Mandibular advancement orthoses used in the treatment of obstructive sleep apnea syndrome

Mandibular advancement devices represent a therapeutic option for obstructive sleep apnea syndrome (OSAS). Clinical improvement has been proven in the different available studies, mainly on nocturnal respiratory events and quality of sleep. Less snoring have been noted by bed partners and objective studies have demonstrated decrease in snoring frequency and intensity. The effect of these ortheses on upper airways resistance syndrome is not yet well documented. The significant clinical improvement is secondary to the decrease in the occurrence of apneas and hypopneas. Polysomnographic improvement criteria with an apnea hypopnea index less than 10 per hour has been noted in certain cases. Although no improvement or even worsening was noted in other cases. Sleep architecture has also changed in these patients, with a decrease in the time spent in stages 1 and 2, and an increase in the time spent in stages 3 and 4 and rapid eye movement sleep. Micro-arousals are also decreased in number certainly with the decrease in the occurrence of respiratory events. Somnolence and loss of attention are improved; these have been evaluated subjectively or by a well known and approved somnolence scale. In some cases a test for vigilance was done.     

Use of an introducer sheath for colonic stent placement

We describe a technical modification of Wallstent implantation for the treatment of malignant rectosigmoid and descending colonic obstructions. The modification is the routine placement of an introducer sheath via the rectum before stent implantation in order to straighten the rectosigmoid region. This device facilitates catheter and guide wire manipulations and obtaining specimen biopsies for histopathological studies. The introducer sheath has been used without complications in 21 consecutive patients.     

Musculoskeletal hydatid disease: a report of 13 cases

This is a retrospective study of 13 patients with muscular hydatidosis--i.e., 4% of the 309 cases of hydatid disease treated in our department during 1983-1999. The commonest clinical finding was an asymptomatic and slowly growing mass (7). Puncture or incision of the mass was followed by an infection of the cystic cavity with fistulization in 2 patients. The immunological findings were false negative in 4 patients. MR images were obtained in 4 patients before diagnosis, and were highly suggetive of hydatid disease. The cystic cavities in all 9 patients subjected to radical surgery healed without chemotherapy. Radical surgery was not possible in 4 cases, in 3 of whom the sacrum was involved. Medical treatment of these patients did not eliminate the disease and new operations were necessary.     

Prediction of second virial coefficients from intrinsic viscosities in ternary polymer systems

Deviations in the determination of the unperturbed dimensions of polymers arising in ternary polymer systems (solvent (1)/solvent (2)/polymer) can be explained by the inaccurate use of an interaction parameter independent of polymer molecular weight. On this basis, a new formalism for the calculation of the second virial coefficient from intrinsic viscosity is proposed. This formalism was tested (and compared with well established formalisms) for all ternary polymer systems with simultaneous intrinsic viscosity and second virial coefficient data in the literature.     

Pleiotropic effects of genes for insulin resistance on adiposity in baboons

OBJECTIVE: Previous research has suggested a genetic contribution to the development of insulin resistance and obesity. We hypothesized that the same genes influencing insulin resistance might also contribute to the variation in adiposity. RESEARCH METHODS AND PROCEDURES: A total of 601 (200 male, 401 female) adult baboons (Papio hamadryas) from nine families with pedigrees ranging in size from 43 to 121 were used in this study. Plasma insulin, glucose, C-peptide, and adiponectin were analyzed, and homeostasis model assessment of insulin resistance (HOMA IR) was calculated. Fat biopsies were collected from omental fat tissue, and triglyceride concentration per gram of fat tissue was determined. Body weight and length were measured, and BMI was derived. Univariate and bivariate quantitative genetic analyses were performed using SOLAR. RESULTS: Insulin, glucose, C-peptide, and adiponectin levels, HOMA IR, triglyceride concentration of fat tissue, body weight, and BMI were all found to be significantly heritable, with heritabilities ranging from 0.15 to 0.80. Positive genetic correlations (r(G)s) were observed for HOMA IR with C-peptide (r(G) = 0.88 +/- 0.10, p = 0.01), triglyceride concentration in fat tissue (r(G) = 0.86 +/- 0.33, p = 0.02), weight (r(G) = 0.50 +/- 0.20, p = 0.03), and BMI (r(G) = 0.64 +/- 0.22, p = 0.02). DISCUSSION: These results suggest that a set of genes contributing to insulin resistance also influence general and central adiposity phenotypes. Further genetic research in a larger sample size is needed to identify the common genes that constitute the genetic basis for the development of insulin resistance and obesity.     

Coping with trauma: narrative and cognitive perspectives

The immediate period following a traumatic event is a crucial time in the survivors' process of recovery. During this time, a narrative of the trauma is generated and constructed, alongside a process of cognitive processing of the traumatic events. In the first part of the article we present the outlines of the narrative and cognitive attitudes to trauma; the second part will illustrate the developmental process through which the trauma narrative is shaped, in the stories of five survivors of a terror attack. We suggest that by analyzing three main components of the trauma narrative (coherence, finding meaning and self-evaluation), together with the equivalent cognitive attitudes, it is possible to evaluate the process of recovery, identify foci of difficulties in this process and pinpoint possible therapeutic interventions in the early stages after the trauma.