Biomarkers of pediatric obstructive sleep apnea syndrome and the assessment of quality of life before and after adenotonsillectomy

The study aims to explore the inflammatory cytokines and oxidative stress in children with obstructive sleep apnea syndrome (OSAS) triggered by adenoids and/or tonsillar hypertrophy and their changes after adenotonsillectomy (AT) and to investigate the associated behavioral disorders in OSAS, before and after AT. Thirty patients with OSAS and 20 healthy children, aged 3 - 13 years were included in the study. According to apnea-hypopnea index (AHI), OSAS children were classified into 3 groups: mild (n = 19), moderate (n = 5), and severe OSAS (n = 6). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA) and antioxidant enzymes activities were assessed in serum, preoperative and 6 weeks after AT. TNF-α, IL-6 and malondialdehyde levels were also estimated in adenoid and tonsils tissues. A Pediatric Sleep Questionnaire was completed by the parents before and after AT. As a result of the study, we obtained the following results: TNF-α, IL-6 and malondialdehyde evaluated preoperative increased in serum and tissues in OSAS, especially in severe disease compared to mild and moderate forms. Six weeks after AT, AHI diminished significantly in OSAS, as well as the inflammatory markers and malondialdehyde, in parallel with significant improvement of antioxidant enzymes activities. Daytime sleepiness, hyperactivity and attention deficit in OSAS, even in mild disease were present, with significant improvements of obstructive symptoms after AT. We conclude that OSAS caused by adenoids and/or tonsillar hypertrophy led to changes in the blood parameters, with significant improvement after AT. Postoperatively, a significant improvement in sleep quality and behavior in OSAS patients was also observed.

The impact of Sambucus nigra L. extract on inflammation, oxidative stress and tissue remodeling in a rat model of lipopolysaccharide-induced subacute rhinosinusitis

Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicines could be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1β, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1β. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.

The evaluation of heavy metals in transylvania, as predictor for the health status of the exposed population

It is well known and proven that heavy metal contamination of the soils can severely affect the health of the people living in the contaminated areas given the ease with which trace elements can enter the human body. In addition-to agricultural crop depreciation as well as soil erosion, soil pollution can negatively affect the natural function of ecosystems. While certain heavy metals in high doses can be harmful to the body, others such as cadmium, mercury, lead, chromium, silver and arsenic in minimal amounts have delusional effects on the body, causing acute and chronic intoxication. Our research is focused on the identification of heavy metals from the soil (O, Al, Ca, Cu, Fe, K, Mg, Na, P, Pb, Si, Ti, Zn) in 3 areas in Transylvania where factories were in operation, using 4 methods: UV-VIS spectrometry, AAS, SEM-EDAX and X-ray diffractions. High levels of very toxic trace elements such as lead, aluminum, cadmium were found near the studied areas, especially using SEM-EDAX and AAS methods. Knowledge on the soil concentration of TEs, the time exposure and the side effects can lead us to predict the health status of the exposed population. In our study, by determinating the concentration of TEs we set out to formulate a prediction on the health status of the exposed population using literature data.

Quercetin attenuates naso-sinusal inflammation and inflammatory response in lungs and brain on an experimental model of acute rhinosinusitis in rats

This study aimed to investigate the effect of quercetin without intranasal inflammation and oxidative stress in nasal and sinus mucosa, but also in serum, lungs and brain in a rat model of acute nasal and sinus inflammation induced by administration of lipopolysaccharides (LPS) (from Escherichia coli). Wistar rats were divided into five groups of 10 animals each. The control group received an intranasal saline solution once/day, for seven consecutive days. Rats in groups 2 and 3, received low-dose (5 μg) and high-dose (10 μg) of LPS, once/day, for seven consecutive days. Rats in groups 4 and 5, received low-dose (5 μg) and high-dose (10 μg) of LPS and after 2 h, 80 mg/kg of quercetin, once/day for seven consecutive days was administered. After the treatment period, the histopathological examination of nasal and sinus mucosa was performed and levels of cytokines (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6)) and oxidative stress in the blood, nasal mucosa, lungs and brain were also analyzed. High dose of LPS increased TNF-α, IL-6 and IL-1β levels in serum, nasal mucosa, and lungs homogenates while in brain, this effect was only on TNF-α levels. IL-1β enhanced significantly in serum and mucosa, especially after administration of a high dose of LPS (P < 0.01 and P < 0.05). Histopathological and immunofluorescence analysis revealed acute inflammatory reaction in rats treated with both doses of LPS without significant changes of lipid peroxidation in the studied tissues. Quercetin administration diminished the exudate and degree of inflammation in lamina propria of nasal and sinusal areas, parallel with the decreased secretion of TNF-α (40.2% reduction after the low dose of LPS, and 35.4% reduction after the high dose of LPS) and IL-6 (21.4% reduction after the low dose of LPS and 35.8% reduction after the high dose of LPS). In lungs, quercetin reduced TNF-α (43.3%) and IL-6 levels (24.5%), and in the brain, the protective effect was noticed only on TNF-α (46.5%). The intranasal LPS administration successfully induced acute rhinosinusitis in a rat model and also generated an inflammatory response in the lungs and brain. Intranasal administration of quercetin diminished the nasal inflammation and also exerted protective effect on lungs and partially on brain inflammatory reaction.

675Non-sustained ventricular tachycardia in nonischemic dilated cardiomyopathy: results from a nonischemic cardiomyopathy study

Background

The underlying substrates and mechanisms of non-sustained ventricular tachycardia (NSVT) in nonischemic dilated cardiomyopathy (DCM) are unclear and may be different than those of sustained VT.

Purpose

To characterize NSVT in DCM and analyze its association with late gadolinium enhancement (LGE) on CMR, inducibility of sustained VT during EP study, and ventricular arrhythmias during follow-up.

Methods

In the prospective Leiden Nonischemic Cardiomyopathy Study (ClinicalTrials.gov Identifier: NCT01940081) patients with DCM underwent a comprehensive evaluation. For the present study, 24h-Holters were assessed for the presence of NSVT (defined as ≥3 consecutive beats arising below the atrioventricular node with a rate ≥120 bpm and lasting &lt;30 s) and its features (number of episodes, rate, rate variability &gt;10%, duration, coupling interval and morphology). CMRs were assessed for the presence of LGE and EP studies for inducibility of sustained monomorphic VT. Patients were followed and ICDs were programmed with therapy &gt;188-200 bpm or adjusted to clinically documented VT.

Results

Of all 148 patients, 95 underwent a 24-hour Holter at the Leiden University Medical Center and were included in the present study (age 59 ± 13 years, 76% male, history of sustained VT in 26 [27%], out-of-hospital cardiac arrest in 7 [9%]). NSVT was observed during Holter in 52 patients (55%) and was typically short (median 4 beats, IQR 3-5 beats), relatively slow (median 144 bpm, IQR 134-156 bpm), irregular (median 67%, IQR 43-100% of all episodes per patient) and monomorphic (median 87%, IQR 12-100%). NSVT was not associated with LGE on CMR (p = 0.49) or VT inducibility during EP study (p = 0.96), nor were its features (all p &gt; 0.05). During 4.0 ± 1.7 years follow-up, sustained VT occurred in 25 patients (26%), polymorphic VT/VF in 8 (8%), and any sustained ventricular arrhythmia in 30 (32%). NSVT was associated with a higher rate of sustained VT during follow-up (HR 5.45, p = 0.002) and any sustained ventricular arrhythmia (HR 4.17, p = 0.002), but not with polymorphic VT/VF (p = 0.69). Similarly, inducibility of sustained VT during EP study was also associated with sustained VT during follow-up (HR 5.78, p &lt; 0.001) and any sustained ventricular arrhythmia (HR 4.88, p &lt; 0.001), but not with polymorphic VT/VF (p = 0.13). The findings remained similar when only primary prevention patients were included. In multivariate analysis, NSVT on Holter and inducibility of sustained VT during EP study both remained independently associated with sustained VT and any sustained ventricular arrhythmia during follow-up (all p ≤ 0.001), but not with polymorphic VT/VF.

Conclusion

In DCM, NSVT on Holter and inducible sustained VT during EP study are not directly interrelated, but both predict the occurrence of sustained VT during follow-up. These data suggest that non-sustained and sustained VT may have different underlying mechanisms and provide complementary information in DCM.

Abstract Figure. Sustained VT during follow-up

Burden of varicella in Central and Eastern Europe: findings from a systematic literature review

INTRODUCTION

Vaccination against varicella rapidly reduces disease incidence, resulting in reductions in both individual burden and societal costs. Despite these benefits, there is no standardization of varicella immunization policies in Europe, including countries in Central and Eastern Europe (CEE).

AREAS COVERED

This systematic literature review identified publications on the epidemiology of varicella, its associated health and economic burden, and vaccination strategies within the CEE region, defined as Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, and Slovenia. Twenty-six studies were identified from a search of PubMed, Embase®, and MEDLINE® biomedical literature databases, supplemented by gray literature and country-specific/global websites.

EXPERT COMMENTARY

Limited information exists in published studies on the burden of varicella in CEE. The wide variability in incidence rates between countries is likely explained by a lack of consistency in reporting systems. Funded universal varicella vaccination (UVV) in CEE is currently available only in Latvia as a one-dose schedule, but Hungary together with Latvia are introducing a two-dose strategy in 2019. For countries that do not provide UVV, introduction of vaccination is predicted to provide substantial reductions in cases and rates of associated complications, with important economic benefits.

Effects of prophylactic ibuprofen and paracetamol administration on the immunogenicity and reactogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine (PHiD-CV) co-administered with DTPa-combined vaccines in children: An open-label, randomized, controlled, non-inferiority trial

Prophylactic paracetamol administration impacts vaccine immune response; this study ( www.clinicaltrials.gov : NCT01235949) is the first to assess PHiD-CV immunogenicity following prophylactic ibuprofen administration. In this phase IV, multicenter, open-label, randomized, controlled, non-inferiority study in Romania (November 2010-December 2012), healthy infants were randomized 3:3:3:1:1:1 to prophylactically receive immediate, delayed or no ibuprofen (IIBU, DIBU, NIBU) or paracetamol (IPARA, DPARA, NPARA) after each of 3 primary doses (PHiD-CV at age 3/4/5 months co-administered with DTPa-HBV-IPV/Hib at 3/5 and DTPa-IPV/Hib at 4 months) or booster dose (PHiD-CV and DTPa-HBV-IPV/Hib; 12-15 months). Non-inferiority of immune response one month post-primary vaccination in terms of percentage of infants with anti-pneumococcal antibody concentrations ≥0.2 µg/mL (primary objective) was demonstrated if the upper limit (UL) of the 98.25% confidence interval of difference between groups (NIBU vs IIBU, NIBU vs DIBU) was <10% for ≥7/10 serotypes. Immunogenicity and reactogenicity/safety were evaluated, including confirmatory analysis of difference in fever incidences post-primary vaccination in IBU or DIBU group compared to NIBU. Of 850 infants randomized, 812 were included in the total vaccinated cohort. Non-inferiority was demonstrated for both comparisons (UL was <10% for 9/10 vaccine serotypes; exceptions: 6B [NIBU], 23F [IIBU]). However, fever incidence post-primary vaccination in the IIBU and DIBU groups did not indicate a statistically significant reduction. Prophylactic administration (immediate or delayed) of paracetamol decreased fever incidence but seemed to reduce immune response to PHiD-CV, except when given only at booster. Twenty-seven serious adverse events were reported for 15 children; all resolved and were not vaccination-related.

Use of electroacupuncture to accelerate the antidepressant action of selective serotonin reuptake inhibitors: a single-blind, randomised, controlled study

1. Patients treated with dense cranial electroacupuncture stimulation (DCEAS) had a significantly greater reduction in the 17-item Hamilton Rating Scale for Depression scores and clinically significant response to treatment than those having sham acupuncture (19.4% vs.8.8%). 2. Neither sham acupuncture nor DCEAS had effects on the platelet serotonin system. 3. In the early phase of selective serotonin reuptake inhibitor treatment for depressed patients, DCEAS could be used as an additional therapy. 4. Neurobiological mechanisms responsible for DCEAS effects warrant further investigation using neuroimaging.

[Influence of cheeks support on the results of respiratory resistance measured by the interrupter technique in children]

INTRODUCTION

Interrupter technique (TIF) determines the respiratory resistance (Rocc) and can be used successfully in children, even at low ages as it requires only minimal cooperation. Efforts to standardize this technique are focused on limiting the contribution of upper airway resistance during the measurement.

OBJECTIVE

Assessing the influence of cheeks support during the examination on the results of Rocc determined by TIF, both when used as basal examination or for measurement of bronchodilator response.

MATERIAL AND METHODS

Sixty-one children diagnosed with asthma were included. Rocc was determined in all patients with both cheeks supported, and without support. Forty-three children subsequently performed spirometry in order to assess the correlation between spirometry and Rocc in the two situations described. To assess bronchodilator response two groups of children were studied, one with the basal and postsalbutamol measurements made with the cheeks supported and the other group with the same tests made without support.

RESULTS

Rocc mean values were higher when the cheeks are supported during the examination, the difference being statistically significant. Regarding the correlation with spirometry, there is a good correlation between FEV1, PEF, MEF50 and Rocc in both cases (P < 0.001). deltaFEV1 correlated better with deltaRocc when cheeks were supported.

CONCLUSIONS

Rocc measurements using interrupter technique with the cheeks supported registered higher values than those obtained in the absence of cheek support. Assessment of bronchodilator response using the interrupter technique is more accurate when performed with the cheeks supported.

[Increase of the prevalence of bronchial asthma and related symptoms in students in Cluj-Napoca. Epidemiologic study with a five-years interval]

BACKGROUND

The prevalence of asthma is increasing in developed countries during the past decade. In Romania there are few studies on asthma epidemiology and no data on the trend of the prevalence.

AIMS

The authors investigate the prevalence of asthma and associated symptoms in children and evaluate the trend of prevalence 5 years apart.

METHODS

We used a core questionnaire designed by the International Study of Asthma and Allergy in Children (ISAAC). The questionnaire was applied during 1995 in 2,866 children aged 13-14 years from a Romanian city, and during 2001 in 1,657 children from the same area.

RESULTS

The prevalence of previous diagnosed asthma increased significant, from 3.3% in 1995 to 5.5% in 2001 (p = 0.0005). A higher percentage of pupils presented probable asthma (4.3% in 1995 and 13.6% in 2001; p < 0. 00001). Similar results were obtained regarding symptoms related to asthma like wheezing, cough during exercise and night cough. Previous diagnosed asthma was more frequent in boys, but probable asthma and symptoms related to asthma were more prevalent in girls both in 1995 and in 2001. The prevalence of asthma is similar with that reported in other central and eastern European countries that used the same core questionnaire provided by ISAAC.

CONCLUSION

The prevalence of asthma and associated symptoms increased significantly during the past 5 years.

[Respiratory resistance measured by interrupter technique in asthmatic children. Correlation with spirometry]

Respiratory resistance measured by the interrupter technique (Rocc) is very attractive in young children because minimal comprehension and coordination are needed. It is feasible in children below 5 years of age, in children with acute asthma and the device is simple, small sized, and relatively cheap. The objective of this study was to determine the correlation between Rocc and spirometry in co-operative children with asthma. We studied patients with asthma old enough to perform spirometry. The spirometric parameters evaluated were forced vital capacity (FVC), forced expiratory flow in 1 second (FEV1), peak expiratory flow (PEF), and maximal expiratory flow at 50% of vital capacity (MEF50). Respiratory resistance was measured during normal breathing, with a nose clip, with the neck in slight extension. The maneuver was repeated until 5 relatively constants values were obtained. The mean value was evaluated. We analyzed the results by the Pearson correlation quotient. Thirty-four children were tested (20 boys) with a mead age of 8,91 years (limits: 4-18 years), a mean height of 135.88 cm (106-173 cm), a mean weight of 33.95 kg (17-66 kg). Rocc correlated well with FVC (r = -0.81; p < 0.05), with FEV1 (r = -0.79; p < 0.05), with PEF (r = -0.76; p < 0.05), and with MEF50 (r = -0.76; p < 0.05). In conclusion, Rocc values correlated well with the main spirometric parameters, and this method (Rocc) could be used as a substitute of spirometry in young children, who cannot perform forced expiratory maneuvers.

Revascularized iliac bone graft for mandibular reconstruction

Revascularized iliac bone has advantages over other revascularized bone grafts for the reconstruction of large mandibular defects. This is a detailed anatomical study of the blood supply to the iliac bone using microfil and Batson injection methods. It confirms and extends Taylor's study. Clinical results are reported for six cases of extensive mandibular defects which were reconstructed using this method.

Martial arts and ulnar nerve compression injuries

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A combination theory on the mechanism of acupuncture analgesia

Pain relief is a puzzle in medicine. No possible single theory can give a satisfactory explanation of the mechanism of acupuncture analgesia. Various theories have been advanced but none is acceptable-even to the proponents themselves. In this paper a combination theory is used to try to explain the possible mechanism by using the 'specific receptors theory', 'gate-control theory', 'electro-interference theory' and the most recent 'endorphin-release theory'.

Local skin sensory changes after acupuncture

Forty normal subjects were assessed for local skin sensory changes of the knees after acupuncture needle insertion. Correct insertion sites were used on one knee and incorrect sites on the other knee. No significant change of sensation was found over the L3 and L5 dermatomes when incorrect sites were used. Pain sensation was markedly diminished on the side where correct sites were used; minimal transient diminished sensation of heat and vibration was noted.

The role of hypnotic suggestion in acupuncture

Any form of treatment has some degree of psychosomatic component. A study of the role of hypnotic suggestion in acupuncture was done in a double-blind study setting, which revealed there were minimal effects of hypnosis and/or power of suggestion. Two cases are reported for further illustration.