Low Arousal Threshold Estimation Predicts Failure of Mandibular Advancement Devices in Obstructive Sleep Apnea Syndrome

Introduction: The treatment of choice for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP). However, CPAP is usually poorly tolerated and mandibular advancement devices (MADs) are an alternative innovative therapeutic approach. Uncertainty still remains as to the most suitable candidates for MAD. Herein, it is hypothesized that the presence of low arousal threshold (low ArTH) could be predictive of MAD treatment failure. Methods: A total of 32 consecutive patients, with OSAS of any severity, who preferred an alternate therapy to CPAP, were treated with a tailored MAD aimed at obtaining 50% of their maximal mandibular advancement. Treatment response after 6 months of therapy was defined as AHI 58.3%. Results: There were 25 (78.1%) responders (p-value < 0.01) at 6 months. Thirteen patients (40.6%) in the non-severe group reached AHI lower than 5 events per hour. MAD treatment significantly reduced the median AHI in all patients from a median value of 22.5 to 6.5 (74.7% of reduction, p-value < 0.001). The mandibular advancement device reduced AHI, whatever the disease severity. A significant higher reduction of Delta AHI, after 6 months of treatment, was found for patients without low ArTH. Conclusions: Low ArTH at baseline was associated with a poorer response to MAD treatment and a lower AHI reduction at 6 months. A non-invasive assessment of Low ArTH can be performed through the Edwards' score, which could help to identify an endotype with a lower predicted response to oral appliances in a clinical setting

Prevalence of Temporomandibular Disorders (TMD) in Dental Patients at a Specialized Regional Medical Center in Italy

Background and aim: This study aimed to evaluate the prevalence of temporomandibular disorders (TMDs) in a sample of general dental patients seeking dental treatments in a northeastern Italian university clinic. Materials and methods: Records of all patients presented for the first time to the dental division of Maggiore Hospital, Italy, between January 1, 2016, and December 31, 2017, were collected. Patients comprised those presenting to the dental clinics for non-TMD complaints, who, upon general examination, were found to have TMD signs and were referred for TMD evaluation. Data were extracted and analyzed, retrospectively. The prevalence of TMDs, age, gender, signs, and symptoms were evaluated. Results: Out of the 18,774 patients studied, 284 had signs of TMD. Women predominance was evident (73%), and patients aged 45-50 were the most frequent sub-population within the TMD population. Clicking was the most commonly present symptom (26.8%), and arthralgia was most commonly diagnosed among this sample (30.7%). A considerable number of patients suffered from muscular disease (myalgia and myofascial pain with 10.1% and 20.7% of the patients, respectively). Significant associations were found among those with myofascial pain on the one hand and degenerative disease and disc displacement with reduction, on the other hand. Furthermore, disc displacement with reduction on one side was associated with displacement without reduction on the other side. Conclusion: A considerable number of patients presenting with dental complaints may have asymptomatic TMDs. This highlights the importance of systematic screening of dental patients for TMDs as part of general assessment

Consensus Paper: Radiological Biomarkers of Cerebellar Diseases

Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine

Increasing nickel concentrations in a large river network of South Tyrol, Eastern European Alps

Climate change and cryosphere degradation may enhance the concentrations of heavy metals in high-mountain rivers. However, the downstream export of these contaminants to lower elevations is still overlooked. In this study, we investigated the spatial and temporal patterns of dissolved and bioavailable nickel concentrations in the upper Etsch/Adige river basin (1590 km2; 54 sites) during the period of 2005−2023. Furthermore, we investigated the same concentrations seasonally (2022−2023) along a tributary (Schnals/Senales River), from the glacier origin down to the confluence with the Etsch River (13 sites). Concentrations of both nickel forms increased during the past decade by up to 4 times, yet only in river reaches draining the acidic metamorphic Ötztal Unit. Sulfide oxidation, more intense at sites featuring larger glaciers, rock glaciers, and permafrost extent in their catchment, enhanced nickel concentrations. Along the Schnals River, values were elevated in the proglacial waters (dissolved fraction up to 112 μg L−1), gradually decreased moving to lower elevations, and dropped (from 20 to 30 to 2−5 μg L−1) downstream of a large reservoir. Currently, bioavailable nickel concentrations exceed the EU environmental quality standards at 40% of the investigateinvestigated sites, demonstrating sharp environmental implications that may be extended to other similar geological and cryospheric settings

Fair Play Game::a group contingency strategy to increase students' active behaviours in physical education

A dependent group contingency strategy called Fair Play Game was applied to promote increase in number of steps during physical education classes for sixth-grade students. Results from a multiple baseline design across three classes showed that the mean number of steps for baseline vs. intervention were: Class 1: 43 vs. 64 steps/minute; Class 2: 49 vs. 81 steps/minute; Class 3: 50 vs. 87 steps/minute. Visual inspection of the graphs showed that Class 1 had an upward trend of number of steps (baseline vs. intervention) without a change in level. Classes 2 and 3 demonstrated clearer change in level of number of steps between these two phases. Social validity data showed that students increased their engagement in class and Fair Play Game is a feasible and acceptable strategy. Therefore, it can be concluded that Fair Play Game appeared to be associated with students' increase in active behaviours in physical education lessons

Fifth-graders’ social interactions in a student-designed games unit

Student-designed games (SDG) are a student-centred approach that motivates students to work together while designing and playing their own games based on their ability level. The purpose of this study was to investigate students’ social interactions during 11 lessons of SDG focused on target games. Participants were 27 fifth-graders. Lessons were based on Hastie (2010) [Student-designed games. Champaign, IL: Human Kinetics]. Five-Step SDG implementation process. Field notes and post-intervention interviews transcriptions were analysed through a systematic process of inductive analysis. Two themes were generated based on field note observations and students’ focus interviews: (a) who is the leader and (b) leadership dispute. The results showed that within coeducational groups, girls took the leadership roles. It was found that during intra-group interactions, leaders who took a more democratic approach motivated students engagement, and promoted opportunities for compromising during decision-making process

Amyloid PET predicts longitudinal functional and cognitive trajectories in a heterogeneous cohort

IntroductionAmyloid positron emission tomography (PET) is increasingly available for diagnosis of Alzheimer`s disease (AD); however, its practical implications in heterogenous cohorts are debated.MethodsAmyloid PET from 890 National Alzheimer`s Coordinating Center participants with up to 10 years post-PET follow up was analyzed. Cox proportional hazards and linear mixed models were used to investigate amyloid burden prediction of etiology and prospective functional status and cognitive decline.ResultsAmyloid positivity was associated with progression from unimpaired to mild cognitive impairment and dementia. Amyloid burden in the unimpaired group was associated with lower initial memory levels and faster decline in memory, language, and global cognition. In the Impaired group, amyloid was associated with lower initial levels and faster decline for memory, language, executive function, and global cognition.DiscussionAmyloid burden is an important prognostic marker in a clinically heterogeneous cohort. Future work is needed to establish the proportion of decline driven by AD versus non-AD processes in the context of mixed pathology.HighlightsOur findings highlight the importance of amyloid positron emission tomography (PET) in heterogenous cohorts, including diverse demographics, clinical syndromes, and underlying etiologies. The results also provide evidence that higher amyloid levels were linked to functional progression from unimpaired cognition to mild cognitive impairment (MCI) and from MCI to dementia. In cognitively unimpaired individuals, higher amyloid burden was associated with poorer memory at baseline and subsequent declines in memory, language, and global cognition. Among individuals with cognitive impairment, amyloid burden was associated with worse initial memory, language, executive function, and global cognition, and faster declines over time