Hideo Toyoshima

Thickness of the basement membrane of bronchial epithelial cells in lung diseases as determined by transbronchial biopsy

The thickness of the basement membranes of bronchial epithelial cells varies under various pathological conditions. It has been reported that this membrane is thickened in patients with bronchial asthma. By light microscopy, this parameter was measured in biopsy specimens of bronchial mucosa obtained by fibre-optic bronchoscopy. These specimens were obtained from 171 patients who had undergone bronchial biopsy between 1984 and 1994. It was demonstrated that the thickness of the basement membrane of bronchial epithelial cells was weakly correlated with the patients age, when thickness was examined in patients with lung cancer (r = 0.242, P = 0.0268). The basement membranes in patients with bronchial asthma (8.193 +/- 1.362 mu, mean +/- SEM) were significantly thicker than those without bronchial asthma (5.145 +/- 0.233 mu) (P = 0.0180, Mann-Whitneys U-test). In addition, it is noteworthy that the basement membranes in patients with diabetes mellitus (7.217 +/- 0.753 mu) were also significantly thicker than those without diabetes mellitus (4.968 +/- 0.235 mu) (P = 0.0038, Mann-Whitneys U-test). The background or underlying pathophysiology in such patients should be studied further, with attention directed towards the thickness of the bronchial basement membrane in bronchial biopsy specimens.

Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea

Abstract Aim The aim of this study was to assess the effectiveness of the two-part semi-rigid oral appliance, Silensor ® (Erkodent, Tuttlingen, Germany) which prevents the mandible from retracting during mouth opening. Materials and methods Ten patients with mild or moderate obstructive sleep apnea (2 males and 8 females; mean age=62.5±10.0 years) were recruited and lateral cephalometric radiographs were taken. The patients underwent polysomnography before and after 3 months of receiving treatment with the Silensor ® . The relationship between the improvement in the polysomnographic variables after the therapy and the cephalometric features was analyzed. Results A significant difference was observed in the apnea–hypopnea index after 3 months of Silensor ® therapy (1st (baseline), 17.1±5.5; 2nd (therapy of Silensor ® ), 11.0±7.2, p =0.011). Furthermore there was a significant positive correlation between the improvement in the degree of slow wave sleep (%) and the mandibular plane angle ( R =0.662, p =0.037), as well as between the improvement in degree of slow wave sleep (%) and the lower face height ( R =0.845, p =0.002). A significant negative correlation was observed between the improvement in degree of sleep efficiency (%) and the soft palate area ( R =−0.809, p =0.005). Conclusion These results suggested that keeping the nasopharyngeal airway space during mouth opening improves apnea–hypopnea index of some patients with mild or moderate obstructive sleep apnea and quality of sleep in obstructive sleep apnea patients with a long lower face height and a small soft palate.

Therapeutic Efficacy of Twin‐Block and Fixed Oral Appliances in Patients with Obstructive Sleep Apnea Syndrome

PURPOSE To compare the efficacy of twin-block (i.e., allows mouth opening) and fixed (i.e., maintains mouth closure) mandibular advancement splints (MASs) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSA). MATERIALS AND METHODS From 2011 to 2013, 23 patients with OSA in the twin-block group, and from 2013 to 2015, 29 patients in the fixed MAS group were included. All patients underwent polysomnography before and after 3 months of treatment. The two sets of polysomnographic and cephalometric variables were compared. RESULTS A significant difference (p < 0.001) was observed in the apnea-hypopnea index before and after MAS treatment in both groups (twin-block group: 20.6 ± 11.5 vs. 14.7 ± 9.4; fixed group: 21.4 ± 15.2 vs. 11.2 ± 9.7). In the twin-block group, 5 patients (21.7%) were complete responders, 9 (39.1%) were fair responders, and 9 (39.1%) were nonresponders; the corresponding figures for the fixed group were 14 (48.3%), 9 (31.0%), and 6 (20.7%) patients. A significant between-group difference was observed in the distribution of responders (p = 0.046). The fixed group showed a significant improvement in the snoring index (p = 0.003), arousal index (p = 0.036), and desaturation rate (p = 0.012). Finally, the change in incisal overjet was larger in the fixed group than in the twin-block group (p < 0.001). CONCLUSIONS These results suggest that fixed oral appliances are superior in treating OSA, based on their ability to prevent mouth opening and reduce incisal overjet.