Upper airway stimulation: Fewer complications, ED presentations, readmissions, and increased surgical success.

OBJECTIVES: Evaluate the rate of complications, readmissions, emergency department presentations, and surgical success rates amongst three standard surgical treatment options for obstructive sleep apnea: upper airway stimulation, transoral robotic surgery, and expansion sphincter pharyngoplasty. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary care center. METHODS: Patients were included who were aged ≥18 years old and underwent upper airway stimulation, transoral robotic surgery, or expansion sphincter pharyngoplasty between January 2011 and May 2020. RESULTS: 345 patients were identified: 58% (n = 201) underwent upper airway stimulation, 10% (n = 35) underwent transoral robotic surgery, and 32% (n = 109) patients underwent expansion sphincter pharyngoplasty. There were 22 emergency department presentations and 19 readmissions, most of which were experienced by patients receiving transoral robotic surgery (six emergencies, seven readmissions) and expansion sphincter pharyngoplasty (12 emergencies, 11 readmissions). Patients with upper airway stimulation had four emergencies and one readmission. Only 2% of the upper airway stimulation cohort had a complication, whereas this was 20% and 12% for the transoral robotic surgery and expansion sphincter pharyngoplasty cohorts, respectively. Patients experienced the highest surgical success rate with upper airway stimulation (69%), whereas patients who received transoral robotic surgery and expansion sphincter pharyngoplasty had success rates of 50% and 51%, respectively. CONCLUSION: Treating obstructive sleep apnea with upper airway stimulation led to lower rates of complications, emergency department presentations, and readmissions in this series. In those for whom upper airway stimulation is appropriate, it may be more effective in successfully treating obstructive sleep apnea than transoral robotic surgery and expansion sphincter pharyngoplasty.

Salt water mouthwash post extraction reduced post operative complications.

DESIGN: Randomised controlled trial. INTERVENTION: Patients aged ≥16 years requiring non-surgical extraction were randomised into three groups. Group A (n = 40) were instructed to gargle six times daily with warm saline and group B (n = 40) twice daily; group C (n = 40) were not instructed to gargle with warm saline and served as controls. All patients received the same oral antibiotics and analgesics, and similar postoperative instructions, except regarding saline rinses. Mouth rinsing was to start 24 hours after the procedure and patients were reviewed at 72 hours. OUTCOME MEASURE: The patients were evaluated 72 h post-operatively for the presence of alveolar osteitis, acute inflamed socket and acute infected socket by an independent observer who was blinded to the treatment group. RESULTS: One hundred and twenty patients were randomised (40 per group). The overall prevalence of alveolar osteitis was 10.0% and that of acute inflamed socket was 25.0%. No cases of acute infected socket were observed.There was a statistically significant difference between the study groups with respect to the development of alveolar osteitis (x(2) = 15.43, df = 2, P = 0.001), but not for acute inflamed socket, with only 2.5% of the saline groups (2 out of 80) developing alveolar osteitis compared with 25% (10 of 40) in the control group. CONCLUSIONS: The instruction to use warm saline mouth rinse is beneficial in the prevention of alveolar osteitis after dental extractions. There is no significant difference in the efficacy of the twice-daily warm saline mouth rinse regimen compared to the six times daily regimen. The twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with the six times daily rinse routine.

Experimental and computational investigations of the interactions between model organic compounds and subsequent membrane fouling.

The formation of aggregates of sodium alginate and bovine serum albumin (BSA) (as representative biopolymers) with humic acid were detected by Liquid Chromatography (LC) UV254 response in the biopolymer region for mixture solutions. BSA interaction with humic acid showed that aggregation occurred both in the presence and absence of calcium, suggesting that multivalent ions did not play a part in the aggregation process. Similar analyses of the alginate interaction with humic acid also showed a positive interaction, but only in the presence of calcium ions. The fouling characteristics for the BSA-humic acid mixture appeared to be significantly greater than the fouling characteristics of the individual solutions, while for the sodium alginate-humic acid mixture, the fouling rate was similar to that of the sodium alginate alone. The effectiveness of hydraulic backwashing, 10-15% reversibility, was observed for the BSA-humic acid mixture, while the % reversibility was 20-40% for the sodium alginate-humic acid mixture. Increased humic acid and DOC rejection were observed for both BSA-humic acid and sodium alginate-humic acid solutions compared to the individual solutions, indicating that the biopolymer filter cakes were able to retain humic acids. When compared with BSA-humic acid mixture solution, greater removal of humic acid was observed for alginate-humic mixture, suggesting that sodium alginate may have a greater capacity for associations with humic acid when in the presence of calcium than BSA. Complementary molecular dynamics simulations were designed to provide insights into the specific mechanisms of interaction between BSA and humic acid, as well as between alginate and humic acid. For the BSA-humic acid system; electrostatic, hydrophobic and hydrogen bonding were the dominant types of interactions predicted, whilst divalent ion-mediated bonding was not identified in the simulations, which supported the LC-results. Similarly for the alginate-humic acid system, the interactions predicted were divalent ion-mediated interactions only and this was also supported the LC results. This work suggests that LC-UV254 might be used to identify aggregated biopolymers, and that combined with current characterisation techniques, be used to better explain performance variations between water sources.

Effects of sodium hyaluronate and triamcinolone acetonide on glucosaminoglycan metabolism in equine articular chondrocytes treated with interleukin-1.

OBJECTIVE-To determine whether the effects of a high-molecular-weight sodium hyaluronate alone or in combination with triamcinolone acetonide can mitigate chondrocyte glyocosaminoglycan (GAG) catabolism caused by interleukin (IL)-1 administration. SAMPLE POPULATION-Chondrocytes collected from metacarpophalangeal joints of 10 horses euthanized for reasons unrelated to joint disease. PROCEDURES-Chondrocyte pellets were treated with medium (negative control), medium containing IL-1 only (positive control), or medium containing IL-1 with hyaluronic acid only (0.5 or 2.0 mg/mL), triamcinolone acetonide only (0.06 or 0.6 mg/mL), or hyaluronic acid (0.5 or 2.0 mg/mL) and triamcinolone acetonide (0.06 or 0.6 mg/mL) in combination. Chondrocyte pellets were assayed for newly synthesized GAG, total GAG content, total DNA content, and mRNA for collagen type II, aggrecan, and cyclooxygenase (COX)-2. RESULTS-High-concentration hyaluronic acid increased GAG synthesis, whereas high-concentration triamcinolone acetonide decreased loss of GAG into the medium. High concentrations of hyaluronic acid and triamcinolone acetonide increased total GAG content. There was no change in DNA content with either treatment. Triamcinolone acetonide reduced COX-2 mRNA as well as aggrecan and collagen type II expression. Treatment with hyaluronic acid had no effect on mRNA for COX-2, aggrecan, or collagen type II. CONCLUSIONS AND CLINICAL RELEVANCE-Results indicated that high concentrations of hyaluronic acid or triamcinolone acetonide alone or in combination mitigated effects of IL-1 administration on GAG catabolism of equine chondrocytes.

Effect of dexamethasone supplementation on chondrogenesis of equine mesenchymal stem cells.

OBJECTIVE: To determine whether expansion of equine mesenchymal stem cells (MSCs) by use of fibroblast growth factor-2 (FGF-2) prior to supplementation with dexamethasone during the chondrogenic pellet culture phase would increase chondrocytic matrix markers without stimulating a hypertrophic chondrocytic phenotype. SAMPLE POPULATION: MSCs obtained from 5 young horses. PROCEDURES: First-passage equine monolayer MSCs were supplemented with medium containing FGF-2 (0 or 100 ng/mL). Confluent MSCs were transferred to pellet cultures and maintained in chondrogenic medium containing 0 or 10(7)M dexamethasone. Pellets were collected after 1, 7, and 14 days and analyzed for collagen type II protein content; total glycosaminoglycan content; total DNA content; alkaline phosphatase (ALP) activity; and mRNA of aggrecan, collagen type II, ALP, and elongation factor-1alpha. RESULTS: Treatment with FGF-2, dexamethasone, or both increased pellet collagen type II content, total glycosaminoglycan content, and mRNA expression of aggrecan. The DNA content of the MSC control pellets decreased over time. Treatment with FGF-2, dexamethasone, or both prevented the loss in pellet DNA content over time. Pellet ALP activity and mRNA were increased in MSCs treated with dexamethasone and FGF-2-dexamethasone. After pellet protein data were standardized on the basis of DNA content, only ALP activity of MSCs treated with FGF-2-dexamethasone remained significantly increased. CONCLUSIONS AND CLINICAL RELEVANCE: Dexamethasone and FGF-2 enhanced chondrogenic differentiation of MSCs, primarily through an increase in MSC numbers. Treatment with dexamethasone stimulated ALP activity and ALP mRNA, consistent with the progression of cartilage toward bone. This may be important for MSC-based repair of articular cartilage.