Search

Hepatic artery pseudoaneurysm (HAP) is mostly encountered secondary to trauma or iatrogenic causes. HAP associated with cholangitic liver abscess is a rare complication. We present a case of gallstone disease and choledocholithiasis who developed moderate cholangitis and a liver abscess. A small HAP was detected incidentally on a biphasic CT done to evaluate the biliary system. Repeat CT after management with endoscopic retrograde cholangiopancreatography and antibiotics showed resolution of cholangitic abscess with spontaneous thrombosis of HAP.

Introduction The purpose of this study was to describe symptoms of problematic feeding in infants with tongue-tie, evaluate changes in non-nutritive suck measures before and after frenotomy, and examine tongue-tie severity with changes in non-nutritive suck patterning. Method Parents completed the Neonatal Eating Assessment Tool about infant feeding before frenotomy. Non-nutritive suck data were collected for 5 min before and after frenotomy. We used paired t-tests to compare non-nutritive suck measures pre- and post-frenotomy and linear regression evaluated the effect of tongue-tie severity and infant behavioral state on change in non-nutritive suck mechanics. Results Twenty-one infants had scores that met criteria for problematic feeding. The infant's non-nutritive suck amplitude (cmH2O) (p = .02) and non-nutritive burst duration (sec) (p = .03) decreased post-frenotomy. Discussion This study supports the need for additional research to better understand feeding problems and changes in non-nutritive suck amplitude and duration in infants with tongue-tie.

Reconstructing an esthetic interimplant papilla remains challenging with implant-supported restorations, especially for patients with a thin gingival biotype. This technique report describes a modified approach to rebuilding an interimplant papilla by joining 2 elevated connective tissue flaps at the second-stage surgery.

Background Obstructive sleep apnea (OSA) is known to be an important contributory factor of coronary artery disease (CAD), but the extent of contribution of OSA in young patients suffering from CAD is not known. Thus, with an aim to detect OSA in young patients suffering from CAD by performing portable polysomnography (PSG), the present study was carried out at a tertiary care chest center. Methods A prospective study was carried out from June 2015 to June 2018, wherein 100 consecutive young (age less than 40 years), non-smoking patients with angiographically confirmed CAD, with no identifiable risk factors for cardiovascular diseases except obesity, were subjected to level 3 portable PSG studies. Results Of 100 patients with CAD, 80% had OSA (24% with mild OSA, 28% with moderate OSA, and 28% with severe OSA). Body weight and severity of OSA showed a significant correlation with a P-value of 0.033. SPSS software was used for statistical analysis. The categorical variables were compared using Fischer's exact test. Conclusion The study detected a significant number of young patients with angiographically confirmed CAD having OSA. A significant correlation was also observed between weight and severity of OSA, suggesting that overweight patients and patients with obesity have higher grades of OSA.

Minor salivary gland tumours are enigmatic in their behaviour and presentations. Histopathological diagnosis of these tumours encompasses a large spectrum. Conventionally, small nodular tumours of the upper lip or the labial mucosa are generally adenomas, frequently pleomorphic adenomas. Here, we describe a case of a solitary nodular tumour, occurring in the upper labial mucosa, diagnosed as sclerosing polycystic adenoma (SPA) with intraductal epithelial proliferation of high grade. This is a rare lesion, which has entered into the category of salivary gland tumours recently in the 2017 WHO categorisation. We report a case of paucicystic SPA with intraductal epithelial proliferations in the labial minor salivary gland of a 56-year-old woman, which might be the first report of a case occurring in the upper labial mucosa.

Introduction: Estrogen deficiency is the main risk factor of articular cartilage degeneration, leading to postmenopausal osteoarthritis. Moreover, there were imperfect estrogen-responsive elements that did exist in the 5’-untranslated region of Notch1 and Jagged1. So, our aim was exploring the relationship between estrogen deficiency and the Notch signaling in postmenopausal osteoarthritis. Methods: These rats were divided into four groups as follows1. bilateral ovariectomy and intra-articular injection of collagenase, 2. bilateral ovariectomy, 3. intra-articular injection of collagenase, 4. intra-articular injection of normal saline. Histological and immunohistochemical staining of joint cartilage were used to evaluate the osteoarthritis model, including the morphological changes of articular cartilage and the relative expression of osteoarthritic biomarkers (IL-1β, MMP-1, and type II collagen). The Notch signaling expression (Notch2) were detected using immunohistochemical staining. In addition, the correlation between the osteoarthritic biomarkers and the Notch2 was also investigated. Results: The expression level of Notch signaling were significantly decreased in the postmenopausal osteoarthritic joint, comparing with other groups. No significant differences were observed in all noncollagenase induced joint, regardless of whether being undergone ovariectomy. The expression of Notch2 was negatively correlated to IL-1β and MMP-1 in osteoarthritisoppositely, it was positively correlated to type II collagen. Conclusion: the results hinted that estrogen deficiency reduced the expression of Notch signaling in osteoarthritic joint. Thus, the Notch signaling could be a potential target for treating postmenopausal osteoarthritis.

Introduction One of the most common problems in patients with inherited coagulation disorders, especially hemophilia, is joint problems. This study aims to investigate whether temporomandibular joint (TMJ) is affected in patients with hemophilia or other coagulation factor disorders. Material & methods In this study, a patient group and a control group were formed. The patient group consisted of 44 individuals with hemophilia or other coagulation disorders (von Willebrand disease and rare factor deficiencies) and the control group consisted of 45 healthy individuals. In both groups, TMJ health was evaluated through a questionnaire and clinical examination. Results The prevalence of signs and symptoms of temporomandibular disorders (TMD) that we evaluated was higher in the patient group than in the healthy individuals. Pain in the jaw, temple, in the ear or in front of the ear; pain in the jaw, temple, ear or front of the ear by opening the mouth or moving the jaw forward/sideways; closed locking (subjective); jaw joint noises (subjective) and TMJ noises during open & close movements on the right side in clinical examination were statistically significantly higher in the patient group than in the control group. Discussion There are very limited studies on temporomandibular joint health in patients with coagulation factor deficiency. In this study, it was observed that patients with inherited coagulation disorders, especially hemophilia, were more likely to develop TMD than healthy individuals. This situation was thought to be due to the increased susceptibility to TMJ bleeding in patients with coagulation factor deficiency.

Temporomandibular joint (TMJ) synovial cysts are rare, unlike peripheric locations like the wrist or the knee. They share similar presentations with ganglion cyst, benign and sometimes malignant lesions. Only histopathological analysis confirms diagnosis in some cases, finding a true cyst lined by synoviocytes containing synovial fluid. They seem to be related to an increased articular pressure following trauma. In this study we present two cases of TMJ synovial cyst and a systematic review of the literature. A total of 32 cases were retrieved from published literature in PubMed, Cochrane Library and ClinicalTrials.gov databases using the search terms ‘TMJ synovial cyst’, ‘temporomandibular synovial cyst’, ‘jaw joint synovial cyst’. Swelling (91.3%) and pain (78.3%) were the most common symptoms. MRI was the most commonly used imaging modality that was found to be beneficial for diagnosis. In almost all cases the cyst was removed under general anesthesia, allowing histopathological examination. Only two patients still had pain after removal of the cyst. No recurrence was observed .

A 30-year-old man presented with swelling in the lower left ear. Close examination led to a diagnosis of parotid gland cancer, T4N0M0 Stage IVA, so total resection of the left parotid gland and left neck dissection were performed. Pathological examination led to a diagnosis of high-grade malignant-type mucoepidermoid, and chemoradiotherapy was performed as postoperative treatment. Fourteen days after completion of chemoradiotherapy, the patient was admitted to the hospital with headache and lack of appetite. Echocardiography showed a pericardial effusion and complete collapse of the right ventricle; cardiac tamponade was diagnosed, and pericardiocentesis was performed. The pericardial effusion was bloody, and a metastatic lesion was suspected, but cytological examination showed class IIIa. On day 33 of the illness, respiratory distress and hypotension were observed. A clot was seen covering the lower wall of the heart, and dilatation of the lower wall was significantly impaired. Pericardiotomy was performed on day 36. Pathological examination diagnosed cardiac metastasis of mucoepidermoid carcinoma of the parotid gland. Although only 4 cases of parotid cancer have been reported as primary lesions of metastatic heart tumors, this case represents the world's first description of isolated parenchymal metastasis of mucoepidermoid carcinoma of the parotid gland diagnosed by pericardial biopsy.

The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly.Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments.The respective proportions of patients who improved to obstructive AHI (O-AHI)1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaOMedical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO

Aesthetically satisfying reconstruction of upper lip defects is a major challenge. The aim of this article is to present a case series for closure of superficial lip defects of > 50% of the lateral subunit, using a Burget nasolabial flap. We performed a retrospective case series study on eight patients with upper lip defects between 2013 and 2017, using a Burget nasolabial flap for closure of the wound. Patient demographics, early complication, and final results were described. The Burget nasolabial flap is a suitable option for reconstructing major superficial upper lateral lip defects with a defect/upper lateral lip ration of > 50%. This method respects the normal contours of the upper lip subunits, using skin comparable to the skin of the upper lip, with little risk of complications. Future research needs to investigate the effect on satisfaction of the patient with the results.

Objective To clarify the relationship between oral lichen planus (OLP) and systemic oxidative stress, we examined serum antioxidant and urinary oxidative stress marker levels in patients with OLP. Methods Fifteen female patients with clinical and histopathological diagnoses of OLP were enrolled in this study. The mean patient age was 67.6 years (range, 56–81 years). Ten age- and sex-matched volunteers without oral mucosal lesions were selected as a control group. Serum levels of the antioxidants vitamin A, vitamin C, vitamin E, folate, zinc, uric acid, and superoxide dismutase activity were evaluated. Urinary levels of the oxidative stress marker 8-hydroxy2’-deoxyguanosine (8-OHdG) were measured by enzyme immunoassays. All values were compared between the two groups. Results The mean value of serum vitamin C was lower in the OLP group (5.73 ± 2.34μg/mL) than in the control group (9.22 ± 3.65 μg/mL; P = 0.0125). Serum levels of vitamin A, vitamin E, folate, zinc, uric acid, and superoxide dismutase activity did not significantly differ between the two groups. The mean values of creatinine adjusted urinary 8-OHdG were 10.1 ± 7.34 ng/mg creatinine in the OLP group and 13.7 ± 12.7 ng/mg creatinine in the control group; these values did not significantly differ between the two groups (P = 0.5189). Conclusion Our results suggested that serum levels of vitamin C are low in patients with OLP. However, oxidative stress (determined by measurement of urinary 8-OHdG level) was not significantly higher in patients with OLP. Thus, the relationship between OLP and systemic oxidative stress was not fully elucidated in this study.

Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or 50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.

Objective; Neoplasm of accessory parotid glands are very rare, accounting for only 1% to 7.7% of all parotid gland tumors. External appproaches including parotidectomy or facelift incision are the recommended treatment, allowing a good control over the anterior facial nerve's branches and Stensen's duct, but they require a large flap elevation and leave an external scar. Methods: We report the case of a 76-year-old woman presented with a chief complaint of swelling in the right cheek. The patient underwent ultrasonography, FNAC and MRI which identified a subcutaneous mass over the anterior border of the masseter muscle. Results: An endoscopic-assisted transoral resection was performed, no postoperative complications were recorded. Final histology was consistent with pleomorphic adenoma. Conclusion: In selected cases, the endoscope-assisted transoral approach allow accessory parotid mass excision with better cosmetic results if compared to the transcutaneous approach. Although not negligible, the risk of facial nerve injury is minimized under endoscopic magnification.

Introduction Classic cardiovascular risk factors do not explain all the cardiovascular events. Obstructive sleep apnoea (OSA) has been proposed as a potential and prevalent cardiovascular risk factor. Our study aimed to describe the prevalence of OSA in a middle-aged cohort with mild–moderate cardiovascular risk and evaluate its association with atherosclerotic disease. Methods This is an observational cross-sectional ancillary study of the ILERVAS project which was aimed to study subclinical arterial disease in a cohort with mild–moderate cardiovascular risk. In a sample of consecutive subjects, we performed a sleep study and evaluate OSA prevalence and its association with carotid and femoral atheroma plaques and atherosclerotic burden. Results Overall, 966 subjects with a median age of 57 years (25–75th percentile; 52–62) and a body mass index (BMI) of 28.5 kg/m2 (25.6–31.6) were included. Of these, 72.6% (69.7%–75.3%) had OSA (apnoea–hypopnoea index (AHI) ≥ 5/h); 35.7% (32.8%–38.8%) had mild OSA (AHI 5–14.9/h) and 36.9% (33.9%–39.9%) had moderate/severe OSA (AHI ≥ 15/h). Mean oxygen saturation and the percentage of time with oxygen saturation Conclusions This study confirms a high prevalence of OSA in patients with mild–moderate cardiovascular risk and shows an association between atherosclerotic burden, total and femoral plaque with CT90 and mean oxygen saturation, suggesting the importance of OSA-related hypoxaemia in the induction of atherosclerotic disease.

Different therapeutic methods for chronic drooling in pediatric patients with neurological problems have been described in the scientific literature. However, there is no consensus on the ideal strategy of treatment. The aim of this study was to compare botulinum toxin injection therapy and surgical modalities to control drooling in pediatric patients with neurological disorders. A systematic literature research was conducted on nine electronic databases, which were published until April 2020. Six articles were included in this systematic review. The total sample consisted of 209 patients, 67.4% (n = 141) with cerebral palsy. All studies used injections of botulinum toxin type A with the application to the submandibular and/or parotid salivary glands. The surgical treatments performed were duct ligation in parotid and/or submandibular salivary glands, duct relocation in submandibular salivary glands and glandular excision of the submandibular and sublingual salivary glands. There were complications in only 16.1% (n = 27) of the sample: 11 cases due botulinum toxin application and 16 due to surgery. The drooling control was assessed by objective measures, and subjective measures.Although surgical procedures presented higher risk of adverse effects than the botulinum toxin type A, in all studies and measurements performed, they presented larger and longer-lasting positive effect on drooling than the botulinum toxin type A injection. We suggest performing bilateral submandibular duct relocation with bilateral sublingual gland excision or isolated bilateral submandibular duct ligation, which are the surgical techniques with the largest sample in this review. Nevertheless, further studies are necessary to compare samples with botulinum toxin type A and surgical treatment.

Ameloblastic fibro-odontoma (AFO) is a rare benign mixed odontogenic tumor that affects children and young adults. AFO occurs mainly intraosseous. Extraosseous AFO is extremely rare. We report 2 cases of rare peripheral ameloblastic fibro-odontoma in 2- and 12-year-old female patients. Microscopic examination revealed a benign proliferation of odontogenic epithelium associated with a dentinoid material distributed within a cell-rich mesenchymal stroma resembling dental papilla. Simple surgical excision of the lesion is usually curative. There was no recurrence after a short period of follow-up. Clinicians should be cognizant of this rare entity, which can be considered in a differential diagnosis of gingival growths that are noted in early childhood.

Objective To assess the correlation between oral lichen planus (OLP) and viral hepatitis C (HCV). Methods This retrospective case-control study included a sample of OLP patients in a 3-year interval. The predictor variable was the presence of OLP (yes/no). The outcome variable was the diagnosis of HCV. Other study variables were grouped into demographic, anatomic, and clinical. Descriptive, bi- and multivariate statistics were computed with a significant level at P ≤ 0.05. Results The sample was composed of 237 OLP patients (38.8% females) with a mean age of 59.9 ± 17.8 years (range, 17-96), and 948 age- and gender-matched control individuals. The significant higher frequency of HCV was identified in OLP patients (frequency: 19.8% vs. 2.1%; adjusted matched odds ratio [mORadj], 9.5; 95% confidence interval [95% CI], 5.98 to 15.91; P Conclusions OLP, especially oro-cutaneous disease or steroid-refractory OLP, are associated with an increased frequency of HCV. Not only HCV screening in OLP patients, but oral examination in HCV patients, are both recommended as primary preventive measures.

Objectives Nevoid Basal Cell Carcinoma Syndrome (NBCS) is a rare genetic condition affecting multiple organs including the maxillofacial and dental region. The surgical removal of the odontogenic keratocystic tumors (OKT), the high rate of recurrence leads to a iatrogenic tooth loss requiring dental care. The aim of this study is therefore to describe the dental and orthodontic management, and to assess the impact of surgery on facial growth and oral development. Methods A retrospective study including 14 patients with GGS, followed at the Necker Enfants Malades Hospital. The study was carried out on the medical files and photographic records Results Patients developed on average 5.5 OKT (range: 1 to 11) and 1.7 recurrences (range:0 to 9) during the follow-up. The mean age at diagnosis of first OKT was 11.23 years (range: 6.75 to 16). KOTs were more frequently localized at the mandibular (30.9%) and maxillary molar level (25.1%). Forty-seven impacted teeth were extracted during the OKT removal. Eight patients out of 12 presented a class III skeletal relationship. The remaining ones had a skeletal class II associated with a hyperdivergent typology. Almost all patients had dental impactions with ectopic positions of the succedaneums tooth. At the inter-arch level, all patients needed orthodontic care, 3 patients did not begin their orthodontics. Orthodontic treatments began with an orthopedic phase followed by braces for the majority in 8 patients. Two patients had to undergo orthognathic surgery. Impacted teeth were treated by traction or extraction with further rehabilitation. Conclusion The objective is not to simply compensate the iatrogenic hypodontia generated by the surgical procedure but to take into consideration the maxillofacial phenotype, skeletal characteristics and numerous intra- and inter-arch dental anomalies for a healthy oral management.

Background: The relationship between Alzheimer’s disease (AD) and periodontitis has been recently investigated with heterogenous results. Objective: This study aims to evaluate the oral health status and its relationship with cognitive impairment of participants, enrolled in the Zabút Aging Project, a community-based cohort study performed in a rural community in Sicily, Italy. Methods: A case-control study (20 subjects with AD, 20 with amnestic mild cognitive impairment [aMCI], and 20 controls) was conducted. The protocol included a comprehensive medical and cognitive-behavioral examination. Full-mouth evaluation, microbial analysis of subgingival plaque samples (by RT-PCR analysis), and oral health-related quality of life (OHR-QoL) were evaluated. Results: The decayed, missing, and filled teeth (DMFT) total score of AD subjects was significantly higher than aMCI (p = 0.009) and controls (p = 0.001). Furthermore, the “M” component of DMFT (i.e., the number of missing teeth) was significantly higher in AD than in aMCI (p

This study aimed to explore the diagnostic value and the correlation of the combined detection of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) with sepsis-induced cardiomyopathy (SIC).Admitted to our hospital from January 2017 to January 2019, 96 patients with SIC (a study group) and 90 patients with sepsis (a control group) were enrolled. The three cytokines were determined and the diagnostic value of their combined detection for SIC was analyzed.The cytokines were remarkably higher in the study group (p.001). The combined detection of the three had a better diagnostic value for SIC (p.001). The three cytokines were independent risk factors for the death of patients with SIC.IL-1β, IL-6, and TNF-α in SIC patients rise markedly. The combined detection of the three has a better predictive value for patients with SIC and is closely related to the patients' prognoses, so it may be crucial in diagnosing and treating the disease.

Background The COVID-19 pandemic was associated with several changes in maintenance of children's dental health. The aim of the present study was to evaluate the extent of these changes. Methods Parents were asked to anonymously respond to a questionnaire regarding alterations in their children's oral-habits, such as frequency of eating and drinking, tooth brushing, signs of stress and receiving dental care during the lockdown period. The participants were reached either during their visit to the clinics or by social media groups of the authors. Results 308 parents to children aged 1-18 years responded to the questionnaires. Associations were shown between increased frequency of eating and drinking, decreased frequency of tooth brushing, and postponing dental care. Of the children, 11% suffered from more frequent oral signs of stress, such as temporomandibular disorder and aphthous-stomatitis, during the lockdown. Although children from all age-groups ate and drank more frequently between meals, younger children were diagnosed with more carious lesions during the lockdown (P=0.015). Conclusions During the lockdown many children changed their eating, drinking and tooth-brushing habits, and thus increased their own risk for development of caries.

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents' impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI

BACKGROUND: Effective biomarkers for prediction of recurrence of lung adenocarcinoma cancer (LADC) patients are needed to determine treatment strategies post-surgery to improve outcome. OBJECTIVE: This study evaluates the efficacy of carboxypeptidase E (CPE) mRNA including its splice isoforms, CPE-ΔN, as a biomarker for predicting recurrence in adenocarcinoma patients. METHODS: RNA was extracted from resected tumors from 86 patients with different stages of non-small cell LADC. cDNA was synthesized and qRT-PCR carried out to determine the copy numbers of CPE/CPE-ΔN mRNA. Patients were followed for 7 years post-tumor resection to determine recurrence and death. RESULTS: ROC curve analysis showed the overall AUC for CPE/CPE-ΔN copy number was 0.563 in predicting recurrence and 0.562 in predicting death. Kaplan-Meier survival analysis showed statistical difference (p= 0.018), indicating that patients with high CPE/CPE-ΔN copy numbers had a shorter time of disease-free survival and also shorter time to death (p= 0.035). Subgroup analyses showed that association of disease-free survival time with CPE/CPE-ΔN copy number was stronger among stage I and II LADC patients (p= 0.047). CONCLUSIONS: CPE/CPE-ΔN mRNA is a potentially useful biomarker for predicting recurrence and death in LADC patients, especially in identifying patients at high risk of recurrence at early stages I and II.

Oncocytic carcinoma of the salivary glands is an extremely rare malignant neoplasm. The parotid is the most frequently involved salivary gland, but tumours in the submandibular gland and minor salivary glands have also been described. It appears that oncocytic carcinoma of an ectopic salivary gland has not been reported so far. The unique case of a 78-year-old male patient diagnosed with oncocytic adenocarcinoma of an ectopic salivary gland is reported here. The patient underwent surgery and adjuvant radiotherapy. The clinical, morphological, and immunohistochemical features of this rare entity are also described.

Cribriform adenocarcinoma of minor salivary gland (CAMSG) is a rare malignancy presenting cytologic features resembling papillary thyroid carcinoma, localized in oral cavity and oropharynx. Despite cervical lymph node (LN) metastases as a frequent manifestation of CMSG, there are a scant number of publications evaluating its cytology. The aim of this report was to present a CAMSG in an unusual location in the light of cytological features, thus enriching the spectrum of fine-needle aspiration biopsy (FNAB) differential diagnosis. We report a case of a 76 year-old female presenting an enlarged submandibular LN on physical examination. Computed tomography revealed a submucosal lesion situated predominantly in the nasopharynx. FNAB and subsequently an open biopsy of submandibular LN were conducted. In cytological smear cribriform, dense clusters of monomorphic round-oval tumor cells with scant cytoplasm were observed. Histologically, the tumor was composed of oval, overlapping cells with bright nuclear chromatin and nuclear grooves forming cribriform, papillary and solid structures. Immunohistochemistry panel revealed: TTF-1 (-), thyroglobulin (-), S100 (+), p63 (+), Gal-3 (+), CK19 (+) focally. The diagnosis of CAMSG should be considered when dealing with nasopharyngeal mass. Commonly nodal metastases are observed in this tumor, therefore appropriate evaluation of cytological smear is crucial for patient management.

STUDY OBJECTIVES: To assess determinants of C-reactive protein (CRP) in a cohort of patients referred for investigation of obstructive sleep apnea (OSA) and to determine whether the overlap of OSA and chronic obstructive pulmonary disease (overlap syndrome) is associated with higher levels of CRP. METHODS: This was a cross-sectional study that included 2,352 patients seen at the West Australian Sleep Disorders Research Institute between 2006 and 2010. All patients had circulating CRP levels measured and spirometry performed. OSA was defined as an apnea-hypopnea index ≥ 5 events/h, and chronic obstructive pulmonary disease was defined as a forced expiratory volume in 1 second/forced vital capacity ratio < 0.70 and age > 40 years. Univariate and multivariate regression analysis were used to identify CRP determinants. RESULTS: The mean age was 51 years (60% male), the median apnea-hypopnea index was 27 events/h, the median 3% oxygen desaturation index was 24 events/h, the mean forced expiratory volume in 1 second was 88% predicted, and the median CRP was 3.0 mg/L. In multivariate analyses, age, body mass index, female sex, neck circumference, apnea-hypopnea index, and desaturation markers (nadir and mean oxygen saturation) were independently associated with higher CRP. Spirometric variables were not predictors. There was no significant difference in CRP among patients with OSA with or without coexisting chronic obstructive pulmonary disease. CONCLUSIONS: Markers of OSA severity (apnea-hypopnea index and oxygenation), age, body mass index, neck circumference, and female sex were independent predictors of circulating CRP levels. OSA overlapping with chronic obstructive pulmonary disease was not associated with increased CRP compared to either condition alone, suggesting other mechanisms for the increased cardiovascular disease risk in overlap syndrome. Recognizing factors that predict CRP will help identify patients at higher risk of cardiovascular disease and aid risk stratification. CITATION: Shah A, Mukherjee S, McArdle N, Singh B, Ayas N. Circulating C-reactive protein levels in patients with suspected obstructive sleep apnea. J Clin Sleep Med. 2022;18(4):993–1001.

Objective This study evaluated the prevalence and characteristics of tonsillar human papillomavirus (HPV) infection in tumor-free patients undergoing tonsillectomy. Methods We prospectively enrolled healthy patients who underwent tonsillectomy for tumor-free tonsillar disease. Their tonsillar HPV infections were evaluated using CLART HPV2, and subsequent p16 immunohistochemistry was performed in patients with positive HPV infection. Moreover, the results of tonsillar HPV infection were analyzed according to sex, age, and indication of tonsillectomy. Results A total of 362 patients were included. HPV test was positive in 8 patients, with an overall prevalence of 2.2%. All detected HPV types were high-risk, including HPV 16 in six patients, HPV 52 in one patient, and HPV 58 in one patient. P16 was negative in all 8 patients with HPV infection. The prevalence of tonsillar HPV infection in males and females was 2.4% (6/246) and 1.7% (2/116), respectively (P > 0.999), and in pediatric and adult patients, 2.2% (5/228) and 2.2% (3/134), respectively (P > 0.999). The prevalence showed a bimodal peak at 1st and 6th decades, with the prevalence of 2.6% (5/194) and 7.9% (3/38), respectively. The prevalence of tonsillar HPV infection in tonsillitis and non-tonsillitis groups were 0.0% (0/104) and 3.1% (8/258), respectively (P = 0.111). Conclusion The prevalence of tonsillar HPV infection in tumor-free patients was low, but all detected HPV infections were high-risk types. Our results support using a 9-valent vaccine which covers all high-risk HPV types found in this study

Objective To evaluate the gustatory function before and after vestibular schwannoma (VS) surgery. Methods In this retrospective study, we evaluated the gustatory function of 12 patients who underwent VS surgery at Tsukuba University Hospital between 2012 and 2018. Gustatory function was examined using electrogustometry before VS surgery and 3 months, 6 months and 1 year after surgery. Electrogustometry was tested at the area mapped to the chorda tympani nerve, glossopharyngeal nerve and greater superficial petrosal nerve (GSPN). Intergroup mean comparisons of the threshold were performed using a one-way analysis of variance (ANOVA) followed by the Bonferroni post-hoc test. Results The gustatory function mapped to the chorda tympani nerve was significantly disturbed 6 months after the surgery as compared with the preoperative function (p = 0.033) and that the dysfunction recovered at 1 year. However, gustatory function mapped to the glossopharyngeal nerve and greater superficial petrosal nerve (GSPN) was not impaired. Conclusion The gustatory function mapped to the chorda tympani nerve is impaired after surgery for VS. The dysfunction peaked at 6 months after surgery, and recovered within 1 year.

Background Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. Methods 191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary’s angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°–4.0°), mild (4.1°–14.9°), moderate (15.0°–30.0°) and severe (> 30.0°) pes planus groups according to Meary’s angle. Clinical outcomes were compared at baseline, 6 months and 24 months. Results There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary’s angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. Conclusion Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.

PURPOSE: Serious Illness Conversations (SICs) are structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Although behavioral interventions may prompt earlier or more frequent SICs, their impact on the quality of SICs is unclear. METHODS: This was a secondary analysis of a randomized clinical trial ( NCT03984773 ) among 78 clinicians and 14,607 patients with cancer testing the impact of an automated mortality prediction with behavioral nudges to clinicians to prompt more SICs. We analyzed 318 randomly selected SICs matched 1:1 by clinicians (159 control and 159 intervention) to compare the quality of intervention vs. control conversations using a validated codebook. Comprehensiveness of SIC documentation was used as a measure of quality, with higher integer numbers of documented conversation domains corresponding to higher quality conversations. A conversation was classified as high-quality if its score was ≥ 8 of a maximum of 10. Using a noninferiority design, mixed effects regression models with clinician-level random effects were used to assess SIC quality in intervention vs. control groups, concluding noninferiority if the adjusted odds ratio (aOR) was not significantly < 0.9. RESULTS: Baseline characteristics of the control and intervention groups were similar. Intervention SICs were noninferior to control conversations (aOR 0.99; 95% CI, 0.91 to 1.09). The intervention increased the likelihood of addressing patient-clinician relationship (aOR = 1.99; 95% CI, 1.23 to 3.27; P < .01) and decreased the likelihood of addressing family involvement (aOR = 0.56; 95% CI, 0.34 to 0.90; P < .05). CONCLUSION: A behavioral intervention that increased SIC frequency did not decrease their quality. Behavioral prompts may increase SIC frequency without sacrificing quality.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure partially reverses this hypertrophy, but data regarding the effect of mandibular advancement devices on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of mandibular advancement device therapy on LV geometry and function in patients with OSA. METHODS: At baseline and 6-month follow-up, participants underwent a home sleep apnea test, 24-hour ambulatory blood pressure monitoring and a 2-dimensional Doppler and tissue Doppler echocardiography. RESULTS: Sixty-three patients (age: 49 ± 11 years; body mass index: 27.0 ± 3.4 kg/m(2); baseline apnea-hypopnea index home sleep apnea test: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, blood pressure values and parameters of LV function were within normal ranges at baseline and did not change under mandibular advancement device therapy. In contrast, the interventricular septum thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs 10.6 ± 2.0 mm, P = .03). This significant improvement is only found in responders but not in nonresponders. There was no correlation between the decrease of interventricular septum thickness and the change in blood pressure. CONCLUSIONS: In mildly obese, normotensive patients with OSA we observed significant reverse hypertrophic remodeling after 6 months of successful mandibular advancement device therapy, with maintained normotensive systemic blood pressure. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Evaluation of the Cardiovascular Effects of the MAS in the Treatment of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02320877; Identifier: NCT02320877. CITATION: Dieltjens M, Vanderveken OM, Shivalkar B, et al. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):903–909.

STUDY OBJECTIVES: Mandibular advancement devices (MADs) are a noninvasive treatment option for patients with obstructive sleep apnea (OSA) and act by increasing the upper airway volume. However, the exact therapeutic mechanism of action remains unclear. The aim of this study was to assess MAD mechanisms using functional imaging that combines imaging techniques and computational fluid dynamics and assess associations with treatment outcome. METHODS: One hundred patients with OSA were prospectively included and treated with a custom-made MAD at a fixed 75% protrusion. A low-dose computed tomography scan was made with and without MADs for computational fluid dynamics analysis. Patients underwent a baseline and 3-month follow-up polysomnography to evaluate treatment efficacy. A reduction in apnea-hypopnea index ≥ 50% defined treatment response. RESULTS: Overall, 71 patients completed both 3-month follow-up polysomnography and low-dose computed tomography scan with computational fluid dynamics analysis. MAD treatment significantly reduced the apnea-hypopnea index (16.5 [10.4–23.6] events/h to 9.1 [3.9–16.4] events/h; P < .001, median [quartile 1–quartile 3]) and significantly increased the total upper airway volume (8.6 [5.4–12.8] cm(3) vs 10.7 [6.4–15.4] cm(3); P = .003), especially the velopharyngeal volume (2.1 [0.5–4.1] cm(3) vs 3.3 [1.8–6.0] cm(3); P < .001). However, subanalyses in responders and nonresponders only showed a significant increase in the total upper airway volume in responders, not in nonresponders. CONCLUSIONS: MAD acts by increasing the total upper airway volume, predominantly due to an increase in the velopharyngeal volume. Responders showed a significant increase in the total upper airway volume with MAD treatment, while there was no significant increase in nonresponders. Findings add evidence to implement functional imaging using computational fluid dynamics in routine MAD outcome prediction. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050. CITATION: Van Gaver H, Op de Beeck S, Dieltjens M, et al. Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study. J Clin Sleep Med. 2022;18(3):739–750.

Introduction Glycerol-preserved skin allograft (GPA) plays a vital role, especially in the management of burns injury. Where it is utilized as temporary wound closure, the considerably cost-effective, simpler handling and storage of GPA makes it preferable in almost all clinical indications. The GPA was first introduced to the Hospital Universiti Sains Malaysia in 2001. The supply was imported from Euro Skin Bank, Beverwijk, The Netherlands. In the year 2013, our center had started maintaining an in-house glycerolized skin bank. Method We preserved donor skin grafts from patients who underwent plastic surgery-related procedures in 85% glycerol and stored them at +2 °C to +10 °C. Cost estimation of the GPA per cm2 was calculated to analyze the effectiveness of its preservation technique. Results The cost of GPA from our skin bank is estimated to be almost 90% reduction in cost as compared to the supply from Euro Skin Bank. Conclusion The selective and strategic use of the GPA in major burn patients assure effective advantages in the treatment of burns. The clinical significance of skin allograft usage is very high. The cost-effectiveness of maintaining an in-house skin bank made it possible for various centers for skin allograft usage.

Background Clinical characteristics of women with different obstructive sleep apnoea (OSA) severity and adherence to Continuous Positive Airway Pressure (CPAP) therapy have not been previously explored. Therefore, in this retrospective study we assessed OSA prevalence. predictors, clinical and polysomnographic (PSG) characteristics and adherence to CPAP therapy among adult Australian women. Methods All female patients who underwent a diagnostic PSG between 2014/2015 were included. CPAP adherence was assessed during the study period between 2018/2019 using multiple regression model. Results Among a total of 591 females included in this study (Aboriginal n=86), OSA was diagnosed in 458/591 (78%) patients; mild, moderate and severe OSA was present in 44%, 27% and 29% respectively. Older age, higher BMI and hypertension predicted the presence and severity of OSA. The Epworth Sleepiness Scale (ESS) score was not significantly different with [10 (5, 13)] or without [8 (5, 12)] OSA. PSG showed rapid eye movement (REM) sleep associated apnoea hypopnea index (AHI) was higher with all severity of OSA. Adherence to CPAP therapy was noted in 171 (57%) patients; 47% mild, 57% moderate and 63% with severe OSA respectively. Three multiple regression models [clinical, PSG parameters, OSA severity, combined (clinical and PSG)] showed combined model had strongest predictive value and demonstrated that higher ESS and more severe oxygen desaturation were associated with CPAP adherence irrespective of OSA severity. Conclusion Older age, higher BMI and presence of hypertension predicted the presence of OSA. REM sleep related AHI was higher. Adherence to CPAP was associated with symptomatic OSA and severe oxygen desaturation. This article is protected by copyright. All rights reserved.

We report a clinical technical note of a patient for whom open surgery of temporomandibular joint (TMJ) mobilization was performed for treating bilateral TMJ ankylosis where the temporoparietal fascia flap (TPFF) was found to be useful. We infer that using such biological tissues prevents postoperative readhesion of the TMJ. The TPFF is often used in craniofacial reconstructive surgery and has been found to be useful in covering wounds and filling dead spaces. Our patient was a female in her 70s, and she was earlier diagnosed with bilateral osteoarthritis of the TMJ and underwent bilateral TMJ release surgery at different hospital. However, she had not received enough mouth opening training exercises after surgery. She was referred to our hospital, where we established a diagnosis of bony ankylosis in bilateral TMJ. After performing open surgery of TMJ mobilization, we completed the surgery by performing reconstruction with filling of the TPFF. She then had a favorable course after 19 days of surgery and was discharged from the hospital. This technical note recommends the need for continuous postoperative mouth opening exercises and periodic follow-up by computed tomography to prevent readhesion of the incision by bone hyperplasia in patients with TMJ ankylosis.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is defined by pauses in breathing during sleep, but daytime breathing dysregulation may also be present. Sleep may unmask breathing instability in OSA that is usually masked by behavioral influences during wakefulness. A breath-hold (BH) challenge has been used to demonstrate breathing instability. One measure of breathing stability is breathing rate variability (BRV). We aimed to assess BRV during rest and in response to BH in OSA. METHODS: We studied 62 participants (31 with untreated OSA: respiratory event index [mean ± SD] 20 ± 15 events/h, 12 females, age 51 ± 14 years, body mass index [BMI] 32 ± 8 kg/m(2); 31 controls: 17 females, age 47 ± 13 years; BMI 26 ± 4 kg/m(2)). Breathing movements were collected using a chest belt for 5 minutes of rest and during a BH protocol (60 seconds baseline, 30 seconds BH, 90 seconds recovery, 3 repeats). From the breathing movements, we calculated median breathing rate (BR) and interquartile BRV at rest. We calculated change in BRV during BH recovery from baseline. Group comparisons of OSA vs control were conducted using analysis of covariance with age, sex, and BMI as covariates. RESULTS: We found 10% higher BRV in OSA vs controls (P < .05) during rest. In response to BH, BRV increased 7% in OSA vs 1% in controls (P < .001). Resting BR was not significantly different in OSA and controls, and sex and age did not have any significant interaction effects. BMI was associated with BR at rest (P < .05) and change in BRV with BH (P < .001), but no significant BMI-by-group interaction effect was observed. CONCLUSIONS: The findings suggest breathing instability as reflected by BRV is high in OSA during wakefulness, both at rest and in response to a stimulus. Breathing instability together with high blood pressure variability in OSA may reflect a compromised cardiorespiratory consequence in OSA during wakefulness. CITATION: Pal A, Martinez F, Akey MA, et al. Breathing rate variability in obstructive sleep apnea during wakefulness. J Clin Sleep Med. 2022;18(3):825–833.

Temporomandibular joint herniation (TJH) is a rare condition in which the contents of the temporomandibular joint herniate into the external auditory canal (EAC). The foramen of Huschke (FH), also known as the foramen tympanicum, is an anatomical defect in the anteroinferior aspect of the EAC bone, and persisting FH is thought to be one of the causes of TJH. We report a case of spontaneous TJH along with a review of the literature. A 42-year-old man with aural fullness visited our department for the examination of the temporomandibular joint and a potentially neoplastic lesion in March 2020. Computed tomography performed previously showed a soft tissue density with a bone defect in the anterior wall of the left EAC. Otoscopic examination revealed a dome-shaped raised mass in the anterosuperior wall of the left side of the EAC. The mass protruded when the mouth was closed and disappeared when the mouth was opened. The patient was diagnosed with left TJH based on the clinical and imaging findings. Due to the lack of clinical symptoms, we decided not to perform aggressive surgical treatment for TJH, but to follow up carefully with regular imaging examinations. Fifteen months have passed since the first visit, and the symptoms have not worsened. This case report shows that TJH presents with characteristic clinical and imaging findings. Therefore, understanding the pathophysiology of this disease is essential for oral and maxillofacial surgeons who deal with temporomandibular joint diseases on a daily basis.

Psychological factors might be involved in some oral mucosal diseases, such as recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP). However, there is little information about the psychosomatic approaches to manage these oral mucosal diseases. This review summarizes the reports on the psychological statuses of patients with oral mucosal diseases, including RAS and OLP and others, and discusses the appropriate psychosomatic approaches for the management of these diseases. The psychosomatic background is probably involved in onset and course of inflammatory oral mucosal diseases, and can be called as “psychosomatic diseases”. The field of psychosomatic medicine for oral mucosal diseases may be termed “psychostomatology”.

A mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary gland. It frequently occurs in the parotid and minor salivary glands, but rarely originates from the sublingual gland. We report a case of a low-grade MEC arising from the sublingual gland with a MAML2 gene split on fluorescence in situ hybridization (FISH). In May 2017, a 57-year-old woman visited our hospital with left-sided tongue numbness and swelling of the floor of the mouth. We performed a biopsy, but the lesion was indistinguishable from malignant tumors such as MEC, or atypical epithelium associated with inflammation. Subsequently, an MEC was suspected based on computed tomography findings of invasion into the bone marrow and destruction of the outer margin of the mandibular cortex. In July 2017, tracheostomy, bilateral supraomohyoid neck dissection, combined resection of the floor of the mouth and reconstruction of the free peroneal composite flap with a vascular handle were performed under general anesthesia. Although perineural and mandibular invasion was observed, the tumor was considered a low-grade malignancy based on histopathological findings. Furthermore, a split signal in the MAML2 gene was detected on detailed molecular analysis using FISH. No recurrence was observed more than three years after definitive surgery. The presence of the MAML2 fusion gene is useful for the accurate diagnosis of an MEC. Overall, we report a rare case of an MEC in the sublingual gland with mandibular invasion where MAML2 fusion was confirmed.

Basal cell adenoma (BCA) is classified in benign salivary gland tumors by WHO in 1991. Incidence rate of BCA is 1.0 %–3.7 % of all salivary gland tumors. BCA tend to occur in parotid glands and those of minor gland origin is rare. We present a case of BCA of minor salivary gland in the alveolus of the anterior maxilla. A 41-year-old man was referred to our department because of a swelling in the left alveolus of the anterior maxilla. On the basis of clinical findings, the diagnosis was a benign tumor of the alveolus of the anterior maxilla and the tumor was removed under general anesthesia. The tumor was well-defined, no invasion of surrounding tissue, and was easily resected. Immunohistochemically, tumor cells showed positive reaction for S-100 protein, cytokeratin (AE1/AE3), p40, vimentin and epithelial membrane antigen (EMA). On the contrary, Ki-67 labeling index that is said to be an indicator of malignancy was low. Thus, the tumor diagnosed BCA. One year and six months have passed from the operation, there is no sign of recurrence and metastasis.

The objective of this study was to investigate the clinical manifestations and pathologic appearances of the submandibular gland (SMG) in Stevens-Johnson syndrome (SJS).Patients with autologous transplantation of SMG for treatment of severe dry eye between March 1998 and May 2018 were divided into the SJS group (70 cases) and non-SJS group (50 cases) according to the history of SJS. The SMG weight and computed tomography volume and salivary flow rate were measured. The concentration index and secretion index were estimated using scintigraphy with technetium-99m-pertechnetate. Histopathology studies of SMG tissues were conducted, and the acini parameters were measured using a digital image analyzer.A decreased computed tomography volume and weight was observed in 48.57% the SJS group and 2% in the non-SJS group (P.01). The rest whole, acid-stimulated whole, and SMG rest salivary flow rates decreased in the SJS group (P.05). The normal SMG concentration index (37.5% vs 96.67%, P.001) and secretion index (35% vs 96.67%, P.001) rates were lower in the SJS group than in the non-SJS group. The glandular parenchyma was reduced, the acinar space was widened, and the fat content was increased in the SJS group.SMG atrophic and degenerative changes occurred in the SJS group, with a decrease in salivary secretion function in more than half of the patients.

Adenoid cystic carcinoma (ACC) represents approximately 10% of all epithelial salivary neoplasms and most commonly involves the parotid gland. We report CT and MRI finding of a 38-year-old young man presented to our ENT department with 02 years history of an external auditory canal stenosis. Physical examination revealed bilateral parotid gland swelling with a complete stenosis of the left external auditory canal. Temporal bone contrast enhanced CT-SCAN revealed is an isodense enhancing mass measuring 4 cm involving posterior and inferior external auditory canal wall, and invading the superficial lobe of the homolateral parotid gland. No bone erosion was noted. MRI investigation has shown a tumor process highly suspicious of malignancy centered on the left EAC involving the superficial lobe of the homolateral parotid gland. Adenoid cystic carcinoma (ACC) of the parotid gland was the final diagnosis, after surgical biopsy and histopathological examination. The Pre-operative check-up demonstrated multiple round shape lung lesions suggestive of multiple metastases. Considering the metastatic stage of the tumor, a collegial decision to adopt a palliative treatment approach based on chemotherapy was taken by the multidisciplinary oncology board.

BACKGROUND Obstructive sleep apnea (OSA) is often comorbid with both substance use disorders (SUD) and posttraumatic stress disorder (PTSD), yet frequently goes undiagnosed and untreated. We present data on the feasibility and acceptability of objective OSA diagnosis procedures, findings on OSA prevalence, and the relationship between OSA and baseline SUD/PTSD symptoms among veterans in residential treatment for comorbid PTSD/SUD. METHODS Participants were 47 veterans admitted to residential PTSD/SUD treatment. Participants completed questionnaires assessing PTSD and sleep symptoms, and filled out a sleep diary for seven days. Apnea-hypopnea index (AHI) was recorded using the overnight Home Sleep Apnea test (HSAT; OSA was diagnosed with AHI ≥ 5). RESULTS Objective OSA diagnostic testing was successfully completed in 95.7% of participants. Of the 45 veterans who went through HSAT, 46.7% had no OSA, 35.6% received a new OSA diagnosis, and 8.9% were previously diagnosed with OSA and were using positive airway pressure treatment (PAP); an additional 8.9% were previously diagnosed with OSA, reconfirmed with the HSAT, but were not using PAP. One hundred percent of respondents during follow-up deemed the testing protocol's usefulness as "Good" or "Excellent." CONCLUSION OSA diagnostic testing on the residential unit was feasible and acceptable by participants and was effective in diagnosing OSA. OSA testing should be considered for everyone entering a SUD and PTSD residential unit. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A common clinical phenotype of several neurodegenerative and systemic disorders including Alzheimer’s disease and atherosclerosis is the abnormal accumulation of extracellular material, which interferes with routine cellular functions. Similarly, patients with age-related macular degeneration (AMD), the leading cause of vision loss among the aged population, present with extracellular lipid- and protein-filled basal deposits in the back of the eye. While the exact mechanism of growth and formation of these deposits is poorly understood, much has been learned from investigating their composition, providing critical insights into AMD pathogenesis, prevention, and therapeutics. We identified human osteopontin (OPN), a phosphoprotein expressed in a variety of tissues in the body, as a newly discovered component of basal deposits in AMD patients, with a distinctive punctate staining pattern. OPN expression within these lesions, which are associated with AMD disease progression, were found to co-localize with abnormal calcium deposition. Additionally, OPN puncta colocalized with an AMD risk-associated complement pathway protein, but not with apolipoprotein E or vitronectin, two other well-established basal deposit components. Mechanistically, we found that retinal pigment epithelial cells, cells vulnerable in AMD, will secrete OPN into the extracellular space, under oxidative stress conditions, supporting OPN biosynthesis locally within the outer retina. Finally, we report that OPN levels in plasma of aged (non-AMD) human donors were significantly higher than levels in young (non-AMD) donors, but were not significantly different from donors with the different clinical subtypes of AMD. Collectively, our study defines the expression pattern of OPN in the posterior pole as a function of disease, and its local expression as a potential histopathologic biomarker of AMD.

STUDY OBJECTIVES: Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among older patients with atrial fibrillation (AF). Little is known about the association between OSA and geriatric impairments, including frailty, cognitive performance, and AF-related quality of life. The objective of this study was to examine the associations of OSA with frailty, cognitive performance, and AF-related quality of life among older adults with AF. METHODS: Data from the Systemic Assessment of Geriatrics Elements-AF study were used, which included AF participants 65 years and older and with a CHA(2)DS(2)-VASc ≥ 2. The STOP-BANG questionnaire was used to assess the risk of OSA. Multivariable logistic regression models were used to examine the association between risk of OSA and geriatric impairments, adjusting for sociodemographic, geriatric, and clinical characteristics. RESULTS: A total of 970 participants (mean age 75 years; 51% male) were studied. Of the 680 participants without a medical history of OSA, 26% (n = 179) of participants had a low risk of OSA, 53% (n = 360) had an intermediate risk, and 21% (n = 141) had a high risk for OSA. Compared to those with low risk of OSA, participants with an intermediate or high risk of OSA were more likely to be frail (adjusted odds ratio = 1.67, 95% confidence interval: 1.08–2.56; adjusted odds ratio = 3.00, 95% confidence interval: 1.69–5.32, respectively) in the fully adjusted models. CONCLUSIONS: Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and quality of life among patients with AF. CITATION: Mehawej J, Saczynski JS, Kiefe CI, et al. Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation. J Clin Sleep Med. 2022;18(2):469–475.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a clinical syndrome characterized by recurrent episodes of apnea or hypopnea of the upper airway, leading to increased negative intrathoracic pressure, sleep fragmentation, intermittent hypoxia during sleep, and increased risk for morbidity and mortality of affected patients. The gut microbiome plays a key role in OSA pathogenesis, and fecal metabolic profiling reflects the gut microbial functional readout and mediates host–microbiome interactions. METHODS: Herein, we conducted a cohort study to explore fecal metabolic signatures distinguishing OSA (44 patients) from healthy controls (22 healthy controls) by untargeted gas chromatography–time-of-flight mass spectroscopy. RESULTS: Significant metabolic signatures were detected in stool samples of patients with OSA: 246 metabolites of 24 ontology classes were identified, and 48 metabolites of 6 ontology classes were shifted. An enrichment of arachidonic acid, docosahexaenoic acid, and 11Z-eicosenoic acid and reduction in stearic acid, 5-hydroxyindoleacetic acid, gluconic acid, and α-hyodeoxycholic acid were observed in stool samples from patients with OSA. Fecal variance resulted in alterations in potential metabolic activities and was thereby strongly associated with host phenotypes, such as pulse blood oxygen saturation and apnea-hypopnea index. The prediction model based on feces metabolomics was established to distinguish OSA from healthy controls with high accuracy. CONCLUSIONS: This study revealed the metabolomic signatures of patients with OSA in feces, and the findings provide evidence of an association between metabolome and OSA. CITATION: Dong Y, Wang P, Lin J, et al. Characterization of fecal metabolome changes in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):575–586.

The need for secondary orthognathic surgery (OS) after a high condylectomy (HC) in patients with active unilateral condylar hyperplasia was assessed in 25 patients, reviewing patient characteristics and treatment planning. At 6-12 months after HC, 13 patients (52%) required secondary OS. The amount of mandibular dental midline shift before the HC (P=0.037), and a dental crossbite that was present before the HC (P=0.017) were significantly associated with the need for secondary OS. Overall, the mandibular dental midline coincided with the facial midline in eight patients (32%) at 2 weeks after HC. In 16% of the patients, no additional OS was needed despite this being the initial treatment plan. Additionally, the initially planned type of secondary OS was modified in six other patients. Early HC in skeletally immature patients provided very good results, both aesthetic and functional, with only two of them needing supplementary OS at 6-12 months after HC. The HC remains a valuable treatment in patients with active unilateral condylar hyperplasia, as it can eliminate the need for secondary OS and is very well tolerated by most patients. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:51 issue:2 pages:206-213 ispartof: location:Denmark status: published

STUDY OBJECTIVES: We determined the relationship of cardiovascular risk factors, cardiovascular diseases, nocturnal blood pressure (NBP), and NBP fluctuations (NBPFs) with the severity of obstructive sleep apnea (OSA). We also investigated the effect of short-term continuous positive airway pressure therapy on NBP parameters. METHODS: This retrospective study included 548 patients from our cardiac clinic with suspected OSA. Patients underwent polysomnography and continuous NBP measurement using the pulse transit time. According to their apnea-hypopnea index (AHI), patients were subclassified as controls (AHI < 5 events/h), mild (AHI 5 to < 15 events/h), moderate (AHI 15 to < 30 events/h), and severe OSA (AHI ≥ 30 events/h); 294 patients received continuous positive airway pressure therapy. RESULTS: Analysis of covariance showed that NBP and the frequency of NBPFs were the highest in severe followed by moderate and mild OSA (all P < .001). Multivariable regression analysis revealed a significant association of NBPFs with AHI, body mass index, systolic NBP, and lowest SpO(2). The severity of OSA is also associated with the frequency of obesity, hypertension, diabetes mellitus, atrial fibrillation, heart failure (all P < .001), and coronary artery disease (P = .035). Short-term continuous positive airway pressure decreased the frequency of NBPFs in all OSA groups and the systolic NBP in severe and moderate but not in mild OSA. CONCLUSIONS: The severity of OSA is associated with an increase in NBP and NBPFs. Continuous positive airway pressure reduces NBP parameters already after the first night. In addition to BP, the diagnosis and therapy of NBPFs should be considered in patients with OSA. CLINICAL TRIAL REGISTRATION: Registry: German Clinical Trials Register; Name: Nocturnal blood pressure and nocturnal blood pressure fluctuations associated with the severity of obstructive sleep apnea; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024087; Identifier: DRKS00024087. CITATION: Picard F, Panagiotidou P, Tammen A-B, et al. Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):361–371.