The use of an ambulatory,automatic sleep recording device (QUISI™ Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea

The use of an ambulatory, automatic sleep recording device (QUISI? Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea Electroencephalogram (EEG) evaluation with polysomnography (PSG) according to the Rechtschaffen & Kales (R&K) rules is time and cost consumptive, but ambulatory polygraphy systems do not allow EEG recording routinely. As a consequence, the number of sleep disordered events cannot be calculated exactly. QUISI is a one‐channel, self‐applicable ambulatory EEG recording device. The present study was designed as a prospective, non‐randomized clinical trial. This investigation evaluated the results of 40 patients with primary snoring and obstructive sleep apnoea measured with level 1 PSG and QUISI simultaneously. Fifteen patients (37.5%) were primary snorers with normal sleep profiles, whereas 25 patients (62.5%) suffered from obstructive sleep apnoea (OSA) with a Respiratory Disturbance Index (RDI) of 38.6 ± 23.8. The mean total sleeping time (TST) was underestimated by 4.5%, while Sleep Efficiency Index (SEI) was understimated by 4.6% by the QUISI device compared with PSG. The correlation between the QUISI and the PSG estimates for single sleep stages demonstrated only moderate correlation. The statistical significance for sleep stage 2 was r = 0.42, P = 0.002; for sleep stage 3/4, r = 0.31, P = 0.02; and for WAKE, r = 0.33, P = 0.01. Sleep stage 2 as well as sleep stage 3/4 were underestimated by QUISI substantially (difference: ?5.6% and ?10.3%), while WAKE was overestimated by QUISI to a larger amount (difference: +10.4%). Sensitivity and specificity of QUISI to recognize pathological sleep profiles compared with PSG/R&K were 0.92 and 0.96 respectively. QUISI is able to evaluate normal versus altered sleep profiles in patients with primary snoring and OSA. Comparing the quartile ranges, we found substantial differences between QUISI and PSG/R&K. QUISI gives an impression of sleep architecture and objective verification of a sleep disturbance in an ambulant setting but cannot replace the sleep laboratory‐based PSG.     

Corifollitropin alfa compared with follitropin beta in GnRH-antagonist ovarian stimulation protocols in an unselected population undergoing IVF/ICSI

Recombinant DNA technologies have produced Corifollitropin alfa (CFa) used during IVF/ICSI in order to keep the circulating FSH levels above the threshold necessary to support multi-follicular growth for a week. In this prospective case-control study, we compared 70 participants treated with 150?μg CFa combined with 150?IU of follitropin beta (study group) with 70 subfertile participants with matching baseline characteristics, conforming with the same inclusion criteria and treated with an antagonist protocol using follitropin beta (control group). Live birth was the primary outcome, while secondary outcome measures were IVF/ICSI cycles characteristics, including adverse events and complications. Live birth was determined in reduced rates in the study compared to the control group, reaching statistical significance [6/70 versus 20/70, p?=?0.002], as also in the respective number of clinical pregnancies [9/70 versus 23/70, p?=?0.005], although the incidence of miscarriage was similar for both groups [6/70 versus 5/70, p?>?0.99]. Most of the secondary parameters examined were similar between groups. Logistic regression revealed that protocol and AFC had a direct impact on live birth. Ovarian stimulation with CFa does not seem to constitute an equally effective method as compared with follitropin beta to be offered in a general subfertile population seeking IVF/ICSI treatments.     

Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

BackgroundForce‐time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram‐seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking.HypothesisWe sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions.MethodsFifty patients with CTI‐dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine‐mediated recovery of transisthmus conduction, after a 20‐min waiting period.ResultsThe study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First‐pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first‐pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first‐pass block (29.2% vs. 7.7% respectively, p = .048).ConclusionsCTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine‐mediated recurrence of transisthmus conduction, compared to 400 gs lesions.     

Osteosarcoma of navicular bone. En bloc excision and salvage of the foot

AimTo present foot salvage for osteosarcoma of the navicular bone with en bloc resection and reconstruction using bone allograft and talus-cuneiform arthrodesis.Patient and surgical techniqueA 20 year-old male with a history of osteosarcoma of the distal femur presented to our department 5 years later with a metastatic lesion of the navicular bone of the contralateral foot. The patient received 4 cycles of neo-adjuvant chemotherapy with satisfactory response. Tumor shrinkage allowed en bloc excision of the navicular bone with clear margins. Reconstruction was done using a tricortical allograft and talus-allograft-cuneiform arthrodesis, secured with a mini-fracture plate (Synthes). Weight bearing protection was advised for 2 months and partial weight bearing for another 4 months. Patient received 4 cycles of adjuvant chemotherapy.ResultsThree years postoperatively, the patient was free of local recurrence or distant metastasis. There were no signs of allograft resorption, fracture or non union. The patient was asymptomatic and full weight bearing. Ankle and subtalar joint motion was within normal limits.ConclusionFoot salvage after excision of osteosarcoma of the navicular bone could be possible if en bloc resection of the lesion could be performed. Talus-cuneiform fusion with allograft interposition is a viable reconstructive option.     

Effects of acetylo‐L‐carnitine in end‐to‐side neurorrhaphy: A pilot study

Purpose: End‐to‐side (ETS) nerve repair allows for target‐muscle reinnervation, with simultaneous preservation of donor‐nerve function. Acetyl‐L‐carnitine (ALCAR) was shown to enhance axonal sprouting in early regeneration following transection and repair of the sciatic nerve in rodents. The purpose of this article was to determine the ability of ALCAR to enhance axonal regeneration in an ETS rodent model. Method: The right musculocutaneous nerve in 16 adult male Sprague‐Dawley rats was transected to induce biceps muscle paralysis. The distal stump was then coapted by ETS neurorrhaphy through a perineurial window to the ipsilateral median nerve. Experimental groups received ALCAR for 1, 2, 3, and 4 weeks whereas controls received placebo. Results: Weekly postoperative behavioral evaluations revealed increased functional return over control but the difference was not significant. Potentials from biceps were recorded from the third postoperative week in the experimental group and from the fourth week in the control group. Histomorphometric evaluations revealed higher musculocutaneous nerve axon counts, higher myelin thickness in the fourth postoperative week, and differences in the appearance and the number of motor‐end‐plates in the biceps in experimental versus control group. Conclusion: Intraperitoneal administration of ALCAR can expedite biceps muscle recovery in an ETS model by increasing the rate of axonal regeneration. Despite the morphological changes, no behavioral changes were noted and further studies are needed to confirm clinical efficacy of ALCAR for potential use in the development of therapeutic protocols. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.