Palate shape is associated with Unilateral Hypoglossal Nerve Stimulation Outcomes

OBJECTIVE

The aim was to determine the potential association between palate shape and unilateral hypoglossal nerve stimulation (HNS) outcomes.

METHODS

Preoperative drug-induced sleep endoscopy (DISE) videos were reviewed and scored by 3 blinded reviewers to determine airway narrowing at the hard-soft palate junction (HP), soft palate genu, and inferior velum, as described by Woodson (2014). Scoring was as follows: 1-open airway, 2-narrow, 3-severe narrowing. Overall palate shape (oblique, intermediate, or vertical) was determined based on prior criteria. Successful surgical treatment was defined by the HNS titration polysomnogram as a reduction of ≥50% in the apnea-hypopnea index (AHI) to <15 events/h.

RESULTS

Of 332 adults, the majority was male (77%) with an average BMI of 29.2 ± 3.6 kg/m2 . Overall success rate was 73%. Success rate was lower in patients with vertical palate shape compared with the other shapes (56% vs. 75%, p = 0.029). HP score 3 compared with scores 2 and 1 was associated with lower success rates (60% vs. 76%, p = 0.028), but genu and velum scores were not associated with outcomes. Patients with both HP score 3 and complete oropharyngeal lateral wall-related obstruction had notably worse outcomes (22% vs. 74%, p = 0.026). HP score 3 (OR 0.45, 95%CI 0.22-0.92) and vertical palate shape (OR 0.33, 95%CI 0.15-0.78) were independently associated with lower odds of surgical response after adjustment for DISE findings, age, gender, and BMI.

CONCLUSION

Vertical palate shape and narrowing at the hard-soft palate junction are independently associated with lower HNS surgical success rates.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:981-986, 2024.

Clinical Characteristics of Older Adults Seeking Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

OBJECTIVES

Obstructive sleep apnea (OSA) is a common sleep disorder with numerous clinical correlates. Although effective treatments abound, patient acceptance and adherence is low. Hypoglossal nerve stimulation (HNS) is a surgical treatment alternative for the treatment of OSA; however, the demographic and clinical characteristics of individuals seeking HNS are not well categorized. This study sought to determine the clinical characteristics of older adults seeking HNS for the treatment of OSA.

METHODS

Self-report questionnaires were administered to all patients older than 50 years seeking a HNS consultation at a large university medical center. Questionnaires included validated National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) measures of physical functioning, sleep-related impairment, cognitive abilities, depression, anxiety, and anger along with the Information extracted from electronic medical records included age, sex, race, and apnea-hypopnea index (AHI).

RESULTS

Patients included 113 adults (mean age 63.30 years, 57% male, 79% white) with severe OSA (AHI = 33.91, standard deviation = 20.63). Overall, 88% of patients reported elevated insomnia symptoms, 30% reported mild difficulty with physical functioning, and 36% indicated that they had experienced moderate-severe daytime impairments attributed to poor sleep. Additionally, we found 28% of sampled individuals reported moderate-severe depressive symptomology, over 19% reported moderate-severe anxiety, and over 17% reported moderate to severe anger issues. Approximately, 38% of the sample reported moderate to severe cognitive difficulties.

CONCLUSIONS

The aim of the study was to better understand the clinical characteristics of older patients with OSA seeking HNS treatment. Utilizing NIH PROMIS questionnaires, we identified unique clinical and psychosocial correlates in this sample, which included higher rates of insomnia symptoms, physical dysfunction, cognitive deficits, and depressive symptoms than the general population. Future studies will be needed to investigate these relationships more thoroughly and throughout the course of the treatment.

Field-portable seawater toxicity monitoring platform using lens-free shadow imaging technology

The accidental spill of hazardous and noxious substances (HNSs) in the ocean has serious environmental and human health consequences. Assessing the ecotoxicity of seawater exposed to various HNS is challenging due to the constant development of new HNS or mixtures, and assessment methods are also limited. Microalgae viability tests are often used among the various biological indicators for ecotoxicity testing, as they are the primary producers in aquatic ecosystems. However, since the conventional cell growth rate test measures cell viability over three to four days using manual inspection under a conventional optical microscope, it is labor- and time-intensive and prone to subjective errors. In this study, we propose a rapid and automated method to evaluate seawater ecotoxicity by quantification of the morphological changes of microalgae exposed to more than 30 HNSs. This method was further validated using conventional growth rate test results. Dunaliella tertiolecta, a microalgae species without rigid cell walls, was selected as the test organism. Its morphological changes in response to HNS exposure were measured at the single cell level using a custom-developed device that uses lens-free shadow imaging technology. The ecotoxicity evaluation induced by the morphological change could be available in as little as 5 min using the proposed method and device, and it could be effective for 20 HNSs out of 30 HNSs tested. Moreover, the test results of six selected HNSs with high marine transport volume and toxicity revealed that the sensitivity of the proposed method extends to half the maximum effective concentration (EC50) and even to the lowest observed effective concentration (LOEC). Furthermore, the average correlation index between the growth inhibition test (three to four days) and the proposed morphology changes test (5 min) for the six selected HNSs was 0.84, indicating great promise in the field of various point-of-care water quality monitoring. Thus, the proposed equipment and technology may provide a viable alternative to traditional on-site toxicity testing, and the potential of rapid morphological analysis may replace traditional growth inhibition testing.

Molecular conformation evolutions of trans HNS under high pressure

The molecular conformation evolution of Hexanitrostilbene (HNS) under high pressure was systematically investigated using Raman and Fourier transform infrared (FTIR) spectroscopy. The vibration modes of HNS associated with C-H, nitro groups, CC and the ring have been analyzed and clarified in detail under ambient conditions. trans-HNS is symmetrically distributed about -CHCH-, and six nitro groups are symmetrically distributed under ambient conditions. Two molecular conformation changes of HNS were observed at 1.4 GPa and 5 GPa due to the variations of hydrogen-bond interaction between C-H (in the ring) and N-O and the distortion of trans olefin, respectively. The hydrogen-bond interaction between C-H (in the ring) and N-O strengthened at 1.4 GPa. It induced the degenerated symmetry of the nitro groups and the Raman changes of ν_as (NO₂), ν(CC), ν(C-C) and ν(C-H). In addition, the nonplanarity property of HNS and the sensitivity of trans olefin to pressure promoted the deformation of trans olefin, as well as the hydrogen bond interaction between C-H (in trans olefin) and N-O at about 5 GPa. When further loading pressure on HNS, the variations in the hydrogen-bond interaction between C-H and N-O restricted the vibrations of C-H, NO₂ and the ring. It blocked the nonradiative pathway and activated the strong fluorescent background in the Raman spectra as the pressure increased above 5.7 GPa. These current results reveal that there is no structural transformation and only conformational changes under high pressure for HNS.

Effects of different ablation settings on lesion dimensions in an ex vivo swine heart model: Baseline impedance, irrigant, and electrode configuration

INTRODUCTION

Intramural or epicardial locations of the arrhythmogenic substrate are regarded as one of the main reasons for radiofrequency (RF) catheter ablation failure. This study aims to conduct a comprehensive analysis of various factors including baseline impedance, irrigant and electrode configuration at similar ablation index (AI) value.

METHODS

In 12 ex vivo swine hearts, RF ablation was performed at a target AI value of 500 and a multistep impedance load (100-180 Ω) in 4 settings: (1) conventional unipolar configuration with an irrigant of normal saline (NS); (2) conventional unipolar configuration with an irrigant of half normal saline (HNS); (3) bipolar configuration with an irrigant of NS; (4) sequential unipolar configuration with an irrigant of NS. The relationships between lesion dimensions and above factors were examined.

RESULTS

Baseline impedance had a strong negative linear correlation with lesion dimensions at a certain AI. The correlation coefficient between baseline impedance and depth, width, and volume were R = -0.890, R = -0.755 and R = -0.813, respectively (p < .01). There were 10 (total: 10/100, 10%; bipolar: 10/25, 40%) transmural lesions during the whole procedure. Bipolar ablation resulted in significantly deeper lesion than other electrode configurations. Other comparisons in our experiment did not achieve statistical significance.

CONCLUSION

There is a strong negative linear correlation between baseline impedance and lesion dimensions at a certain AI value. Baseline impedance has an influence on the overall lesion dimensions among irrigated fluid and ablation configurations. Over a threshold impedance of 150 Ω, the predictive accuracy of AI can be compromised.

Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

Post-implant care pathway: lessons learned and recommendations after 5 years of clinical implementation of hypoglossal nerve stimulation therapy

Hypoglossal nerve stimulation (HNS) therapy is now an established and widely-available obstructive sleep apnea (OSA) treatment alternative for continuous positive airway pressure (CPAP)-intolerant patients. Additionally, the HNS body of literature is robust with strong data on safety, efficacy, and durability-from the 5-year STAR Trial outcomes, to post-approval studies of independent institutions, to the multicenter ADHERE registry which recently reported outcomes on over 1,000 patients and is poised to enroll 5,000 HNS patients total. Nevertheless, now with thousands of implanted patients across hundreds of certified centers, and that number growing rapidly, the post-implant management of the HNS patient represents the next critical frontier. Post-implant patient management (therapy titration, troubleshooting, adjustments, and adherence monitoring) across a longitudinal care model is key to ensuring long-term therapy success and optimizing patient outcomes and health benefits. As with CPAP, patient education and close clinical monitoring are often essential to successful long-term management. Although many HNS patients are clear responders with excellent comfort and adherence as well as effective improvement in symptomatic and objective outcome measures, and even a smaller subset is clear non-responders, there is a growing body of patients somewhere in the middle: good outcomes but not great; partial but incomplete response. These are the patients in whom a standardized best-practice approach to treatment monitoring and targeted therapy modifications is likely critical to optimizing long-term outcomes.

Toxic effect of p-chloroaniline and butyl acrylateon Nannochloropsis oculata based on water samples from two sea areas

To compare the influence of water samples collected from various areas on toxic effect of HNS, we examined the toxic effect of two commonly found HNS: p-chloroaniline and butyl acrylate, on Nannochloropsis oculata cultured in seawater collected from Laizhou bay and Jiaozhou bay (China). The results showed that both p-chloroaniline and butyl acrylate had significant toxic effect on N. oculata cultured in both water samples. P-chloroaniline inhibited its net oxygenation rate and oxygen consumption rate. Butyl acrylate inhibited the net oxygenation rate whereas significantly stimulated oxygen consumption rate. Performance of N. oculata changed between two water samples under same level of p-chloroaniline and butyl acrylate. The net oxygenation rate of N. oculata cultured in the seawater from the Jiaozhou bay increased by 11.60 %, the oxygen consumption rate increased by 26.91 %, algae cell growth decreased by 16.83 %, compared to those from Laizhou bay. The Fv/Fm of N. oculata cultured in Jiaozhou bay was more significantly inhibited at 0.5 and 2.0 mg L^-1 p-chloroaniline, while it was significantly inhibited at 5. 0 mg L^-1 of butyl acrylate, compared to those from Laizhou bay. Moreover, the toxic effect of both HNS on net oxygenation rate and oxygen consumption rate were significantly attenuated as the concentration increased. The growth inhibition of microalgae cultured in two seawater samples was more evident at 0.5 and 5.0 mg L^-1 p-chloroaniline than at 2.0 mg L^-1 p-chloroaniline,and the growth inhibition of microalgae cultured in two seawater samples was more evident at 2.0 and 5.0 mg L^-1 butyl acrylate than at 0.5 mg L^-1 butyl acrylate. These results indicated that toxic effect of p-chloroaniline and butyl acrylate on the growth of N. oculata was influenced by the pollutants in the two water samples. Consequently, a corresponding research on water sample is required in advance to increase accuracy of future ecological risk assessment of HNS.

Environmental risk assessment of accidental marine spills: A new approach combining an online dynamic Hazardous and Noxious substances database with numerical dispersion, risk and population modelling

The foreseen rise on maritime transportation of Hazardous and Noxious Substances (HNS) increases the likelihood of accidents, leading to a higher risk of chemical spillage that can have severe ecological impacts. Considering the lack of information on HNS spills, the response to these events is less well established than those involving oil. Moreover, a paramount knowledge of the physicochemical and ecotoxicological properties of the substance involved is required for an effective environmental risk assessment and response to an HNS spill. In the present work, a new online interface, in which a dynamic HNS database feeds a chemical numerical dispersion model, was developed with the aim to improve predictions regarding the behaviour and environmental risk of HNS spills on marine ecosystems. Potential impacts to pelagic organisms were characterized by coupling model outputs with toxicity risk ratios. Furthermore, a simple population model was developed, foreseeing impacts at the ecological level. The integration of the developed tools establishes an innovative framework, which aims to improve predictions related to HNS plumes' behaviour and potential hazards to the marine environment and associated ecosystem services. Further, this new approach fosters an improved preparedness and response to coastal pollution incidents, enhancing effective decision making and management by competent authorities.

Initial environmental risk assessment of hazardous and noxious substances (HNS) spill accidents to mitigate its damages

In this study, a system was established to perform an initial environmental risk assessment of hazardous and noxious substances (HNS) spill accidents. Initial environmental risk assessment was performed using exposure and hazard assessments. An integrated hydrodynamic and chemical fate model was used to predict HNS concentrations at harbors, taking into account local environmental conditions. To consider the worst case HNS spill accident, the spill amount of 10,000 tonnages, was used for this study. The results show that highly soluble HNS are fatal to marine organisms during the neap tide. The results were based on a hypothetical worst case HNS spill accident and, not any specific actual HNS spill accident. Nevertheless, the method and system developed in this study, which includes the physical/chemical properties of 158 priority HNS, can be readily used to perform an initial environmental risk assessment for future HNS spill accidents.

Fabrication and Characterization of Nanoenergetic Hollow Spherical Hexanitrostibene (HNS) Derivatives

The spherization of nanoenergetic materials is the best way to improve the sensitivity and increase loading densities and detonation properties for weapons and ammunition, but the preparation of spherical nanoenergetic materials with high regularization, uniform size and monodispersity is still a challenge. In this paper, nanoenergetic hollow spherical hexanitrostibene (HNS) derivatives were fabricated via a one-pot copolymerization strategy, which is based on the reaction of HNS and piperazine in acetonitrile solution. Characterization results indicated the as-prepared reaction nanoenergetic products were HNS-derived oligomers, where a free radical copolymerization reaction process was inferred. The hollow sphere structure of the HNS derivatives was characterized by scanning electron microscopy (SEM), transmission electron microscope (TEM), and synchrotron radiation X-ray imaging technology. The properties of the nanoenergetic hollow spherical derivatives, including thermal decomposition and sensitivity are discussed in detail. Sensitivity studies showed that the nanoenergetic derivatives exhibited lower impact, friction and spark sensitivity than raw HNS. Thermogravimetric-differential scanning calorimeter (TG-DSC) results showed that continuous exothermic decomposition occurred in the whole temperature range, which indicated that nanoenergetic derivatives have a unique role in thermal applications. Therefore, nanoenergetic hollow spherical HNS derivatives could provide a new way to modify the properties of certain energetic compounds and fabricate spherical nanomaterials to improve the charge configuration.

Suppression of capsule expression in Δlon strains of Escherichia coli by two novel rpoB mutations in concert with HNS: possible role for DNA bending at rcsA promoter

Analyses of mutations in genes coding for subunits of RNA polymerase always throw more light on the intricate events that regulate the expression of gene(s). Lon protease of Escherichia coli is implicated in the turnover of RcsA (positive regulator of genes involved in capsular polysaccharide synthesis) and SulA (cell division inhibitor induced upon DNA damage). Failure to degrade RcsA and SulA makes lon mutant cells to overproduce capsular polysaccharides and to become sensitive to DNA damaging agents. Earlier reports on suppressors for these characteristic lon phenotypes related the role of cochaperon DnaJ and tmRNA. Here, we report the isolation and characterization of two novel mutations in rpoB gene capable of modulating the expression of cps genes in Δlon strains of E. coli in concert with HNS. clpA, clpB, clpY, and clpQ mutations do not affect this capsule expression suppressor (Ces) phenotype. These mutant RNA polymerases affect rcsA transcription, but per se are not defective either at rcsA or at cps promoters. The results combined with bioinformatics analyses indicate that the weaker interaction between the enzyme and DNA::RNA hybrid during transcription might play a vital role in the lower level expression of rcsA. These results might have relevance to pathogenesis in related bacteria.

Ecological modelling and toxicity data coupled to assess population recovery of marine amphipod Gammarus locusta: Application to disturbance by chronic exposure to aniline

A population agent-based model of marine amphipod Gammarus locusta was designed and implemented as a basis for ecological risk assessment of chemical pollutants impairing life-history traits at the individual level. We further used the model to assess the toxic effects of aniline (a priority hazardous and noxious substance, HNS) on amphipod populations using empirically-built dose-response functions derived from a chronic bioassay that we previously performed with this species. We observed a significant toxicant-induced mortality and adverse effects in reproductive performance (reduction of newborn production) in G. locusta at the individual level. Coupling the population model with the toxicological data from the chronic bioassay allowed the projection of the ecological costs associated with exposure to aniline that might occur in wild populations. Model simulations with different scenarios indicated that even low level prolonged exposure to the HNS aniline can have significant long-term impacts on G. locusta population abundance, until the impacted population returns to undisturbed levels. This approach may be a useful complement in ecotoxicological studies of chemical pollution to transfer individual-collected data to ecological-relevant levels.

Effect of cold working on biocompatibility of Ni-free high nitrogen austenitic stainless steels using Dalton's Lymphoma cell line

The aims of the present work are to explore the effect of cold working on in-vitro biocompatibility of indigenized low cost Ni-free nitrogen containing austenitic stainless steels (HNSs) and to compare it with conventionally used biomedical grade, i.e. AISI 316L and 316LVM, using Dalton's Lymphoma (DL) cell line. The MTT assay [3-(4,5-dimethythiazol 2-yl)-2,5-diphenyltetrazolium bromide] was performed on DL cell line for cytotoxicity evaluation and cell adhesion test. As a result, it was observed that the HNS had higher cell proliferation and cell growth and it increases by increasing nitrogen content and degree of cold working. The surface wettability of the alloys was also investigated by water contact angle measurements. The value of contact angles was found to decrease with increase in nitrogen content and degree of cold working. This indicates that the hydrophilic character increases with increasing nitrogen content and degree of cold working which further attributed to enhance the surface free energy (SFE) which would be conducive to cell adhesion which in turn increases the cell proliferation.