Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta‐analysis

Lifestyle interventions addressing diet, exercise‐training, sleep hygiene, and/or tobacco/alcohol cessation are recommended in the management of obstructive sleep apnoea (OSA). Yet their effectiveness on this condition still requires further research. This systematic review and meta‐analysis was aimed at establishing (a) the effectiveness of lifestyle interventions on apnoea‐hypopnoea index (AHI), oxygen desaturation index (ODI), excessive daytime sleepiness (EDS), and secondary OSA measures among adults, and (b) which intervention characteristics may drive the greatest improvements. A systematic search of studies was conducted using CINAHL, ProQuest, Psicodoc, Scopus, and Web of Science, from inception to April 2018. Standardized mean differences were calculated using the inverse variance method and random‐effects models. The meta‐analyses of 13 randomized controlled trials and 22 uncontrolled before‐and‐after studies (1420 participants) revealed significant reductions on AHI (d = ?0.61 and ?0.46, respectively), ODI (d = ?0.61 and ?0.46) and EDS (d = ?0.41 and ?0.49). Secondary OSA outcomes were also improved after interventions. However, effectiveness of interventions differed depending on their components, OSA severity, and gender. Thus, until future research further supports the differential effectiveness among lifestyle interventions on OSA, those addressing weight loss through diet and exercise‐training may be the most effective treatments for male patients with moderate‐severe OSA.     

A simple way to fix a trocar during pediatric laparoscopy

We introduce a simple method of fixing trocars to the abdominal wall in children. After the trocar is inserted into the abdominal wall, we place a 2/0 silk suture through the skin next to the trocar, then a sterile Nylon 6.6 plastic seal (Sumar Inc, Buenos Aires, Argentina) is wrapped around the trocar and the end of one of the sutures. Lastly, both suture ends are tied around the plastic seal. To further ease and speed the procedure, we recently introduced a plastic seal fastening device. This method is simple, fast, efficacious, and inexpensive and can be used with all trocar sizes.     

Changes in chest compression indexes with breathing underestimate surgical candidacy in patients with pectus excavatum: A computed tomography pilot study

Background

Haller Index (HI) ≥ 3.25 by computed tomography (CT) at end-inspiration has been used to indicate surgical correction in patients with pectus excavatum. However, chest wall diameters vary with breathing and may modify HI values and surgical indications. The aim of our study was to report the changes in HI with breathing and their impact in the surgical indication rates.

Methods

Thirty six patients with pectus excavatum underwent chest CT evaluation at both end-inspiration and end-expiration. HI was derived by dividing the transverse diameter (TD) of the chest by the anteroposterior diameter (APD). Cardiac compression index (CCI) was then calculated by dividing the cardiac TD by the APD.

Results

Mean patient age was 19 ± 7 years old and 86.8% were males. From end-inspiration to end-expiration, large changes in APD values corresponded to large changes (29.6%) in HI values. CCI increased significantly during end-expiration, primarily driven by an increase on the cardiac TD. Surgical indication was found in 71% and 91% of patients during end-inspiration and end-expiration, respectively (p < 0.05).

Conclusions

This study showed that the severity indexes of the pectus excavatum were all significantly more severe at end-expiration than at end-inspiration, leading to an increase in surgical candidacy. We therefore recommend performing the CT at end-expiration.     

Community-acquired methicillin-resistant Staphylococcus aureus, Uruguay

A novel, methicillin-resistant [corrected] Staphylococcus aureus clone (Uruguay clone) with a non-multidrug-resistant phenotype caused a large outbreak, including 7 deaths, in Montevideo, Uruguay. The clone was distinct from the highly virulent community clone represented by strain MW2, although both clones carried Panton-Valentine leukocidin gene and cna gene.     

Splenic epidermoid cyst: laparoscopic partial decapsulation

The splenic cysts are rare among all age groups and there are a few reports in the world literature. The splenic epidermoid cyst is a true congenital one, that can cause signs and symptoms, or suffer complications. For these reasons, some form of treatment is recommended. The management of splenic cysts continues to evolve. The standard treatment was splenectomy, but the knowledge about the immunologic function of the spleen and the existence of postesplenectomy mortal sepsis, have conduced most of pediatric surgeons to adopt techniques that preserves splenic tissue. The treatment by percutaneous drainage with injection of a sclerosing agent has complications and a significant recurrence rate. During the last two decades, preservation procedures such as partial splenectomy or partial cyst excision and omental packing have gained the preference of most pediatric surgeons. The second technique has advantages over the partial splenectomy. The possibility to perform the procedure by a laparoscopic approach add the advantages of this last technique. We present two patients with splenic epidermoid cyst treated by laparoscopic partial cyst decapsulation and review the literature.     

NOD2 drives early IL-33–dependent expansion of group 2 innate lymphoid cells during Crohn’s disease–like ileitis

Innate lymphoid cells (ILCs) are enriched at barrier surfaces, including the gastrointestinal tract. While most studies have focused on the balance between pathogenic group 1 ILCs (ILC1s) and protective ILC3s in maintaining gut homeostasis and during chronic intestinal inflammation, such as Crohn’s disease (CD), less is known regarding ILC2s. Using an established murine model of CD-like ileitis, i.e., the SAMP1/YitFc (SAMP) mouse strain, we showed that ILC2s, compared with ILC1s and ILC3s, were increased within draining mesenteric lymph nodes and ilea of SAMP versus AKR (parental control) mice early, during the onset of disease. Gut-derived ILC2s from CD patients versus healthy controls were also increased and expanded, similarly to ILC1s, in greater proportion compared with ILC3s. Importantly, we report that the intracellular bacteria–sensing protein, nucleotide-binding oligomerization domaining–containing protein 2, encoded by Nod2, the first and strongest susceptibility gene identified for CD, promoted ILC2 expansion, which was dramatically reduced in SAMP mice lacking NOD2 and in SAMP mice raised under germ-free conditions. Furthermore, these effects occurred through a mechanism involving the IL-33/ST2 ligand-receptor pair. Collectively, our results indicate a functional link between NOD2 and ILC2s, regulated by the IL-33/ST2 axis, that mechanistically may contribute to early events leading to CD pathogenesis.     

Interleukin 33 Triggers Early Eosinophil-Dependent Events Leading to Metaplasia in a Chronic Model of Gastritis-Prone Mice

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