Influence of body mass index on treatment of breathing-related sleep disorders.

BACKGROUND: Breathing-related sleep disorders cover several conditions (isolated snoring, UARS - upper airway resistance syndrome, obstructive sleep apnea, hypopnea, obesity hypoventilation syndrome) characterized by a variety of symptoms and complex etiology. The conditions can be successfully treated in most cases. Excessive body mass is a factor increasing the probability of the disorders. In most patients it is the only reason for breathing-related sleep disorders. However, it often coexists with various anatomical abnormalities in the upper airway, endocrinological diseases or genetic defects of the facial skeleton, and occurs more frequently in older people, especially men. Excessive body mass significantly affects the range and success of the treatment. OBJECTIVE: To analyze treatment outcome in patients treated at the otolaryngology unit for snoring and related diseases with submucosal tissue reduction within the nasal cavity, pharynx, and soft palate. MATERIAL AND METHODS: Patients were stratified into three study groups depending on the body mass index (BMI): normal, overweight, and obese. The BMI value was compared to the severity of breathing disorders during sleep, with the incidence of other systemic diseases (e.g., hypertension, diabetes), and with treatment outcome. RESULTS AND CONCLUSIONS: The analysis demonstrated a significant influence of body mass on snoring, particularly in complicated and severe types of breathing disorders, such obstructive sleep apnea or hypopnea, and the obesity hypoventilation syndrome. Corrective interventions carried out to eliminate anatomical abnormalities causing obstruction of upper airways provided the best therapeutic effects in patients with normal body mass.

Changes of laryngeal parameters during intrauterine life.

OBJECTIVE: Increased care of fetal and neonatal airways has led to advances in neonatal medicine. The early diagnosis and treatment of respiratory diseases require a detailed knowledge of fetal airway anatomy and development. The aim of this study was to determine the anatomical development of the thyroid and cricoid cartilages and their structural variability during fetal life. MATERIAL AND METHODS: The study was performed on the thyroid and cricoid cartilages of 55 human fetal larynges of both sexes, between the ages of 13 and 27 weeks of intrauterine life. Numerous measurements of the thyroid and cricoid cartilages were performed. RESULTS: Correlations between the obtained results were calculated in relation to the crown-rump (C-R) length of human fetuses and to sex. The structural variability of the thyroid and cricoid cartilages of human male and female fetuses in subsequent weeks of intrauterine life was observed. In both genders a correlation between laryngeal size and fetal crown-rump length, regardless of sex, was found. The thyroid cartilage presents a sexual dimorphism. CONCLUSIONS: The results of this study can be useful in the analysis of prenatal examinations, and in planning the treatment of airway emergencies.

Evaluation of spirometry values in relation to beta-2-adrenergic receptor gene polymorphism.

INTRODUCTION: The vagus nerve plays a special role in the control of respiratory system activity which represents the parasympathetic part of the autonomic nervous system. A small bronchial innervation by the sympathetic system also is observed, and there is a significant expression of adrenergic receptors, in particular ß⊂2 receptors, in the airways. The development of genetics and molecular biology allows for a detailed study which can clarify the essential elements in the pathogenesis of many types of lung disease, as well as the physiological phenomena - bronchial smooth muscle tone and their contractile mechanism. MATERIAL AND METHODS: The study involved 148 healthy male volunteers aged 20-26. In all subjects, gene polymorphism at nucleotide position 46 and 79 of ß⊂2-adrenergic receptor (ß⊂2-ADR) was assessed. According to the gene polymorphism data, we divided the whole examined population of males into 6 groups for further studies. Moreover, in all the subjects, we performed spirometry testing to verify their pulmonary functions. RESULTS: The basic values of spirometry tests in all subjects were in the range of normal values. The frequency of different genotypes in the gene polymorphism of the ß⊂2-adrenergic receptor at nucleotide positions 46 and 79 were typical for the Caucasian population. Analysis of the output values of spirometry, conducted in the particular groups based on their genotype, showed significant inter-group differences in the selected spirometry tests. CONCLUSIONS: Our results may be useful in explaining the differences in the measured values of spirometric indices in healthy subjects in relation to the polymorphism of ß⊂2-ADR, and may also contribute to the verification of standards for spirometric indices for this selected group of young males in the Polish population.

Mechanisms of cancer metastasis: involvement of cancer stem cells?

The leading cause of death from cancer is tumor expansion, which usually leads to dissemination and metastasis of malignant cells. Accumulating evidence suggests growing tumors contain some very rare primitive cells that are mobile and thus endowed with metastatic potential. If these cells survive radio/chemotherapy, they are responsible for tumor re-growth after treatment. In this review, we discuss the origin of these cells, which: 1) are true cancer stem cells (CSCs) that initiate tumor growth and are subsequently responsible for metastatic dissemination; or 2) are derived from transformed tumor cells by the epithelial mesenchymal transition phenomenon. We also address major molecular mechanisms involved in trafficking of these cells during metastasis, paying special attention to the underappreciated side effects of radio/chemotherapy that may induce pro-metastatic environments in various organs. Overall, we envision that the process of pathological metastasis of cancer cells reflects a physiological property of normal SCs for their ability to migrate, as seen during embryogenesis. Finally, we discovered highly migratory, very small embryonic-like SCs that are deposited during development in adult tissues. As we hypothesize, these cells could: 1) give rise to some primitive types of tumors; and 2) may have a direct role in cancer expansion by being involved in tumor angiogenesis and formation of tumor stroma.