highly selective β2-agonist available in USA and Europe in association with umeclidinium bromide (a long-acting anti-muscarnic agent) and fluticasone furoate (an inhaled corticosteroid) for the once-daily maintenance treatment of COPD. Vilanterol combined in fixed-dose treatments has been tested in numerous clinical trials involving thousands of patients. Expert commentary: These new once-daily formulations have the potential to improve compliance to long-term inhaled therapy. This paper will review the clinical and experimental data regarding vilanterol use in the regular treatment of COPD as well as provide a critical discussion of possible future treatment settings

JKarma: A Highly-Modular Framework for Pattern-Based Change Detection on Evolving Data

Pattern-based change detection (PBCD) describes a class of change detection algorithms for evolving data. Contrary to conventional solutions, PBCD seeks changes exhibited by the patterns over time and therefore works on an abstract form of the data, which prevents the search for changes on the raw data. Moreover, PBCD provides arguments on the validity of the results because patterns mirror changes occurred with any form of evidence. However, the existing solutions differ on data representation, mining algorithm and change identification strategy, which we can deem as main modules of a general architecture, so that any PBCD task could be designed by accommodating custom implementations for those modules. This is what we propose in this paper through jKarma, a highly-modular framework for designing and performing PBCD

Are Different Rhythms Good for Different Functions?

This essay discusses the relationship between the physiology of rhythms and potential functional roles. We focus on how the biophysics underlying different rhythms can give rise to different abilities of a network to form and manipulate cell assemblies. We also discuss how changes in the modulatory setting of the rhythms can change the flow of information through cortical circuits, again tying physiology to computation. We suggest that diverse rhythms, or variations of a rhythm, can support different components of a cognitive act, with multiple rhythms potentially playing multiple roles

Generalized aggressive periodontitis in prepubertal age: description and comparison of two cases.

Aggressive periodontitis is a rare form of periodontal disease and it can involve both the deciduous dentition and the permanent one. It causes a rapid loss of periodontal attachment. The paper aims to describe two cases of severe generalized prepubertal periodontitis: the first child doesn't suffer from neither systemic diseases nor alteration of functionality of polymorphonuclear and periodontal disease involved both his deciduous dentition and the first permanent molars. The second child had a deficiency of functionality of polymorphonuclear but periodontal disease involved only primary dentition thanks to his immediate improvement of home dental hygiene. This comparison shows the importance of early diagnosis and especially of optimal dental oral hygiene. Infant healthcare professionals, as pediatric dentists and pediatricians, should have the necessary knowledge for early and correct diagnosis and clinical management of disease

Relation Between EEG Measures and Upper Limb Motor Recovery in Stroke Patients: A Scoping Review

Current clinical practice does not leverage electroencephalography (EEG) measurements in stroke patients, despite its potential to contribute to post-stroke recovery predictions. We review the literature on the effectiveness of various quantitative and qualitative EEG-based measures after stroke as a tool to predict upper limb motor outcome, in relation to stroke timeframe and applied experimental tasks. Moreover, we aim to provide guidance on the use of EEG in the assessment of upper limb motor recovery after stroke, suggesting a high potential for some metrics in the appropriate context. We identified relevant papers (N = 16) from databases ScienceDirect, Web of Science and MEDLINE, and assessed their methodological quality with the Joanna Briggs Institute (JBI) Critical Appraisal. We applied the Preferred Reporting Systems for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Framework. Identified works used EEG to identify properties including event-related activation, spectral power in physiologically relevant bands, symmetry in brain dynamics, functional connectivity, cortico-muscular coherence and rhythmic coordination. EEG was acquired in resting state or in relation to behavioural conditions. Motor outcome was mainly evaluated with the Upper Limb Fugl-Meyer Assessment. Despite great variability in the literature, data suggests that the most promising EEG quantifiers for predicting post-stroke motor outcome are event-related measures. Measures of spectral power in physiologically relevant bands and measures of brain symmetry also show promise. We suggest that EEG measures may improve our understanding of stroke brain dynamics during recovery, and contribute to establishing a functional prognosis and choosing the rehabilitation approach