Sleep bruxism based on self-report in a nationwide twin cohort

The relative roles of genetic and environmental factors in bruxism are not known. In 1990 a questionnaire sent to the Finnish Twin Cohort yielded responses from 1298 monozygotic and 2419 dizygotic twin pairs aged 33–60 years. We used structural equation modelling to estimate genetic and environmental components of variance in the liability to bruxism. There was a significant gender difference both in childhood (P =0.001) and adult (P =0.007) bruxism. Females compared to males reported childhood bruxism ‘often’ 5.2% vs 4.1% and ‘sometimes’ 17.4% vs 17.3%, and as adults ‘weekly’ 3.7% vs 3.8% and ‘monthly’ 3.9% vs 4.6%, respectively. Bruxism in childhood and adulthood is highly correlated (0.86 in males and 0.87 in females). The proportion of total phenotypic variance in liability to bruxism attributed to genetic influences in childhood bruxism was 49% (95% CI 37–60%) in males and 64% (55–71%) in females, and for adults 39% (27–50%) among males and 53% (44–62%) among females. The correlation between the genetic effects on childhood bruxism and the genetic effects on adult bruxism was estimated in a bivariate model to be 0.95 (95% CI 0.94–0.96) in males and 0.89 (0.88–0.90) in females. Bruxism appears to be quite a persistent trait. There are substantial genetic effects on bruxism both in childhood and as adults, which appear to be highly correlated.     

Left ventricular function in children with the Marfan syndrome

Aortic dilatation and heart valve lesions are common in theMarfan syndrome but whether primary alterations occur in leftventricular (LV) function has not been studied hitherto. LVsize, mass and systolic as well as diastolic function were studiedby M-mode and Doppler echocardiography and cine magnetic resonanceimaging in 22 Marfan children aged 3.0–15.4 years andin 22 age-matched healthy children. No child had significantvalve disease. Heart rate and systolic blood pressure were comparablein the groups but diastolic blood pressure was higher in thecontrols (67 ± 7 mmHg vs 62 ± 8 mmHg, P=0.030).No statistically significant differences were found in LV size,mass or systolic function. The Marfan children had slower LVpeak diameter lengthening rates (106 ± 27 mm s^–1vs 132 ± 29 mm. s^–1, P=0.004), prolonged relaxationtimes (155 ± 22 ms vs 140 ± 19ms, P=0.023), slowerdeceleration of the early transmitral velocity (580 ±144 cm.s^–2 vs 720 ± 160 cm. s^–2, P=0.006),and smaller early-to-late peak velocity ratios (1.99 ±0.40 vs 2.29 ± 0.46, P=0.031). These data indicate thatI.V early diastolic function (relaxation) is impaired in theMarfan syndrome. Weakened elastic recoil due to the underlyingconnective tissue abnormality may best explain this novel observation.     

Acute effects of alcohol, beta blockade, and their combination on left ventricular function and hemodynamics in normal man

Twenty-three healthy males, aged 23 to 62 years, were examinedby M-mode echocardiography and systolic time intervals for 3h after (1) ethanol 1 g/kg by mouth taken over 60 minutes; (2)atenolol 100 mg by mouth; (3) ethanol (1 g/kg) + atenolol (100mg). The peak mean blood ethanol (± s.e.) was 112 ±4mg/100 ml in test 1 and 104 ± 7 mg/100 ml in test 3.During increasing blood ethanol, heart rate (HR), systolic bloodpressure (BP), cardiac output (CO) and echocardiographic indicesof left ventricular (LV) function were significantly augmented,while total peripheral resistance (TPR) decreased. During decliningblood ethanol, systolic BP, L V end-diastolic and end-systolicdiameters, stroke volume (SV) and circumferential wall stresswere significantly reduced; echocardiographic indices of LVfunction were unaltered, but the pre-ejection period/LV ejectiontime ratio was increased, Atenolol decreased llR, systolic BP,SV, CO, and all estimates of LV function, but increased TPR.Ethanol + atenolol tended to cause smaller depressions in theindices of LV function than did atenolol alone, in spite ofsimilar plasma atenolol concentrations (n = 6). It is concludedthat ingestion of modest doses of ethanol evokes vasodilationand enhances LV function during increasing blood ethanol, andreduces LV preload and afterload during decreasing blood ethanolwithout impairing contractility. Social drinking and beta blockadeseem not to have any harmful acute combined effects on the heartand circulation, at least in normal subjects.     

Distribution of placental protein 14 in tissues and body fluids during pregnancy

Summary. Placental protein 14 (PP14) levels were measured in serum samples from non-pregnant and pregnant women. amniotic fluid, cord blood, and extracts of placenta, decidua and fetal membranes. The levels were low (15–40 μg/ l ) in serum of non-pregnant women. In four pregnancies following in-vitro fertilization, the serum PP14 levels started to rise 2–12 days after embryo replacement. In normal pregnancy, the highest serum PP14 concentrations (up to 2200 μg/l) were detected between 6 and 12 weeks. After 16 weeks the level decreased and plateaued at 24 weeks to around 200 μg/l. In amniotic fluid, the highest PP14 levels (232 mg/l) were found between 12 and 20 weeks, being considerably higher than those in maternal serum throughout pregnancy. In cord blood, the levels were low (15–22 μg/l) or undetectable. In early pregnancy decidua. the PP14 content was higher (41–160 mg/g total protein) than in late pregnancy decidua (60–2700 μg/g total protein). In amnion and chorion laeve, the PP14 concentration varied from 50 to 750 and 50 to 1000 μg/g protein, respectively. Early pregnancy placenta contained 0-25-15 mg/g and late pregnancy placenta 3–430 μg/g protein of PP14. These results show that the levels of PP14 in pregnancy serum have a similar profile to hCG, but in contrast to other placental proteins, the amniotic fluid PP14 levels are remarkably high. This may be explained by suggesting that decidua is a source of PP14.     

Clodronate Treatment in Patients with Malignancy-associated Hypercalcemia

ABSTRACT. Rastad J, Benson L, Johansson H, Knuutila M, Pettersson B, Wallfelt C, Åkerström G, Ljunghall S (Departments of Surgery and Internal Medicine, University Hospital, Uppsala, Sweden). Clodronate treatment in patients with malignancy-associated hypercalcemia. Acta Med Scand 1987; 221:489–94. The possibility of reducing symptomatic hypercalcemia and of maintaining total serum calcium concentrations <2.8 mmol/1 with clodronate (dichloromethylene bisphosphonate) was evaluated in 28 patients with various types of malignant tumors. Four episodes of hypercal-cemic crisis with mean serum calcium concentrations of 4.43 mmol/1 were controlled within 4–6 days of intravenous clodronate (4 mg/kg BW/day). This was accompanied by a moderate increase in serum creatinine values which, however, returned to pretreatment levels after therapy withdrawal in all but one case. Oral clodronate successfully reduced a mean serum calcium concentration of 3.16 mmol/1 in 22 out of 25 patients after 3–12 days (800–3 200 mg/ day). After reversal of the hypercalcemias oral clodronate controlled the serum calcium concentration for up to 42 weeks in six out of 15 patients After discontinuation of initial therapy five of seven recurrent hypercalcemias were successfully treated with oral or intravenous clodronate. Hypocalcemia and subjective side-effects were uncommon. It is concluded that clodronate is a valuable clinical tool in the management of patients with malignancy-associated hypercalcemia.     

Magnetocardiographic Pacemapping for Nonfluoroscopic Localization of Intracardiac Electrophysiology Catheters

The purpose of the study was to validate, in patients, the accuracy of magnetocardiography (MCG) for three-dimensional localization of an amagnetic catheter (AC) for multiple monophasic action potential (MAP) with a spatial resolution of 4 mm2. The AC was inserted in five patients after routine electrophysiological study. Four MAPs were simultaneously recorded to monitor the stability of endocardial contact of the AC during the MCG localization. MAP signals were band-pass filtered DC-500 Hz and digitized at 2 KHz. The position of the AC was also imaged by biplane fluoroscopy (XR), along with lead markers. MCG studies were performed with a multichannel SQUID system in the Helsinki BioMag shielded room. Current dipoles (5mm; 10mA), activated at the tip of the AC, were localized using the equivalent current dipole (ECD) model in patient-specific boundary element torso. The accuracy of the MCG localizations was evaluated by: (1) anatomic location of ECD in the MRI, (2) mismatch with XR. The AC was correctly localized in the right ventricle of all patients using MRI. The mean three-dimensional mismatch between XR and MCG localizations was 6 ± 2 mm (beat-to-beat analysis). The coefficient of variation of three-dimensional localization of the AC was 1.37% and the coefficient of reproducibility was 2.6 mm. In patients, in the absence of arrhythmias, average local variation coefficients of right ventricular MAP duration at 50% and 90% ofrepolarization, were 7.4% and 3.1%, respectively. This study demonstrates that with adequate signal-to-noise ratio, MCG three-dimensional localizations are accurate and reproducible enough to provide nonfluoroscopy dependant multimodal imaging for high resolution endocardial mapping of monophasic action potentials.     

HUMAN GRANULOSA CELLS CONTAIN INSULIN-LIKE GROWTH FACTOR-BINDING PROTEIN (IGF BP-1) mRNA

Previous studies have demonstrated expression of insulin-like growth factor-binding protein (IGF BP-1) in secretory and decidualized endometrium, in adult and fetal liver, and in HepG2 liver cancer cells. We have studied the expression of IGF BP-1 in various types of ovarian neoplasias, normal ovary, and granulosa cells from hyperstimulated human ovarian follicles by RNA blot hybridization. A single 1.6 kb mRNA species, similar to that present in human decidua, was identified in poly(A)RNA-containing preparations of granulosa cells and of a borderline malignant ovarian cystadenoma. This finding verifies the postulated production of IGF BP-1 by the human ovary.     

Thallium Scintigraphy in Prediction of Occlusion of Bypass Grafts in Asymptomatic and Symptomatic Patients

ABSTRACT To evaluate thallium scintigraphy in predicting coronary artery bypass graft patency, exercise thallium scintigraphy and selective graft and native vessel angiograms were performed in 22 asymptomatic and 29 symptomatic consecutive patients three months after coronary artery bypass grafting (CABG). Twelve out of 22 asymptomatic patients (55%) had reversible thallium defects on postoperative images; in 10 patients the postoperative scans were normal. The graft patency was significantly lower in asymptomatic patients with abnormal thallium perfusion compared to those with normal perfusion after CABG (68% vs. 91%. p<0.05). The rate of graft patency in symptomatic patients was 66/87 (76%). Thallium scintigraphy was 77% sensitive and 78% specific in detecting one or more stenosed or occluded bypass grafts in patients without angina (accuracy 77%). When data from exercise electrocardiography were combined with scintigraphy, all but one patient with incomplete revascularization could be detected (positive predictive accuracy 92%). In symptomatic patients, thallium scintigraphy accurately predicted the presence or absence of graft occlusion in 24/29 (83%) cases. Thus, abnormal myocardial perfusion due to stenosis or occlusion of bypass grafts is common in both asymptomatic and symptomatic patients after CABG. Thallium scintigraphy together with exercise electrocardiography appear to be useful non-invasive methods in detecting painless myocardial ischemia and in predicting bypass graft occlusion after CABG.     

Reproducibility of M-mode echocardiographic assessment of left ventricular function. Significance of the temporal range of measurements

The aim of this study was to evaluate the reproducibility ofM-mode echocardiography in sequential studies on left ventricular(LV) function. To that end, 3 to 8 serial recordings were performedon 4 groups of healthy subjects (total number, 49) within dissimilartime periods: (1) within 3 h, (2) within 24 h, (3) within 1to 2 weeks and (4) within 14 to 18 months. The examination techniquewas carefully standardized and the recordings were analysedby digitization and computer assistance; the data were averagedfrom 5 beats on each recording. The random variation ofLV transversedimensions and performance was roughly equal in the first 3of these studies; the mean coefficients of variation rangedfrom 1.2 to 1.8% for end-diastolic dimension, from 1.7 to 2.3%for end systolic dimension, and from 2.5 to 3.6% for ejectionfraction. In the long term study the respective mean coefficientswere larger: 3.2%, 3.7% and 5.5%. The coefficients of variationfor estimates of stroke volume, cardiac output, and peripheralvascular resistance ranged from 4.1 to 8.4% in studies completedwithin 1 day or inside Ior2 weeks but increased to 10-15.5%in the long-term study. The beat to beat variability of LV dimensionsand performance, as assessed in a subgroup of 11 subjects, wasroughly equal in quantity to the variability observed in thelong-term study. It is concluded that provided the beat-to-beatvariation is adequately taken into account the reproducibilityof the basic M-mode echocardiographic LV measurements is excellentin short term studies in normal man and is satisfactory in studiesrepeated at intervals of several months or even longer. Theuse of this method to assess changes in cardiac volumes andhaemodynamics should, however, be restricted to short-term studies.     

Stopping Insulin Treatment in Middle-aged Diabetic Patients with High Postglucagon Plasma C-Peptide

ABSTRACT We studied the successfulness of stopping insulin treatment in middle-aged diabetic patients aged 45–64 with a high postglucagon C-peptide level and the effects of this change on glycaemic control, serum lipids and lipoproteins. Insulin treatment was successfully stopped in 15 of our 22 patients who satisfied the inclusion criteria for the study and were selected on the basis of a computer file including practically all diabetic patients treated with insulin in the Kuopio University Central Hospital region (population base 250000 inhabitants). Insulin therapy was restarted in seven patients during the first 3 months after discharge. During the following 9 months insulin therapy was restarted in another three patients so that after a 1-year follow-up period half of the diabetic patients whose insulin therapy was stopped had been switched back to insulin. Insulin therapy was seldom successfully stopped if the postglucagon C-peptide value was under the limit of 1.0 nmol/l. Glycaemic control did not change during the follow-up, although there was a significant weight loss in diabetic patients. No changes were observed in serum lipids or lipoproteins with the exception of LDL cholesterol, which showed a significant reduction during the 3-month follow-up. In conclusion, insulin therapy can often be successfully stopped in patients with postglucagon C-peptide over the limit of 1.0 nmol/l without worsening of glycaemic control and without unfavourable changes in serum lipid and lipoprotein levels.