Lateral Wall Type Research Articles

Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy.

The goal of this study was to investigate the value of the long-term average spectrum in the acoustic analysis of snore sounds arising from different sources in the upper airway. Long-term average spectrum was used to analyze sequences of 10 consecutive snore sounds that had been divided into 2 groups, soft-palate type and lateral-wall type, according to the vibration site generating the snore sounds and the patterns of soft tissue collapse in the upper airway as identified by drug-induced sleep endoscopy. We calculated the first spectral peak, mean spectral energy, high-frequency energy, 0-1 kHz spectral energy, 1-5 kHz spectral energy, and 0-1 kHz/1-5 kHz difference from each group and compared the differences between them. All parameters except mean spectral energy showed significant differences between the 2 groups. The first spectral peak of less than 265.53 Hz, and the 0-1k/1-5 kHz difference of less than -11.6 dB strongly suggests soft-palate-type snore sounds. Long-term average spectrum has potential application for snore sound source identification. We recommend using first spectral peak and a 0-1 kHz/1-5 Hz difference to identify soft-palate-type snore sounds. Peng H, Xu H, Xu Z, Jia R, Yu H. Long-term average spectrum measures of consecutive snore sounds from different sources determined by drug-induced sleep endoscopy. J Clin Sleep Med. 2023;19(1):145-150.

Effect of Biodegradable Magnesium Alloy Biomaterials on Neurological Rehabilitation of Cerebrovascular Diseases

Elements such as Mg, Zn, and Sr were selected in this research, and the Zn content was set to 3.8%. The relative content of Sr was determined to be 1.0% after the influence of Sr on the microstructure and properties of Mg–Sr alloys was explored. Then, the Mg–3.8Zn–1.0Sr alloy material was prepared, and the uniformity and tensile strength of the material were further increased through solution treatment and aging treatment. When the biodegradation test was performed and the biocompatibility of the material was analyzed, the material was used in the rehabilitation treatment of intracranial wide-necked aneurysms. In the test, the addition of Zn and Sr helped to form the passivation film on the surface of the magnesium alloy, and the second phase of the cross-section generated can prevent the expansion of corrosion. The corrosion rate continued to decrease with time (P < 0.05), and the pH of the DMEM solution participating in the experiment also showed a rising trend (P < 0.05). The hemolysis rate of Mg–3.8Zn–1.0Sr (wt.%) alloy was only 4.54%, indicating that it had a good anti-hemolytic function and showed low toxicity in the cytotoxicity test of the extract. The lateral wall type aneurysm model was constructed in white rabbits, and Mg–3.8Zn–1.0Sr (wt.%) was set as the stent material. Postoperative follow-up showed that the material implantation in the model promoted the complete occlusion of the aneurysm and the unobstructed common carotid artery. The molybdenum target test showed that the prepared magnesium alloy stent gradually degraded with time, and most of it degraded after 12 months. Moreover, clinical trials of intracranial wide-necked aneurysms suggested that alloy stent materials based on the preparation of Mg–3.8Zn–1.0Sr can help patients realize complete embolization. Although there was residual tumor, no recurrence of aneurysm occurred in the re-examination, which proved that the stent material was effective.

Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes

With the increasing use of the Pipeline Embolization Device for the treatment of aneurysms, predictors of clinical and angiographic outcomes are needed. This study aimed to identify predictors of incomplete occlusion at last angiographic follow-up.In our retrospective, single-center cohort study, 105 ICA aneurysms in 89 subjects were treated with Pipeline Embolization Devices. Patients were followed per standardized protocol. Clinical and angiographic outcomes were analyzed. We introduced a new morphologic classification based on the included angle of the parent artery against the neck location: outer convexity type (included angle, <160°), inner convexity type (included angle, >200°), and lateral wall type (160° ≤ included angle ≤200°). This classification reflects the metal coverage rate and flow dynamics.Imaging data were acquired in 95.3% of aneurysms persistent at 6 months. Complete occlusion was achieved in 70.5%, and incomplete occlusion, in 29.5% at last follow-up. Multivariable regression analysis revealed that 60 years of age or older (OR, 5.70; P = .001), aneurysms with the branching artery from the dome (OR, 10.56; P = .002), fusiform aneurysms (OR, 10.2; P = .009), and outer convexity-type saccular aneurysms (versus inner convexity type: OR, 30.3; P < .001; versus lateral wall type: OR, 9.71; P = .001) were independently associated with a higher rate of incomplete occlusion at the last follow-up. No permanent neurologic deficits or rupture were observed in the follow-up period.The aneurysm neck located on the outer convexity is a new, incomplete occlusion predictor, joining older age, fusiform aneurysms, and aneurysms with the branching artery from the dome. No permanent neurologic deficits or rupture was observed in the follow-up, even with incomplete occlusion.

Effect of Cochlear Implant Electrode Array Design on Electrophysiological and Psychophysical Measures: Lateral Wall versus Perimodiolar Types.

Background and ObjectivesThe present study aims to investigate whether the cochlear implant electrode array design affects the electrophysiological and psychophysical measures.Subjects and MethodsEighty five ears were used as data in this retrospective study. They were divided into two groups by the electrode array design: lateral wall type (LW) and perimodiolar type (PM). The electrode site was divided into three regions (basal, medial, apical). The evoked compound action potential (ECAP) threshold, T level, C level, dynamic range (DR), and aided air conduction threshold were measured. ResultsThe ECAP threshold was lower for the PM than for the LW, and decreased as the electrode site was closer to the apical region. The T level was lower for the PM than for the LW, and was lower on the apical region than on the other regions. The C level on the basal region was lower for the PM than for the LW whereas the C level was lower on the apical region than on the other regions. The DRs on the apical region was greater for the PM than for the LW whereas the DR was narrower on the apical region than on the other regions. The aided air conduction threshold was not different for the electrode design and frequency.ConclusionsThe current study would support the advantages of the PM over the LW in that the PM had the lower current level and greater DR, which could result in more localized neural stimulation and reduced power consumption.

Noninvasive Assessment of LV Contraction Patterns Using CMR to Identify Responders to CRT

Type II activation describes the U-shaped electrical activation of the left ventricle (LV) with a line of block in patients with left bundle branch block (LBBB). We sought to determine if a corresponding pattern of contraction could be identified using cardiac magnetic resonance (CMR) cine imaging and whether this predicted response to cardiac resynchronization therapy (CRT). U-shaped LV electrical activation in LBBB has been shown to predict favorable response to CRT. It is not known if the degree of electromechanical coupling is such that the same is true for LV contraction patterns. A total of 52 patients (48% ischemic) scheduled for CRT implantation prospectively underwent pre-implantation CMR cine analysis using endocardial contour tracking software to generate time-volume curves and contraction propagation maps. These were analyzed to assess the contraction sequence of the LV. The effect of contraction pattern on CRT response in terms of reverse remodeling (RR) and clinical parameters (New York Heart Association functional class, 6-min walk distance and Heart Failure Questionnaire score) was assessed at 6 months. Two types of contraction pattern were identified; homogenous spread from septum to lateral wall (type I, n = 27) and presence of block with a subsequent U-shaped contraction pattern (type II, n = 25). Rates of RR in those with a type 2 pattern were significantly greater at 6 months (80% vs. 26%, p < 0.001) as was mean increase in 6-min walk distance (126 ± 106 m vs. 55 ± 60 m; p = 0.004). Cine CMR can identify a U-shaped pattern of contraction which predicts increased echocardiographic and clinical response rates to CRT in patients with LBBB.

Pathophysiological evaluation of cerecyte coil embolization for experimental broad neck aneurysms.

Cerecyte second-generation coils feature inner surfaces coated with an absorbable polyglycolic acid (PGA) polymer. Their use is expected to accelerate aneurysm organization, but time course data are limited. The present experimental study was therefore conducted to clarify the processes by pathological examination. Methods. Two types of experimental aneurysms were initially generated in adult mongrel dogs, one bifurcation and another of lateral wall type. Long-term persistence of each was defined by follow-up angiography for more than 1 year. Embolization of the aneurysms was then performed using only cerecyte coils, and follow-up angiography was conducted after 2 and 4 weeks followed by pathological examination. Results. Organization of both types of broad neck aneurysm was apparent 4 weeks after embolization, which is earlier as compared with already reported data for bare coils.

中咽頭へん平上皮癌における頚部リンパ節郭清

In the present study, we retrospectively investigated states of occult metastases and lymph nodes with recurrent mesopharyngeal squamous cell carcinoma (MPSCC) to find an appropriate mode of neck dissection for MPSCC.Thirty-one patients with MPSCC who underwent neck dissection or were diagnosed with a recurrence in the neck lymph nodes following curative therapy were available for the present study. In cases of NO MPSCC (9 cases), occult metastases and recurrent nodes were mostly limited to ipsilateral levels 1 to 3. One case with recurrence on the lower border (hypopharynx) in the primary region had a reccurred node at level 6. In cases with a single swelling node (3 cases of N1 and 8 cases of N2a), metastases or recurrence never ocurred at level 5. In cases with multiple swelling nodes or a large (>6 cm) node (8 cases of N2b, 1 case of N2c and 2 cases of N3), metastases were spread through ipsilateral levels 1 to 5 but never occurred in contralateral level 5. In cases of lateral wall type, residual lymph node metastases after curative radiation therapy were observed in 3 cases. Consequently, we conclude that ipsilateral level 1 to 4 neck dissection is appropriate for NO mesopharyngeal cancer, ipsilateral or bilateral level 1 to 4 neck dissection for Nl and N2a cases, and ipsilateral level 1 to 5 and contralateral level 1 to 4 neck dissection for more than N2a cases. We also conclude that it is necessary in some cases of lateral wall type to perform neck dissection after curative radiotherapy.

Concomitant Intra-arterial Chemotherapy and Radiation Therapy for Carcinoma of the Oropharynx

Our treatment of carcinoma of the oropharynx has basically been chemoradiotherapy or preoperative radiation therapy. Selective continuous intra-arterial chemotherapy with concurrent radiotherapy has been performed with the aim of organ preservation and improved local control, especially for lateral or superior wall type lesions, and lesions of other subsites (anterior or posterior wall type) have been treated with preoperative radiation therapy with or without chemotherapy. The focus of the present study was to determine whether use of this intraarterial chemotherapy approach improves the outcome of oropharyngeal cancer . A total of 47 patients with squamous cell carcinoma of the oropharynx were treated at Mie University between 1985 and 1998, and all of them have been followed-up for at least 2 years . Thirty-seven of the 47 patients had lateral or superior wall type lesions, and they were divided into two groups for evaluation in this study. The 19 patients in the intra-arterial group were treated by intra-arterial chemotherapy with concurrent radiotherapy, and they were compared with the other 18 patients, who received another form of treatment (control group). In the control group, eight patients were treated by radiation therapy alone and 10 patients were treated by surgery. A complete response rate of 68% was achieved at the primary site in the intra-arterial group. The local control rate was 15/19 (79%) in the intra-arterial therapy group and 9/18(50%) in the control group. The 5-year disease-free survival rates have been 54% and 53%, respectively. The regional control rates have been similar in both groups, but there have been six deaths from distant metastasis in the intra-arterial therapy group and one in the control group. These results indicate that intra-arterial therapy requires further investigation.

A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants.

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome.

A Fiberscopic Analysis of Velopharyngeal Movement before and after Primary Palatoplasty in Cleft Palate Infants

There have been few studies done on the abnormal function of velopharyngeal muscles in unrepaired cleft palate infants. To examine and assess velopharyngeal movement before primary palatoplasty offers supposedly any valuable information for the successful operation and the restoration of excellent velopharyngeal function. We designed to investigate and analyze velopharyngeal movement before and after primary palatoplasty in 26 cleft palate infants with a fine nasopharyngeal fiberscope. We found three different patterns of velopharyngeal movement in unrepaired cleft palate infants when crying or strangulation reflex occurred: (1) posterior movement type (10 cases, 38.5 percent), where the soft palates moved only posteriorly and cephalically and did not move medially; (2) medial movement type (10 cases, 38.5 percent), where the soft palates moved only medially and did not move posteriorly or cephalically; and (3) posteromedial movement type (6 cases, 23.0 percent), where the soft palates moved both posteriorly and cephalically as well as medially. Postoperative velopharyngeal closure was classified into three patterns: (1) the soft palate type, in which the soft palate mainly operates; (2) the lateral wall type, in which compensational medial movement of the lateral pharyngeal wall is mainly observed; and (3) the mixed type, in which both the soft palate and the lateral pharyngeal wall operate. Also, we demonstrated a close relationship between velopharyngeal movement before and after primary palatoplasty in cleft palate infants. In total, 10 of 16 cleft palate infants with the posterior movement type or posteromedial movement type, in which posterior movement of the soft palates was observed before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. On the other hand, only 2 of 10 cleft palate infants with the medial movement type, in which the soft palates did not move posteriorly but medially before primary palatoplasty, postoperatively showed the soft palate type of velopharyngeal closure. The Fisher's exact probability test clarified that cleft palate infants with the posterior movement type or posteromedial movement type were more likely to show postoperatively the soft palate type of the velopharyngeal closure compared with those with the medial movement type (p = 0.051). This is the first trial to examine velopharyngeal movement in unrepaired cleft palate infants. Our Findings indicate the probability that velopharyngeal closure mechanism in repaired cleft palate infants is able to be predicted by velopharyngeal movement behavior before primary palatoplasty. Next, we must clarify a correlation between preoperative velopharyngeal movement and postoperative velopharyngeal function and speech outcome. (Plast. Reconstr. Surg. 102: 668, 1998.)

Incidence of abnormal Q and QS patterns classified by the Minnesota Code in 74 autopsied cases of myocardial infarction in the aged.

The incidence of abnormal Q and QS patterns classified by the Minnesota code in 74 cases of the aged, which were proved at autopsy to have myocardial infarcts, were reviewed with special reference to their size, location and the pathological type according to Wartman's classification. Incidence of the abnormal Q and QS patterns met in each criteria among the infarcted cases was as follows; I-1: 42%, I-2: 16%, I-3: 5%, and I-0: 36%. Among 27 cases of I-0, 13 were showed monophasic elevation of the ST segments or coronary T waves. Although a precise correlation between the size of each type of lesions and the grade of the Q and QS patterns was not confirmed, the small sized transmural lesions involving lateral or posterior wall and islands type of lesions failed to show the abnormal Q and QS patterns. It would seem difficult to make a correct diagnosis of myocardial infarction in about one third of the infarcted cases of the aged group, if diagnosis is based on only the abnormal Q and QS patterns.