Predictors of surgical outcomes for limited palatal muscle resection in patients with obstructive sleep apnea.

OBJECTIVE: Limited palatal muscle resection (LPMR) is a modified palatal surgical technique to correct retropalatal obstruction without complications. This study aims to determine the associated factors affecting the success and cure rate of LPMR in patients with obstructive sleep apnea (OSA), thus guiding patient selection and improving surgical outcome. METHODS: Thirty-five OSA patients underwent LPMR were enrolled. All patients received routine physical examination, preoperative drug-induced sleep endoscopy (DISE), and polysomnography (PSG). Clinical, polysomnographic, cephalometric variables, and DISE findings were evaluated. These measurements were compared between the surgical success and failure group based on the results of preoperative and postoperative PSG. Furthermore, we compared the cured and non-cured groups in the surgical success group. RESULTS: Among 35 patients, the overall success rate was 57 % with a cure rate of 31.4 %. Patients with Friedman stage II had a significantly higher success rate (p = 0.032). According to DISE results, tongue base obstruction affected the surgical outcome (p < 0.001). The success rate was 100 % in the no tongue base obstruction during DISE, 72.2 % in the partial obstruction, and 9.1 % in the total obstruction. Tonsil size is also helpful in predicting surgical success rate (p = 0.041). Furthermore, patients with mild AHI were more likely to be surgical cures. when compared with patients with severe AHI (p = 0.044). CONCLUSION: Patients with larger tonsil size and no tongue base obstruction during DISE may have a higher chance of surgical success with LPMR. The lower AHI may be predictors of surgical cure after LPMR.

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study.

OBJECTIVE: Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHODS: Seventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients' subjective symptoms while the packing was in situ, hemostatic properties, patients' pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Both packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing. CONCLUSION: The use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.

In situ fabrication of self-transformable and hydrophilic poly(ethylene glycol) derivative-modified polysulfone membranes.

A self-transformable sulfonated poly(ethylene glycol) acrylate diblock copolymer (PEG-SO3A/OA) entrapped into polysulfone membrane was studied. The asymmetric membrane structure was prepared by a phase inversion process. The induced hydrophilicity by reorientation of diblock copolymer at the interface was evaluated by contact angle measurement, platelet adhesion test, and electron spectroscopy for chemical analysis (ESCA) depth profiling with ion sputtering. Molecular dynamic (MD) simulations as a function of copolymer density were also performed to obtain optimum interfacial structure information. The dependency of water clustering behavior as a hydrophilicity parameter was described in terms of an atom-atom radial distribution function (RDF). The results showed that the sulfonated diblock copolymer enhanced the hydrophilicity and long-term stability more than the copolymer having no hydrophobic block. Also, according to the ESCA, oxygen composition significantly began to decrease along the membrane depth, indicating the reorientation of diblock chains. The copolymer-entrapped surfaces significantly induced the degree of water clustering, and the resulting equilibrium rearrangement of interfacial structure was distinctly dependent upon the density of the copolymer.

Protein array consisting of sol-gel bioactive platform for detection of E. coli O157:H7.

Sol-gel-derived bioactive platform was fabricated for detection of pathogenic microbes, E. coli O157:H7. Design flexibility of sol-gel technique and ease of fabrication can fulfill to create the surfaces with structural and chemical features that are compatible with biomaterials such as antibody, enzymes, etc. In this study, the bioactive platform was prepared based on the silica gels, which were produced by hydrolyzing tetraethylorthosilane (TEOS) in ethanol. The mercaptopropyl triethoxysilane (MPTS) was mixed with the TEOS solution for the surface functionalization of bioactive platform. During TEOS hydrolysis, the modified thin film was prepared by sol-gel dip coating. Antibody against E. coli O157:H7 was immobilized with a configuration of protein array using piezo-type dispensing system. Surface morphology of the prepared bioactive platform was analyzed using atomic force microscopy (AFM). The antibody-antigen interaction was investigated with fluorescence microscopy and sandwich type immunoassay using fluorescein isothiocyanate (FITC)-labeled antibody. The results showed that antibody was sequestered within the sol-gel-derived bio-gel due to physical adsorption. The measurement of E. coli O157:H7 was done using the fabricated antibody surface. The fluorescence intensity was proportional to the concentration of E. coli O157:H7, of which the detection limit was 10(2)CFU/ml.

Effects of organic matrix proteins on the interfacial structure at the bone-biocompatible nacre interface in vitro.

The biocompatibility and potential osteoinductivity of nacre have favored its use as a bone-grafting material. The present study is to investigate the interfacial structure at the bone-nacre interface resulting from organic matrix proteins, which emphasizes the mechanism of bone-bonding ability and biocompatibility of the shell tissues such as nacre and biogenic calcite. To understand the interfacial reaction, the zeta potential measurements, provide for a unique method to quantify the actual state of the interface in situ, were used for synthetic and biogenic calcium carbonate suspensions with respect to pH and the organic matrix as an additive. The zeta potentials and surface charge density show that the organic matrix proteins are main charge regulators, resulting in the stabilized tissue properties as compared with synthetic crystals. Also, in forming calcium carbonate crystals with the additives, the conformation of organic matrix has an important role in the understanding of the newly formed interfacial structure. The result provides the primary role of the organic matrix proteins in controlling the formation of interfacial structure and biocompatibility with bone as well as the stability of biogenic tissues. And it gives a new insight into the usefulness of zeta potential measurement to describe the in vivo interaction between the bone and implants.

Solitary peritoneal lymph node metastasis of head and neck cancer diagnosed with FDG-PET/CT imaging.

Distant metastasis of head and neck squamous cell carcinoma (SCC) to the infraclavicular lymph nodes-with the exception of the upper mediastinal lymph nodes-is rare. We report the case of a 44-year-old man who was treated with surgery and radiotherapy for SCC of the floor of the mouth. During regular follow-up 6 months after the cessation of radiotherapy, F18-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) detected a hypermetabolic lesion in the left lobe of the liver that was diagnosed as a metastasis of the head and neck SCC; no locoregional recurrence was found. The metastasis was surgically removed and more radiotherapy was administered, but the SCC recurred at the same site and the patient died of disseminated disease 12 months after the appearance of the first metastasis. To the best of our knowledge, this is the first reported case of a solitary peritoneal lymph node metastasis from an SCC of the floor of the mouth. We believe that regular FDG-PET/CT follow-up scans are useful for the detection of unusual distant metastases of head and neck cancers.

The efficacy of Cutanplast nasal packing after endoscopic sinus surgery: a prospective, randomized, controlled trial.

OBJECTIVES/HYPOTHESIS: Absorbable packing materials are commonly used after endoscopic sinus surgery (ESS). Cutanplast is a novel gelatin sponge with a powerful hemostatic effect that is rapidly absorbed. The purpose of this study was to investigate the efficacy of Cutanplast in patients following ESS. STUDY DESIGN: A multicenter, prospective, randomized, double-blind, paired, controlled trial. METHODS: One hundred adult patients with chronic sinusitis requiring the same extent of ESS were included. Patients were excluded if they were undergoing septoplasty, turbinate surgery, revision surgery, and taking anticoagulants. Following surgery, one nasal cavity was packed with Cutanplast and the other one with Merocel. Hemostatic properties, patient discomfort while the packing was in situ, patient pain on removal, degree of bleeding on removal, time required to control bleeding after removal, the cost of the pack, and postoperative wound healing were evaluated. RESULTS: Both packs were effective at preventing postoperative hemorrhage. However, Cutanplast was significantly more comfortable while in situ (mean difference, 0.90; 95% confidence interval [CI], 0.75-1.25) and less painful on removal of the pack (mean difference, 1.36; 95% CI, 0.85-1.71). The Merocel pack was associated with significantly more bleeding on removal (mean difference, 1.23; 95% CI, 0.61-2.29), therefore much time was needed to control hemorrhage (mean difference, 1.05; 95% CI, 0.31-1.45). There was no significant difference in the cost of the pack used and outcome measure of wound healing. CONCLUSIONS: Cutanplast nasal pack results in significantly less pain and less bleeding compared to Merocel pack.