Obstructive Sleep Apnea - Influence on the Cardiovascular System and Cognition. / Obstruktive Schlafapnoe ­ Einfluss auf kardiovaskuläres System und Kognition.

Kardiovaskuläre und kognitive Erkrankungen sind ebenso wie die obstruktive Schlafapnoe sehr häufige Krankheiten mit einer erheblichen Beeinträchtigung der Lebensqualität und einer deutlichen sozioökonomischen Bedeutung. Die Auswirkungen einer unbehandelten obstruktiven Schlafapnoe (OSA) auf das kardiovaskuläre und kognitive Erkrankungsrisiko und die Therapieeffekte einer OSA sind für die meisten kardiovaskulären und kognitiven Folgeerkrankungen wissenschaftlich nachgewiesen. Für die klinische Praxis besteht ein deutlicher Bedarf nach mehr Interdisziplinarität. Aus schlafmedizinischer Sicht müssen bei der Therapieindikation das individuelle kardiovaskuläre und kognitive Risiko berücksichtigt und kognitive Erkrankungen bei der Beurteilung der Therapieintoleranz und residuellen Symptomatik beachtet werden. Aus internistischer Sicht sollte bei Patienten mit schlecht einstellbarem Hypertonus, Vorhofflimmern, koronarer Herzkrankheit und Schlaganfall die Abklärung einer OSA in die Diagnostik integriert werden. Bei Patienten mit milder kognitiver Beeinträchtigung, Alzheimer-Krankheit und Depression können sich die typischen Symptome wie Fatigue, Tagesmüdigkeit und Reduktion der kognitiven Leistungen mit OSA-Symptomen überschneiden. Die Diagnostik einer OSA sollte in die Abklärung dieser Krankheitsbilder integriert werden, da eine Therapie der OSA die kognitiven Beeinträchtigungen reduzieren und die Lebensqualität verbessern kann.

Iodine doping of a photocuring, one-component embedding medium for µCT and histology.

OBJECTIVE: Evaluation of µCT scans of bone implant complexes often shows a specific problem: if an implant material has a very similar radiopacity as the embedding medium (e.g. methacrylate resin), the implant is not visible in the µCT image. Segmentation is not possible, and especially osseointegration as one of the most important parameter for biocompatibility is not evaluable. METHODS: To ensure µCT visualisation and contrast enhancement of the evaluated materials, the embedding medium Technovit® VLC7200 was doped with an iodine monomer for higher radiopacity in different concentrations and tested regarding to handling, polymerisation, and histological preparation, and visualisation in µCT. Six different µCT devices were used and compared with regard to scan conditions, contrast, artefacts, image noise, and spatial resolution for the evaluation of the bone-implant blocks. RESULTS: Visualisation and evaluation of all target structures showed very good results in all µCT scans as well as in histology and histological staining, without negative effects caused by iodine doping. Subsequent evaluation of explants of in vivo experiments without losing important information was possible with iodine doped embedding medium. CONCLUSION: Visualisation of implants with a similar radiopacity as the embedding medium could be considerably improved. µCT scan settings should be selected with the highest possible resolution, and different implant materials should be scanned individually for optimal segmentation. µCT devices with higher resolutions should be preferred. ADVANCES IN KNOWLEDGE: Iodine doped embedding medium is a useful option to increase radiopacity for better visualisation and evaluation of special target structures in µCT.

Electrospun mucosal wound dressings containing styptics for bleeding control.

Two major aspects need to be focused to accelerate wound healing of mucosal damages especially in the field of otorhinolaryngology. (i) The problem of application due to the small access during surgery, (ii) the fixation of the wound dressing to reveal a stable healing process. In the present work the high request to a mucosal wound dressing which additionally support hemostasis was addressed. We developed an electrospun fabric made of poly(l-lactide-co-d/l-lactide) (PLA) which can be loaded with the hemostatic agents adrenaline and tranexamic acid to cover mucosal lesions analogues to common skin patches. These loaded electrospun fabrics were demonstrated to be biocompatible, thin and flexible, and thus could be adapted individually to the mucosal defect with respect to localization and size of the lesion. The treatment of mucosal defects with these loaded PLA wound dressings induced a faster and time controlled hemostatic reaction, which significantly improved the healing process.

[Influence of a structured follow-up on CPAP adherence in patients with an OSAS]. / Einfluss einer strukturierten Nachsorge auf die Therapietreue bei OSAS-Patienten unter CPAP-Therapie.

OBJECTIVE: Continuous positive airway pressure (CPAP) therapy is the reference therapy for moderate and severe obstructive sleep apnea syndrome (OSAS). However, CPAP adherence is dissatisfying. We analyzed influencing factors on CPAP adherence and we evaluated if a structured follow-up enhances its adherence. MATERIAL AND METHODS: In this study all patients (n = 237) with a newly adjusted CPAP therapy due to the diagnosis of mild to severe OSAS between 2011 and 2013 were investigated. Follow-up took place every 1593.7 ± 77.4 CPAP operation hours. RESULTS: AHI (Apnea-hypopnea index) decreased significantly during therapy (5.6 ± 8.5/h; p < 0.001). 79 % fulfilled the criteria of CPAP adherence (at least 4 operation hours at 7 days a week). There were no significant influences on CPAP adherence seen in patients' demographic, clinical and pharmacological characteristics. The most common problems of patients receiving a CPAP therapy were dryness of the mucous membranes (43.7 %) and pressure marks (22.4 %). Considering the changes in Epworth Sleepiness Scale there were no significant relations to CPAP adherence. Satisfaction with our follow-up significantly correlated with CPAP adherence (r = 0.185; p = 0.032), whereas therapy pressure did not have any significant influence on CPAP adherence (r = -0.072; p = 0.383). CONCLUSION: A structured and individually adapted follow-up is important. In future, apart from control of therapy success, greater attention in the follow-up of CPAP therapy should be given to aspects of problem solution, feedback, education, and motivation.

Impairments of Speech Comprehension in Patients with Tinnitus-A Review.

Tinnitus describes the subjective perception of a sound despite the absence of external stimulation. Being a sensory symptom the majority of studies focusses on the auditory pathway. In the recent years, a series of studies suggested a crucial involvement of the limbic system in the manifestation and development of chronic tinnitus. Regarding cognitive symptoms, several reviews addressed the presence of cognitive impairments in tinnitus as well and concluded that attention and memory processes are affected. Despite the importance for social communication and the reliance on a highly functional auditory system, speech comprehension remains a largely neglected field in tinnitus research. This is why we review here the existing literature on speech and language functions in tinnitus patients. Reviewed studies suggest that speech comprehension is impaired in patients with tinnitus, especially in the presence of competing noise. This is even the case in tinnitus patients with normal hearing thresholds. Additionally, speech comprehension measures seem independent of other measures such as tinnitus severity and perceived tinnitus loudness. According to the majority of authors, the speech comprehension difficulties arise as a result of central processes or dysfunctional neuroplasticity.

Computed tomography-based training model for otoplasty.

Otoplasty for the correction of protruding ears is characterized by various techniques and a common and popular cosmetic procedure. For the surgeon, whether beginner or advanced, it is essential to understand the principles and master techniques for standard auricular deformities before applying further sophisticated methods, because a lot of complications and failures are caused by wrong indication and incorrect surgical techniques. The different surgical steps are best learned from teaching models. Therefore, we developed two different silicone models of protruding ears with moderate auricular deformities: one with conchal hyperplasia for the training of conchal resection, and one without antihelix for creating an antihelical fold by suturing technique, based on computed tomography scans of patients. The silicone ear models were evaluated during four standardized surgery courses for residents in otorhinolaryngology by 91 participants using specially designed questionnaires. Nearly all participants rated the training on the auricular models as very helpful (n = 51) or good (n = 31); the scores for the different techniques and properties of the models ranged from 2.0 to 2.6 in a range from 1 (very good) to 4 (inadequate). The good results demonstrate the possibility for learning different surgical otoplasty techniques with this newly designed teaching tool.

Surgical preparation for articular cartilage regeneration without penetration of the subchondral bone plate: in vitro and in vivo studies in humans and sheep.

BACKGROUND: To prevent hemorrhage, fibrin clot formation, and subsequent activation of the inflammatory response, surgical preparation for articular cartilage regeneration should avoid penetration of the subchondral bone plate. HYPOTHESIS: Current surgical procedures with ring curettes do not violate the subchondral bone plate. STUDY DESIGN: Controlled laboratory study. METHODS: The subchondral bone plates of normal human (n = 5) or sheep (n = 12) cadaver femoral condyles were prepared in vitro using either traditional debridement for autologous chondrocyte implantation/transplantation (ACI/ACT) or a modified approach aimed at deliberately violating the subchondral bone plate (ie, brute force). Effects were analyzed by light microscopy. In addition, subchondral bone plates of osteoarthritic (OA) human knees undergoing total knee arthroplasty (n = 5) or normal sheep knees (n = 5) were prepared in vivo. To approximate normal/regular wear, in humans, only OA samples with maximally grade 3A (International Cartilage Repair Society score) were used. RESULTS: In both human and sheep (in vitro), no penetration of the subchondral bone plate was observed by either standard preparation or brute force. In vivo, standard preparation of human or sheep knees also did not violate the tidemark line. Human and sheep specimens prepared by brute force, however, occasionally showed areas with an open bone marrow space. CONCLUSION: Traditional debridement techniques for ACI/ACT using a ring curette do not violate the normal subchondral bone plate in vitro or in vivo. Even in OA knee joints, the bone plate is only violated by brute force. Therefore, the standard technique appears suitable for studies on cartilage regeneration in cases of traumatic and possibly even osteoarthritic defects. CLINICAL RELEVANCE: The described surgical preparation technique is the traditional debridement technique for the ACI/ACT. The classic indication for the ACI/ACT is an articular cartilage injury, common in athletes.

Sinonasal inhalation of dornase alfa in CF: A double-blind placebo-controlled cross-over pilot trial.

OBJECTIVE: The paranasal sinuses are almost always involved in cystic fibrosis, and chronic rhinosinusitis and nasal polyps are very frequent in the disease. Hereby, the patients' quality of life and their overall health are relevantly impaired. Although dornase alfa, a mucolytic agent, may also be effective in the upper airways, deposition of inhaled drugs into paranasal sinuses is substantially limited. The novel PARI SINUS™ nebuliser has been shown in deposition studies to deliver aerosol into paranasal sinuses but has not yet been clinically tested. This DBPC pilot-trial applying dornase alfa aims to evaluate outcome parameters and sample sizes for a subsequent efficacy trial. METHODS: Primary outcome parameters assessed were the Sino-Nasal Outcome Test (SNOT-20, a disease-specific quality of life assessment tool) and ventilated volume as measured by magnetic resonance imaging. Five CF patients were randomised to inhale either dornase alfa or 0.9% NaCl for 28 days and, after a wash-out period of 28 days, crossed over to the alternative treatment. RESULTS: Whereas normal saline was not associated with relevant changes in SNOT-20 scores, dornase alfa improved quality of life (p=0.043). MRI results showed no definite trend. CONCLUSION: This first clinical study with the novel device gives promising results for the new therapeutic concept of sinonasal inhalation with vibrating aerosols in regard to further analysis involving larger collectives.

Bone regeneration with glass ceramic implants and calcium phosphate cements in a rabbit cranial defect model.

Hydroxyapatite cement (BoneSource®) and brushite calcium phosphate cement (chronOS™ Inject) were tested for fixation of glass ceramic implants (Bioverit®) in experimentally created cranial defects in 24 adult New Zealand White rabbits. Aim of the in vivo study was to assess and compare the biocompatibility and osseointegration of the implanted materials. Macroscopic and histological evaluations were performed 1 month, 3 months, and 6 months postoperatively. All implanted materials were well tolerated by the surrounding tissue. Both bone cements exhibited osteoconductive properties. Differences could be detected regarding to the rates of cement resorption and new bone formation. The brushite cement was resorbed faster than the hydroxyapatite cement. The chronOS™ Inject samples exhibited a higher rate of connective tissue formation and an insufficient osseointegration. BoneSource® was replaced by bone with minimal invasion of connective tissue. New bone formation occurred faster compared to the chronOS™ Inject group. Bioverit® implants fixed with BoneSource® were successfully osseointegrated.

Tissue adhesives in otorhinolaryngology.

The development of medical tissue adhesives has a long history without finding an all-purpose tissue adhesive for clinical daily routine. This is caused by the specific demands which are made on a tissue adhesive, and the different areas of application. In otorhinolaryngology, on the one hand, this is the mucosal environment as well as the application on bones, cartilage and periphery nerves. On the other hand, there are stressed regions (skin, oral cavity, pharynx, oesophagus, trachea) and unstressed regions (middle ear, nose and paranasal sinuses, cranial bones). But due to the facts that adhesives can have considerable advantages in assuring surgery results, prevention of complications and so reduction of medical costs/treatment expenses, the search for new adhesives for use in otorhinolaryngology will be continued intensively. In parallel, appropriate application systems have to be developed for microscopic and endoscopic use.