Long-Term Generator Replacement Experience in Hypoglossal Nerve Stimulator Therapy Recipients With CPAP-Intolerant Obstructive Sleep Apnea.

OBJECTIVE: In the last decade, hypoglossal nerve stimulation (HNS) has emerged as a therapeutic alternative for patients with obstructive sleep apnea. The original clinical trial cohorts are entering the phase of expected battery depletion (8-12 years). This study aimed to examine the surgical experience with implantable pulse generator (IPG) replacements and the associated long-term therapy outcomes. STUDY DESIGN: Retrospective analysis of patients from the original clinical trial databases (STAR, German post-market) who were followed in the ongoing ADHERE registry. SETTING: International multicenter HNS registry. METHODS: The ADHERE registry and clinical trial databases were cross-referenced to identify the serial numbers of IPGs that were replaced. Data collection included demographics, apnea-hypopnea index (AHI), therapy use, operative times, and adverse events. RESULTS: Fourteen patients underwent IPG replacement 8.3 ± 1.1 years after their initial implantation. Body mass index was unchanged between the original implant and IPG replacement (29 ± 4 vs 28 ± 2 kg/m2 , p = .50). The mean IPG replacement operative time was shorter than the original implant (63 ± 50 vs 154 ± 58 minutes, p < .002); however, 2 patients required stimulation lead replacement which significantly increased operative time. For patients with available AHI and adherence data, the mean change in AHI from baseline to latest follow-up (8.7 ± 1.1 years after de novo implant) was -50.06%, and the mean therapy use was 7.2 hours/night. CONCLUSION: IPG replacement surgery was associated with low complications and shorter operative time. For patients with available outcomes data, adherence and efficacy remained stable after 9 years of follow-up.

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review.

Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.

Novel Positional Devices for the Treatment of Positional Obstructive Sleep Apnea, and How This Relates to Sleep Surgery.

If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with severe OSA can reverse to less severe positional OSA or, in other words, the AHI drops more in the lateral position than in supine position. This has been shown for palatal surgery, multilevel surgery, bimaxillary osteotomies, and bariatric surgery. The absence or presence of positional dependency has a great influence on sleep surgery. First, the results of sleep surgery might be worse in positional patients. Second, the addition of positional therapy to sleep surgery might improve the overall outcome and, as such, enhance the indication of sleep surgery as an alternative to continuous positive airway pressure and mandibular advancement device treatment.

Advances in the Diagnosis of Obstructive Sleep Apnea: Drug-Induced Sleep Endoscopy.

Drug-induced sleep endoscopy was introduced in 1991 and has recently evolved into a pivotal instrument for patients in whom obstructive sleep apnea surgery is considered. Here, we discuss the indications, contraindications, technique, anesthesia, scoring systems, validity, and insights of the literature.

Повышение приоритетности образования, здоровья и благополучия школьников: водоснабжение, санитария и гигиена в школах в Общеевропейском регионе

Невозможно гарантировать хорошее здоровье, благополучие, образование и соблюдение человеческого достоинства школьников, если у них в школе не будет доступа к воде и средствам санитарии и гигиены (WASH) приемлемого качества. Обеспечение всем детям здоровых условий окружающей среды в школах в Общеевропейском регионе является одним из фундаментальных положений Пармской декларации по окружающей среде и охране здоровья 2010 г. Все страны региона обязались к 2020 году обеспечить все центры по уходу за детьми, детские сады и школы безопасной питьевой водой и средствами санитарии и возродить здоровую практику соблюдения правил гигиены. Вне всякого сомнения, именно исходя из прав человека на воду и санитарию и на образование в Повестке дня в области устойчивого развития на период до 2030 г. поставлена цель добиться всеобщего и справедливого доступа к безопасным услугам WASH и создать такие учреждения образования, в которых для всех будет обеспечена безопасная среда для учебы. В сфере WASH главным инструментом политики в Общеевропейском регионе является Протокол по проблемам воды и здоровья 1999 г., цель которого заключается в обеспечении доступа к питьевой воде и санитарии для всех – включая детей в школах. Негативное влияние неудовлетворительного качества системы WASH в школах не ограничивается рамками одного сектора. Здоровье, образование, питание и весь комплекс WASH тесно взаимосвязаны и дополняют друг друга. Эта мысль нашла свое отражение в рамочной основе европейской политики в области здравоохранения – Здоровье-2020, где подчеркивается необходимость улучшения сотрудничества между сектором здравоохранения и другими стратегическими секторами, такими как сектор образования, и осуществления совместных инвестиций этими секторами. Подчеркивая, как неудовлетворительное качество услуг WASH в школах подрывает учебу, здоровье и благополучие школьников, авторы данной публикации настаивают на том, что лица, формирующие политику во всех заинтересованных секторах, должны вынести эту проблему в число приоритетных в контексте Протокола и постепенно реализовывать устремления, сформулированные в Повестке дня в области устойчивого развития на период до 2030 г. и в Пармской декларации по окружающей среде и охране здоровья.

Prioritizing pupils’ education, health and well-being: water, sanitation and hygiene in schools in the pan-European region

The good health, well-being, education and dignity of schoolchildren cannot be guaranteed without access to adequate water, sanitation and hygiene (WASH) in schools. Attainment of healthy school environments for all children in the pan-European region is a core pillar of the 2010 Parma Declaration on Environment and Health. All countries in the region have committed to provide all child-care centres, kindergartens and schools with safe drinking-water and sanitation and to revitalize hygiene practices by 2020. Clearly underpinned by the human rights to water and sanitation and to education, the 2030 Agenda for Sustainable Development aspires to reach universal and equitable access to safe WASH services and create educational facilities that provide safe learning environments for all. The 1999 Protocol on Water and Health is the primary policy instrument in the WASH domain in the pan-European region, aiming to ensure access to drinking-water and sanitation for everyone – including children in schools. The impact of inadequate WASH in schools transcends sector boundaries. Health, education, nutrition and WASH are closely associated and complementary. This is well reflected in the European health policy framework Health 2020, which emphasizes the need for enhanced collaboration and joint investment between health and other policy sectors, such as education. By underlining how inadequate WASH in schools compromises pupils’ education, health and well-being, this publication advocates for policy-makers of all involved sectors to prioritize this in the context of the Protocol, incrementally realizing the aspirations of the 2030 Agenda for Sustainable Development and the Parma Declaration.

Delivery of tumor associated antigens to antigen presenting cells using penetratin induces potent immune responses.

Cytoplasmic delivery of proteins or CTL epitopes is crucial for the presentation of antigen for the generation of CTL. We previously described the use of the 16-amino acid peptide penetratin from the Drosophila Antennapedia domain (Int) to transport CTL epitopes into cells. Here we show that, Int, incorporating MUC1 CTL epitopes in tandem is able to facilitate their rapid uptake by macrophages and dendritic cells (DC) in an energy-dependent endocytic pathway. We also demonstrate for the first time that Int conjugated proteins are also able to be efficiently taken up by DC. Furthermore, C57BL/6 and HLA-A2 transgenic mice immunized with the Int-peptides or Int-proteins induce strong IFN-gamma secreting T cells and weak IgG1 antibodies. Immunized C57BL/6 mice were protected against the growth of a MUC1(+) tumor cell line.