Maxillomandibular Advancement Efficacy in Obstructive Sleep Apnea Patients With Class 2 Versus 3 Dentofacial Deformity.

OBJECTIVE: To compare the efficacy of maxillomandibular advancement (MMA) for patients with obstructive sleep apnea (OSA) with class 2 versus 3 dentofacial deformities (DFDs). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary sleep surgery center. METHODS: Patients with OSA and DFD class 2 versus 3 undergoing MMA at Stanford Sleep Surgery between 2014 and 2021 were matched by preoperative body mass index (BMI), age, and sex. Postoperative outcome was compared with polysomnography measures and patient-reported outcome measures (PROMs). RESULTS: Twenty-eight matched subjects, 14 in each deformity group were identified and assessed. The mean age (standard deviation) was 34.29 (10.21) and 33.86 (10.23) for classes 2 and 3, respectively. The apnea-hypopnea index (AHI) decreased from 43.42 (28.30) to 9.6 (5.29) (p < .001) and 37.17 (35.77) to 11.81 (15.74) (p = .042) in class 2 and 3 subjects, respectively. The oxygen desaturation index (ODI) changed from 30.48 (24.02) to 6.88 (3.39) (p = .024) and 11.43 (11.40) to 5.44 (7.96) (p = .85) in class 2 and 3 subjects, respectively. The Epworth sleepiness scale changed from 8.93 (5.28) to 3.91 (2.70) (p = .018) and 10.23 (4.38) to 4.22 (3.07) (p = .006) in class 2 and 3 subjects, respectively. CONCLUSION: Among age, sex, and BMI-matched subjects, MMA is equally effective in both dentofacial class 2 and 3 groups, both objectively and subjectively. Preoperatively, dentofacial class 2 patients with OSA presented with the more severe disease with higher AHI and ODI. Dentofacial class 3 patients with OSA may require additional attention to improve nasal function outcomes.

T-Cell Receptor Repertoire Sequencing in the Era of Cancer Immunotherapy.

T cells are integral components of the adaptive immune system, and their responses are mediated by unique T-cell receptors (TCR) that recognize specific antigens from a variety of biological contexts. As a result, analyzing the T-cell repertoire offers a better understanding of immune responses and of diseases like cancer. Next-generation sequencing technologies have greatly enabled the high-throughput analysis of the TCR repertoire. On the basis of our extensive experience in the field from the past decade, we provide an overview of TCR sequencing, from the initial library preparation steps to sequencing and analysis methods and finally to functional validation techniques. With regards to data analysis, we detail important TCR repertoire metrics and present several computational tools for predicting antigen specificity. Finally, we highlight important applications of TCR sequencing and repertoire analysis to understanding tumor biology and developing cancer immunotherapies.

Static and dynamic pupillary characteristics in multiple sclerosis.

PURPOSE: To examine the static and dynamic pupillary functions with automated pupillography in multiple sclerosis (MS) patients with preserved visual acuity. METHODS: Forty-seven MS patients with preserved visual acuity were included in the study group and 43 healthy volunteers in the control group. The visual evoked potential of the patients was obtained. After routine ophthalmologic examination contrast sensitivity and the retinal nerve fiber layer (RNFL) thickness were measured. Finally scotopic, mesopic, and photopic pupillographies followed by dynamic pupillography were undertaken, and the pupillary dilatation speed was calculated. RESULTS: The contrast sensitivity and RNFL thickness of the MS group were significantly lower than those of the control group (p < 0.05; for both). In the MS and control groups, the scotopic pupil diameters were 5.48 ± 1.03 and 5.28 ± 0.78 mm, mesopic pupil diameters were 4.82 ± 0.83 and 4.48 ± 0.70 mm, and photopic pupil diameters were 3.84 ± 0.79 and 3.42 ± 0.49 mm, respectively (p = 0.315, p = 0.044, and p = 0.004, respectively). In dynamic pupillography, the pupil in the MS group was more dilated than control group at all time sections examined except the sixth second (p < 0.05; for all). Although the mean pupillary dilation speed in the first second was higher in the MS group (p = 0.044), there was no significant difference between the groups for the other time intervals examined (p > 0.05; for all). There was no correlation between pupillary parameters and P100-wave latency, RNFL thickness, or contrast sensitivity (p > 0.05; for all). CONCLUSIONS: Static and dynamic pupillary functions may be affected in MS patients with preserved visual acuity. Although scotopic pupillary functions are preserved, mesopic, and photopic pupil functions are weakened.

Cingulate infarction: A neuropsychological and neuroimaging study.

BACKGROUND AND PURPOSE: Ischemic lesions rarely affect the cingulate cortex (CC) in isolation, restricting human lesion/behavioural change correlational analysis. The aim of this study was to determine clinical, neuropsychological and neuroimaging features of isolated cingulate infarcts. METHODS: We studied, 3800 patients with first-ever ischemic stroke included in our Stroke Registry between 2012 and 2018. Among them we studied 7 patients with an acute isolated cingulate infarct confirmed by MRI. RESULTS: Among all patients, 7 patients (0.01%) showed ischemic lesions in the territory of cingulate cortex territory, allowing us to delineate 2 substantial distributions; (1) Anterior cingulate cortex (ACC) infarction (4 patients [57%]) was presented low vigilance level with apathy, mutism, deficits in executive function, attention, and disturbances of working, episodic and verbal memory; (2) Posterior cingulate cortex (PCC) infarction (3 patients [43%]) developed topographic disorientation, visual memory deficit and affective-emotional behavioural changes. CONCLUSIONS: According rarely seen CC infarction events, we suggest that anterior and posterior CC are functionally separated and differences in clinical presentation are explained by considering; ACC plays a role in executive functions, episodic and working memory, set maintenance, and PCC is focused on spatial and verbal attention, and memory system. We considered that different patterns of cingulate infarcts are the result of variation in cingulate arterial supply or suggest a source of embolism.