One-year results: palatal implants for the treatment of obstructive sleep apnea.

OBJECTIVE: To evaluate long-term effectiveness of palatal implants for treatment of mild to moderate obstructive sleep apnea (OSA). STUDY DESIGN: A prospective study of 26 referred patients with a pretreatment apnea-hypopnea index (AHI) of 10 to 30 and a body mass index of < or =30, representing an extended follow-up of a subset of 41 patients enrolled in previous short-term trials. RESULTS: Twenty-one of 26 patients (80.8%) experienced a decrease in AHI. Fifteen of 26 patients (57.7%) had a follow-up AHI <10 at 1 year, whereas 13 patients (50%) had a 50% or greater reduction to an AHI <10 at 1 year. Mean AHI was reduced from 16.5 +/- 4.5 at baseline to 12.5 +/- 10.5 at 3 months (P < 0.014) and to 12.3 +/- 12.7 at 1 year (P < 0.019). CONCLUSIONS: Patients initially responding to palatal implants with improved AHI maintained improvement through long-term follow-up at 1 year.     

An ultrastructural evaluation of toluene toxicity using cultured mammalian cells

Animal cells were cultured in media containing toluene and then examined by electron microscopy to determine changes in subcellular architecture. Cellular viability and cloning studies indicated toluene toxicity at concentrations of 50-500 ppm. At all dosage levels, toluene accelerated cell death compared to comparable control cells that had not been exposed to toluene. However, media composition and, particularly, the presence or absence of fetal bovine serum (FBS), markedly affected toluene toxicity. In media without FBS reversible changes in filopodia and cell shape were identified after 15 min of exposure to as little as 50 ppm toluene, and cell death occurred within 5 min at concentrations of 500 ppm toluene. In media with FBS, no filopodial changes were observed at 50 ppm toluene, and cell death, although accelerated, was clearly evident only after 24-48 h of exposure to 200-500 ppm toluene. Except for the cell-surface changes, chronic toluene exposures (50-100 ppm without FBS or 200-500 ppm with FBS in the growth medium) produced no unusual intracellular changes until 24-48 h of toluene exposure. With toluene exposures of 24 h or longer, cellular changes included condensation of heterochromatin in nuclei, formation of bulbous protuberances at the cell surface, loss of polyribosomes (but not ribosomes) and, ultimately, degeneration of organelles. These late changes were irreversible and the prelude to cell death.     

The cytotoxic HLA-DQ3 reactive human hybridoma antibody 4166 that May distinguish DQ7 + 8 from DQ9

The human cytotoxic hybridoma antibody 4166 (IgM_χ) was generated by fusing an in vitro EBV-transformed B-LCL from a multiparous woman with the mouse-human heteromyeloma fusion partner CB-F7. In microcytotoxicity and IIF tests with B-LCLs as target cells, the mAb 4166 was specific for DQ3 ( = DQ7 + 8 + 9). However, when used for DQ typing of class-II-positive PBMCs, 4166 could be rendered functionally specific for DQ7 + 8and did not react with DQ9⁺ PBMCs. Binding of mAb 4166 to DQ8-positive cells was efficiently blocked by several allotype-specific mAbs recognizing DQ8. Other HLA class-II-specific mAbs were unable to inhibit. With the use of mAb 4166, it is possible to discriminate DQ7 + 8 from DQ9 in serologic DQ typing.     

Are subjective health complaints a result of modern civilization?

Subjective health complaints without or with minimal somatic findings (pain, fatigue) are common and frequent reasons for encounter with the general practitioner and for long-term sickness leave and disability. The complaints are often attributed to the stressors of modern life. Is this true? We interviewed 120 Aborigine Mangyans (native population, M age = 33.5 years, 72.5% women) living under primitive conditions in the jungle of Mindoro, an island in the Philippines, and 101 persons living in a small coastal town on the same island (coastal population, M age = 33.8 years, 60.4% women). Both groups had more musculoskeletal complaints, fatigue, mood changes, and gastrointestinal complaints than a representative sample from the Norwegian population (N = 1,243). Our common subjective health complaints, therefore, are not specific for industrialized societies.     

C-reactive protein concentration is not related to islet autoimmunity status in offspring of parents with type 1 diabetes

Autoimmunity may be associated with acute or chronic inflammation. In order to determine whether the inflammatory marker C-reactive protein (CRP) was an indicator of inflammatory events that precede, predict, or associate with islet autoimmunity or type 1 diabetes, CRP was measured in sequential antibody-negative, seroconversion, and follow-up-positive samples from 65 prospectively studied islet autoantibody-positive children. Although changes in CRP concentrations were observed in some children, overall CRP concentrations were similar in antibody-negative samples (median, 0.21 mg/L), antibody-positive samples (median, 0.26 mg/L), and samples at seroconversion (median, 0.26 mg/L). CRP concentrations at diabetes onset (median, 0.59 mg/L) were not significantly increased over antibody-negative samples (P = 0.07). CRP concentrations did not predict diabetes development. CRP concentrations were related to age (r = 0.26; P < 0.001) and were increased in samples obtained from October to January (P < 0.001). These findings suggest that CRP concentrations are not a valuable marker of progression to type 1 diabetes and highlight the importance of correcting analyses for seasonal variations.     

Phase I/II tolerability/pharmacokinetic study with one-hour intravenous infusion of doxifluiridine (5′-dFUrd) 3 g/m2 VS 5 g/m2 QD x 5 per month

Summary Eighteen patients with advanced solid cancer were treated with daily 5-dFUrd infusions given over 1 h on days 1–5 of a 4-week cycle. Nine patients received 3 g/m² 5-dFUrd daily and another nine patients 5 g/m². One patient on 5 g/m² 5-dFUrd was not fully evaluable for tolerability due to early death (progressive disease) 4 weeks after the first cycle. A total of 48 cycles was given. The gastrointestinal and hematological toxicity was generally mild (grade 1–2). Central neurotoxicity (ataxia, unsteadiness, diplopia, dysarthria, sometimes confusion) was observed in 7 of 8 patients on 5 g/m² 5-dFUrd leading to premature discontinuation of treatment in 3 patients (after 2 cycles). Only 3 of the 9 patients in the 3 g/m² group had slight signs of cerebellopathy. Typically, the reversible neurological side effects started at the end of the 2nd week of a cycle. The serum elimination kinetics of 5-dEUrd and its metabolites 5-FU and 5-dFUH₂ have been investigated in the serum and showed very low intra- and interindividual variations. Peak concentrations of the 5-dFUrd at the end of the infusion approximated 500 mol/l and 1000 mol/l for the 3 g/m² and 5 g/m² group, respectively. The peak of the serum 5-FU was reached at the same time, the ratio 5-FU/5-dFUrd being around 10%. The elimination half-life time for 5-FU was protracted by a factor of 2–3 compared with the direct injection of 5-FU.Monthly infusion of 5-dFUrd 5 mg/m² per day on days 1–5 lead to an unacceptable frequency and degree of neurological toxicity. Similar infusions of 5-dFUrd 3 g/m² per day on days 1–5 were well tolerated.     

Practical Considerations in Sepsis Resuscitation

Background

Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment.

Farm-Related Concerns and Mental Health Status Among Norwegian Farmers

The agricultural sector in Norway has undergone structural changes over the past 50 years. The objective of this study was to analyze the distribution of concerns about farm economy, work time, and mental complaints among Norwegian farmers. In a sample of single principal owner-operators (n = 2,676), we calculated the unadjusted and adjusted odd ratios (ORs) for concerns about the farm economy, concerns for insufficient time to complete work, and high symptom load of mental complaints. Structural equation modeling (SEM) was used to explore the associations between farm characteristics, concerns, and mental health. Farmers had a high probability for an increased symptom load of mental complaints. The level of farm income was more strongly associated with economic concerns and mental health concerns when a major part of total household income resulted from farming. The high workload required in farming combined with off-farm supplemental employment was additionally associated with higher levels of time concerns and mental complaints. Norwegian farmers have a relatively high workload both in farming and in off-farm work but are able to make sustainable plans for their individual workload needs. The high individual workload in both these arenas poses a challenge, but was not associated with a greater probability for a high symptom load of mental complaints.