Surgery for obstructive sleep apnea (OSA) has changed in concept and technique that transformed from radical excision to functional reconstruction. The aim of this study was to investigate the safety ...and effectiveness of palatal hybrid surgery in OSA patients.
Palatal hybrid surgery is a tissue-specific technique (mucosa-preservation, tonsil-excision, fat-ablation, muscle-relocation/suspension) used in treating OSA patients with velopharyngeal obstruction. The study included 46 consecutive adults OSA patients. The palatal hybrid surgery annotates uvulopalatopharyngoplasty in stereoscopic reconstruction of tonsillar fossa (pharyngoplasty), omni-suspension of the soft palate (palatoplasty) and advancement of uvula (uvuloplasty).
No patient experienced airway compromise, voice change or persistent nasal regurgitation following palatal hybrid surgery. One patient existed postoperative tonsillar fossa bleeding received conservative treatment. Postoperative pain in visual analogue scale (VAS) showed average score of 3, 3, 2, 0 at the 1st, 3rd, 7th, 14th day, respectively. Perioperative snoring severity (VAS) (8.7 vs 2.6) and daytime sleepiness (Epworth Sleepiness Scale) (11.3 vs 5.5) all improved significantly (p < 0.001). Posterior air space in retropalatal area increased from 8.4 to 11.1 mm (p < 0.001). Home sleep test showed that apnea–hypopnea index significantly reduced from 41.8 to 18.2 event/h and minimal oxygen saturation increased from 72.4 to 81.5% (p < 0.001). The success rate in individual Friedman stage was 100% (stage I), 63% (stage II) and 58% (stage III) with a total success rate of 63%.
Palatal hybrid surgery using tissue-specific maneuver annotates UPPP in concept and technique. The results show that palatal hybrid surgery is mini-invasive with low morbid and is effective in improving subjective clinic symptoms, objective sleep parameters and success rate of OSA.
Oral squamous cell carcinoma is a prominent cancer worldwide, particularly in Taiwan. By integrating omics analyses in 50 matched samples, we uncover in Taiwanese patients a predominant mutation ...signature associated with cytidine deaminase APOBEC, which correlates with the upregulation of APOBEC3A expression in the APOBEC3 gene cluster at 22q13. APOBEC3A expression is significantly higher in tumors carrying APOBEC3B-deletion allele(s). High-level APOBEC3A expression is associated with better overall survival, especially among patients carrying APOBEC3B-deletion alleles, as examined in a second cohort (n = 188; p = 0.004). The frequency of APOBEC3B-deletion alleles is ~50% in 143 genotyped oral squamous cell carcinoma -Taiwan samples (27A3B
:89A3B
:27A3B
), compared to the 5.8% found in 314 OSCC-TCGA samples. We thus report a frequent APOBEC mutational profile, which relates to a APOBEC3B-deletion germline polymorphism in Taiwanese oral squamous cell carcinoma that impacts expression of APOBEC3A, and is shown to be of clinical prognostic relevance. Our finding might be recapitulated by genomic studies in other cancer types.Oral squamous cell carcinoma is a prevalent malignancy in Taiwan. Here, the authors show that OSCC in Taiwanese show a frequent deletion polymorphism in the cytidine deaminases gene cluster APOBEC3 resulting in increased expression of A3A, which is shown to be of clinical prognostic relevance.
博士
國立成功大學
化學工程學系碩博士班
95
Hydroxyl radical (HO•) is very reactive, underlying the chemistry of advanced oxation processes (AOPs) for degrading organic compounds in water. Among various AOPs, Fenton’s ...reagent (H2O2/Fe2+) has been known to be an effective and simple oxidant. The major drawback of Fenton’s reaction is the production of substantial amount of Fe(OH)3 sludge that requires further separation and disposal. To solve this problem, using the low concentration of iron ions in conventional homogeneous Fenton and Fenton-like reaction was attempted. Furthermore, the application of iron oxide as the heterogeneous photoassisted Fenton catalyst in oxidizing organic contaminants deserves an in-depth investigation.
This study investigated Fenton and Fenton-like reactions at low iron concentration (≦10 mg l-1) to oxidize three commercial azo dyes, namely Red MX-5B, Reactive Black 5 (RB5) and Orange G. This investigation reveals that both of these methods can remove the color of these dyes completely after 120 min of reaction in the presence of only 1 mg l-1 iron concentration. However, only 37%, 28% and 31% TOC of 0.1 mM Red MX-5B, Reactive Black 5 and Orange G can be eliminated after 480 min of reaction in the presence of 1 mg l-1 Fe3+, and 100 mg l-1 H2O2 at pH 2.5. This result is also found that it is easily to decolorize but hardly to mineralize the azo dyes in Fenton-like system at low iron concentration. In addition, this system has two major shortcomings. The first is that the system must be operated at low pH value. The second is that the TOC removal of this system is low. Therefore, heterogeneous catalysts of the photoassisted Fenton reaction instead of conventional homogeneous Fenton and Fenton-like reaction.
A novel activated alumina-supported iron oxide (denoted as FeAA-25), prepared using a fluidized-bed reactor (FBR), and was utilized as a catalyst of the heterogeneous photoassisted Fenton degradation of azo-dye RB5. The major components coated on the surface were identified as amorphous iron oxide and α-FeOOH. The characteristics of supported FeAA-25 including the particle morphology, surface atomic compositions, total and oxalate-soluble Fe contents and the specific surface area were determined. Photooxidation of RB5 by H2O2 was performed with FeAA-25 in a batch reactor in the range of pH 2.5–6.0. The degradation of RB5 comes from two perspectives. One is the catalysis from the iron oxide (hetergeneous reaction). The other is the catalysis from the Fe ions leaching form the catalyst to solution (homogeneous reaction). Conclusively, although the homogeneous catalysis is primarily below pH 3.5, heterogeneous catalysis contributes increasing importance to the oxidation of RB5 at pH 4.0–6.0. It has been found that the presence of UVA light, both for homogeneous and heterogeneous reactions shows that the efficiency of degradation of RB5 could be raised about 20%.
Furthermore, a simplified mechanism of RB5 decomposition that is consistent with the experimental findings for a solution with a pH of up to 7.0 is proposed. About 70% decolorization was measured and 45% of the total organic carbon was eliminated on the surface of the iron oxide at pH 7.0 after 240 min in the presence of 0.1 mM RB5, 5.0 g FeAA-25/L, 29.4 mM H2O2, under 15W UVA. In this mechanism, the adsorption and desorption behaviours of RB5 on FeAA-25 were also studied. The advantage of the use of the FeAA-25 as the heterogeneous photoassisted Fenton catalyst is that the degradation up to pH 7.0. However, the degradation rate of the system is slow.
Finally, we hope to combine the homogeneous photo-Fenton with heterogeneous photoassisted Fenton for degradation of RB5. For reducing the amount of Fe leaching from the FeAA-25 catalyst in an acidic environment, we modify the structure of the FeAA-25 catalyst surface by calcining. After calcining, the FeAA-25 became another novel photo-catalyst (denoted as FeAA-500). The photo-catalytic activity of the FeAA-500 was evaluated in the photooxidative degradation of 0.1 mM RB5 in the presence of H2O2 and UVA light (λ = 365 nm) in a solution with a pH of 2.5. Complete decolorization of the model pollutant RB5 was achieved; the total organic carbon (TOC) removal ratio was 95% after 120 min of reaction.
Zr46Ti26Ni28 thin film metallic glass was fabricated by radio frequency magnetron single target sputtering on Si and stainless steel substrates. The as-deposited film was found to be fully amorphous ...with high glass transition and crystallization temperatures of 466°C and 502°C, respectively. Its hardness progressively increased from 6.2GPa to as high as 11.1GPa when subjected to annealing near the glass-transition temperature at 450°C. It was also of good adhesive strength and scratch resistance after the annealing treatment at 400°C. Transmission electron microscopy results revealed annealing-induced nanocrystals that accounted for such superior mechanical properties. With the above unique properties, Zr–Ti–Ni thin film metallic glass has the potential for the fabrication of high strength micro parts and protective coating.
Progress in the development of sensor technology has increased the speed and convenience of remote sensing (RS) image acquisition. As the volume of RS images steadily increases, the challenge is no ...longer in producing and acquiring an RS image, but in finding a particular image from numerous RS images that precisely meets user application needs. Some spatial measuring methods specific to the recommendation of RS images have been proposed and could be used to score and sort RS images according to users’ requests. Our previous study introduced two measuring methods, namely, available space (AS) and image extension (IE), which have similar results but complementary effects for spatially ranking recommended images. The AS indicator could cover the inadequacies of the IE indicator in some cases and vice versa. The current study combines these two indicators using principal component analysis and produced a new indicator called INDEX, which we used in the RS image spatial recommendation. The ranking results were measured using a normalized discounted cumulative gain (NDCG) and several other statistic criteria. The results indicate that users are more satisfied with the recommendations of the INDEX indicator than those of AS, IE and Hausdorff distance for single RS image type selections which is the most common scenario for RS image applications. When dealing with hybrid RS image types, the INDEX indicator performs very closely to the dominant IE indicator, yet maintaining the characteristics of the AS indicator.
Patients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal ...cartilage implant (SCI) for snoring and obstructive sleep apnea.
This was a preliminary study of 10 consecutive patients who were enrolled retrospectively from electronic charts. The patients had undergone a single-stage operation including septoturbinoplasty and palatal SCI at a tertiary referral hospital. After nasal surgery, the harvested cartilage was prepared and trimmed into strips for palatal implantation. Key procedures of palatal SCI include vertical tunneling of the midline and paramedian soft palate, insertion of the septal cartilage strips, and fixation suture of the implants. The primary outcome measures were adverse events, including implant extrusion, infection, bleeding, velopharyngeal insufficiency and globus symptoms, assessed by the Glasgow–Edinburgh Throat Scale (GETS) questionnaire (10-item, 8-grade 0–7 Likert scale). Secondary outcomes were subjective snoring loudness (visual analogue scale, VAS), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and objective apnea-hypopnea index. All patients were followed up for at least 1 year.
None of the aforementioned adverse events were noted during the one-year follow-up. Among the ten items of the GETS, the median score of nine items was 0, and the median score of the total GETS was 2.0, which was classified as “asymptomatic”. The snoring loudness improved significantly from 8.0 points (IQR 8.0–9.0) preoperation to 4.0 points (IQR 2.5–6.0) at 3 months postoperation and 4.5 points (IQR 3.3–6.0) at 1 year postoperation (P=0.002 and P=0.002, respectively). The ESS score improved significantly from 11.5 points (IQR 8.3–18.5) preoperation to 8.0 points (IQR 6.3–10.8) at 3 months postoperation and 8.5 points (IQR 6.3–10.8) at 1 year postoperation (P=0.004 and P=0.004, respectively). The apnea-hypopnea index significantly decreased from 54.7 (IQR 23.4–62.8) to 20.5 (IQR 14.7–45.6) (P=0.047) in patients with a lower tongue position (modified Mallampati class≤II; n=7).
Palatal SCI is a safe and feasible procedure. The advantages include providing implants of tailor-made length, biocompatible autologous cartilage and no need for extra-payment for the implant material. By using the SCI procedure, both nasal obstruction and sleep-disordered breathing can be managed in a single-stage operation. The long-term effectiveness of SCI deserves further research.
The overnight rostral fluid shift from the lower limbs is one of the causes of obstructive sleep apnea (OSA). Compression stockings (CS) prevent lower limb fluid retention and have been reported to ...decrease nighttime fluid shift. The aim of this study is to evaluate the effect of CS on fluid shift and the severity of OSA.
A systematic literature search was performed in the PubMed, EMBASE and Cochrane Library databases. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Studies evaluating the effect of CS on the overnight fluid shift and OSA severity were included in the analysis.
A total of 4 studies were included in this meta-analysis. The pooled analysis showed that the apnea-hypopnea index (AHI) of the overall study group was significantly lower after using CS (SMD, -1.08; 95% CI, -1.49 to -0.67). Decreases in the AHI were also observed in the normal fluid status (SMD, -1.05; 95% CI, -1.73 to -0.37) and fluid overload status (SMD, -1.17; 95% CI, -1.76 to -0.58) populations. The overall study group had significant decreases in overnight changes in neck circumference (SMD, -1.05; 95% CI, -2.06 to -0.03) and leg fluid volume (SMD, -1.14; 95% CI, -1.88 to -0.41) after using CS. However, no significant differences in overnight changes in neck circumference and leg fluid volume were observed in normal fluid status patients.
CS may help decrease overnight fluid shift and could be a treatment option for OSA.
Abstract
With the proliferation of genomic sequence data for biomedical research, the exploration of human genetic information by domain experts requires a comprehensive interrogation of large ...numbers of scientific publications in PubMed. However, a query in PubMed essentially provides search results sorted only by the date of publication. A search engine for retrieving and interpreting complex relations between biomedical concepts in scientific publications remains lacking. Here, we present pubmedKB, a web server designed to extract and visualize semantic relationships between four biomedical entity types: variants, genes, diseases, and chemicals. pubmedKB uses state-of-the-art natural language processing techniques to extract semantic relations from the large number of PubMed abstracts. Currently, over 2 million semantic relations between biomedical entity pairs are extracted from over 33 million PubMed abstracts in pubmedKB. pubmedKB has a user-friendly interface with an interactive semantic graph, enabling the user to easily query entities and explore entity relations. Supporting sentences with the highlighted snippets allow to easily navigate the publications. Combined with a new explorative approach to literature mining and an interactive interface for researchers, pubmedKB thus enables rapid, intelligent searching of the large biomedical literature to provide useful knowledge and insights. pubmedKB is available at https://www.pubmedkb.cc/.
Graphical Abstract
Graphical Abstract
pubmedKB: an interactive web server for exploring biomedical entity relations in the biomedical literature.
(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide ...retrospective cohort study on the sleep apnea-DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (
< 0.001). A strong sleep apnea-DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28-2.28;
< 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.
This study aims to explore the factors that contribute to epiglottic collapse (EC) in patients with obstructive sleep apnea (OSA).
This study enrolled 35 patients (34 males; median age, 39 years; ...median apnea-hypopnea index (AHI), 55.4 events/h; median body mass index (BMI), 26.9 kg/m
). EC (epiglottis attaching onto the posterior pharyngeal wall) was diagnosed by drug-induced sleep computed tomography (DI-SCT). Three dimensions were assessed for comparison between the EC and non-EC (NEC) groups that included anatomical measurement: epiglottic length and angle, endoscopic classification of epiglottis obstructing the glottis (Type I, none; Type II, partial; and Type III, total), and dynamic hyoid movement during DI-SCT (Δ hyoid = √(x
+ y
), maximal displacement of hyoid in
and
axes during sleep breathing cycle).
EC was found in 12 patients (34%). No difference in age, gender, AHI, and BMI between the two groups was noted. The anatomical measurement revealed that epiglottis length was significantly different between the EC and NEC groups (21.2 vs 15.8 mm;
< 0.001), with a cutoff value of 16.6 mm (sensitivity, 100%; specificity, 65.2%). The EC group patients showed larger hyoid movement than the NEC group patients (Δ hyoid, 4.8 vs 3.0 mm;
= 0.027). By contrast, epiglottic angle and endoscopic classification revealed an insignificant difference between the two groups.
Epiglottis is a potential collapse site among multilevel obstruction in moderate to severe OSA patients. Epiglottic length is highly sensitive in predicting EC, with the cutoff value of 16.6 mm. Hyoid movement plays a role in contributing to EC in OSA patients.
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