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The objective of this study was to examine to what extent the anatomic characteristics of the upper airway can influence the effect of nocturnal wearing of dentures on the sleep of edentulous elders with untreated sleep apnea. This study used the data from a randomized crossover clinical trial and an exploratory approach to address its objectives. Cone beam computed tomography scans of 65 edentulous individuals (female, n = 37; male, n = 28; mean ± SD age, 74.54 ± 6.42 y) with untreated obstructive sleep apnea (OSA) were used to identify anatomic variables. Polysomnography data were collected by means of one portable overnight recording. The respiratory variable values, including apnea–hypopnea index (AHI), with and without denture worn during sleep were used to calculate the change. Statistical analyses included multiple linear regressions, cluster analysis, and binary logistic regressions. A receiver operator characteristic curve was used to illustrate the accuracy of the statistical model. The regression model explained 15.8% ( R2) of AHI change. An increase in the lateral dimension of the minimum cross-sectional area was associated with a decrease in AHI, oxygen desaturation index, and respiratory arousal index changes ( P ≤ 0.041). Furthermore, an increase in the length of the hypopharynx was associated with an increase in AHI and oxygen desaturation index changes ( P ≤ 0.027). An increase in the lateral dimension of the minimum cross-sectional area of the upper airway was associated with a decreased likelihood of being in the group having a worsened AHI (odds ratio = 0.85; 95% CI, 0.76 to 0.95; P = 0.006). An increase in the length of the oropharynx was associated with an increased likelihood of having increased AHI (odds ratio = 1.10; 95% CI, 1.01 to 1.20; P = 0.026). The nocturnal aggravation of respiratory variables in edentulous individuals with OSA who wear dentures at night can be linked to certain anatomic characteristics of the upper airway. Replication of these findings may open novel avenues for personalized advice regarding nocturnal wearing of dentures in edentulous individuals with OSA (ClinicalTrials.gov: NCT01868295).

International audience; Essentials Nucleosomes and free DNA are two newly described biomarkers in venous thromboembolism (VTE). Reliability of nucleosomes, plasma free DNA and conventional hemostasis markers were studied. Hemostasis biological parameters vary over a short time-frame in VTE patients. Hemostasis biological parameters also vary over a short time-frame in healthy controls. SUMMARY: Background Previous studies have associated neutrophil-derived circulating nucleosomes and plasma free DNA with venous thromboembolism (VTE). However, there are few data concerning these two biomarkers and no studies have compared the reliability of nucleosomes and plasma free DNA against that of conventional hemostasis markers. Objectives We performed a 3-year prospective study of nucleosomes and plasma free DNA levels in comparison with conventional hemostatic biomarkers and blood cells. Patients/Methods Fifteen healthy controls and 22 randomly selected patients with a history of VTE were followed monthly for 6~months. The reliability of these markers was evaluated by the intraclass correlation coefficient (ICCs). Results and Conclusions In healthy controls and patients, we found a low reliability for nucleosomes and plasma free DNA, with ICCs at 0.538 (95% confidence interval [CI], 0.334-0.764) and 0.091 (95% CI, -0.026-0.328), respectively, in the healthy controls, and at 0.213 (95% CI, 0.042-0.463) and 0.161 (CI 95%, 0.008-0.398) in the patient group. For the conventional hemostasis biomarkers and for blood cells, reliability ranged from poor to good in the healthy volunteers and from poor to acceptable in the patient group. Our study shows for the first time that hemostasis biological parameters spontaneously vary over a short time-frame in VTE patients and, more surprisingly, in normal individuals. The clinical value of such intra-individual variations is currently unknown. This variability might mean reinterpreting diagnostic or prognostic models based on static evaluation of individuals. Studying the intrinsic value of individual patterns of markers' variability is warranted.

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

TED (Technology Entertainment Design), a collection of regularly updated talks, offers a web-based platform that is easily accessible. This platform affords language learners across multiple proficiency levels an opportunity to develop autonomy and critical thinking skills alongside their second language (L2) development. With an international community of TED presenters proffering diverse and progressive ideas, learners gain access to authentic language settings and valuable exposure to World Englishes. This will serve learners as they become members of an increasingly global community. By adapting literature circles into the context of blended learning, this article illustrates how such a learning platform can offer students a meaningful and interactive (language) learning experience. This article also contributes to ongoing discussions regarding technology and second language acquisition, and how these intersect to provide effective and relevant social media–based lessons that serve the demands of L2 learners in the digital age.

Introduction: Opioid side effects are common when treating chronic pain. However, the rate of opioid side effects for acute pain has rarely been examined, particularly in the post emergency department (ED) setting. The objective of this study was to evaluate the short-term incidence of opioid induced side effects (constipation, nausea/vomiting, dizziness, and drowsiness) in patients discharged from the ED with an opioid prescription. Methods: This was a prospective cohort study of patients aged ≥18 years that visited the ED for an acute pain condition (≤ 2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain medication use and side effects. Results: Mean age of the 386 patients included was 55 ± 16 years; 50% were women. During the 2-week follow-up, 80% of patients consumed at least one dose of opioids. Among the patients who used opioids, 38% (95%CI: 33-48) reported constipation, 27% (95%CI:22-32) nausea/vomiting, 30% (95%CI:25-35) dizziness, 51% (95%CI:45-57) drowsiness, and 77% (95%CI:72-82) reported any side effects. Adjusting for age, sex, and pain condition, patients who used opioids were more likely to report any side effect (OR 7.5, 95%CI:4.3-13.3) and constipation (OR 7.5, 95%CI:3.1-17.9). A significant dose response effect was observed for constipation but not for the other side effects. Nausea/vomiting (OR 2.0, 95%CI:1.1-3.6) and dizziness (OR 1.9, 95%CI:1.1-3.4) were associated with oxycodone compared to morphine. Conclusion: Similar to chronic pain, opioid side effects are highly prevalent during short-term treatment for acute pain. Physicians should be aware and inform patients about those side effects.

Introduction: Studies suggest that acute pain evolution after an emergency department (ED) visit has been associated with the development of chronic pain. Using group-based trajectory modeling (GBTM), we aimed to evaluate if ED discharged patients with similar pain intensity profiles of change over 14 days are associated with chronic pain at 3 months. Methods: This is a prospective cohort study of patients aged 18 years or older who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity level (0-10 numeric rating scale). Three months post-ED visit, participants were interviewed by phone to report their pain intensity related to the initial pain. Results: A total of 305 patients were retained at 3 months (mean age ± SD: 55 ± 15 years, 49% women). Using GBTM, six distinct pain intensity trajectories were identified during the first 14 days of the acute pain period; two linear one with moderate or severe pain during the follow-up (representing almost 40% of the patients) and four cubic polynomial order trajectories, with mild or no-pain at the end of the 14 days (low final pain). Twelve percent (11.9; ±95%CI: 8.2-15.4) of the patients had chronic pain at 3 months. Controlling for age, sex and types of pain condition, patients with trajectories of moderate or severe pain and those with only severe pain were 5.1 (95%CI: 2.2-11.8) and 8.2 (95%CI: 3.4-20.0) times more likely to develop chronic pain at 3 months, respectively, compared to the low final pain group. Conclusion: Trajectories could be useful to early identification of patients at risk of chronic pain.

Birth is the first haemostatic challenge for a child with haemophilia. Our aim was to examine the association between perinatal risk factors and major neonatal bleeding in infants with haemophilia. This observational cohort study in 12 European haemophilia treatment centres (HTC) incorporated 508 children with haemophilia A or B, born between 1990 and 2008. Risk factors for bleeding were analysed by univariate analysis. Head bleeds occurred in 18 (3·5%) children within the first 28 d of life, including three intraparenchymal bleeds, one subdural haematoma and 14 cephalohaematomas. Intra-cranial bleeds were associated with long-term neurological sequelae in two (0·4%) cases; no deaths occurred. Assisted delivery (forceps/vacuum) was the only risk factor for neonatal head bleeding [Odds Ratio (OR) 8·84: 95% confidence interval (CI) 3·05-25·61]. Mild haemophilia and maternal awareness of her haemophilia carrier status seemed to be protective (OR 0·24; 95%CI 0·05-1·05 and OR 0·34; 95%CI 0·10-1·21, respectively), but due to the low number of events this was not statistically significant. We found no association between neonatal head bleeding and country, maternal age, parity, gestational age or presence of HTC. Maternal awareness of carrier status protected against assisted delivery (unadjusted OR 0·37; 95%CI 0·15-0·90; adjusted OR 0·47 (95%CI 0·18-1·21).

Introduction L’hemoglobinurie paroxystique nocturne (HPN) entraine une hemolyse avec anemie. Dans certains cas du fait d’anomalies associees des plaquettes, presence de thromboses multiples. Les complications les plus frequentes sont le syndrome de Budd–Chiari, douleurs abdominales, insuffisance renale, fievre, et troubles de l’erection. Nous rapportons le cas d’une atteinte hypophysaire gonadotrope isolee. Cas clinique Patient de 30 ans consultant pour baisse progressive de la libido avec difficulte a l’erection et diminution des rapports. ATCD d’HPN (multiples thromboses a repetition : axillaires, veines sus-hepatiques, sous claviculaires) et rhinites a repetition. Developpement des caracteres secondaires a 14 ans. TRT neant. A l’examen 190 cm 97 kg : musculature, pilosite et OGE sans anomalie. Pas de syndrome tumoral. Bilan hormonal : hypogonadisme hypogonadotrope isole (testosterone 4,7 nmol/L [N 9–27], FSH 0,7 UI/L et LH 1,7). IRM hypophysaire normale. Apres avis hematologique et TRT par Kardejic 75O rajout TRT AndrotardylO250/28 j : pas d’amelioration de la symptomatologie malgre la normalisation biologique. Apres 6 mois passage TRT type (HCG-HMC) avec amelioration clinique mais jugee insuffisante. Association avec avis urologique TRT d’inhibiteurs phosphodiesterases permettant une reprise d’une activite sexuelle quasi normalisee. Proposition d’envisager un spermogramme (refus du patient pour l’instant). Conclusion L’HPN entraine habituellement une alteration de la sexualite via un mecanisme de thromboses arterielles peniennes. Ce cas clinique pose la question de la participation de l’atteinte hypophysaire, eventuellement via un mecanisme thrombotique ?

Summary. We describe six families in which associated high levels of coagulation factors (F) XI, FIX and FVIII (each with a plasma concentration higher than the 95th percentile found in a control group of 500 asymptomatic individuals: respectively, 135, 145 and 155 IU dL−1) were inherited as a dominant autosomic genetic traits. In these six families, this syndrome is associated with venous thromboembolic events (Odds ratio 41 [4.9–353], P = 0.0006). It seems to predispose to idiopathic events and, as age increases, is often associated with recurrence. First thrombotic episodes occur in young patients (50% of the carriers are symptomatic at the age of 32 years) and in women, can be unmasked by hormonal treatments, mainly oral contraceptives. The association of high levels of coagulation FXI, FIX and FVIII is thus a new rare high-risk inherited thrombophilia syndrome.

A 50% reduction in pain intensity difference (50%PID) between baseline and follow-up evaluation is commonly accepted as adequate pain relief in emergency departments (EDs). However, 50%PID seems to be problematic with the 11-point numerical rating scale (NRS) since even baseline values are more divisible by 2 (50% reduction) than odd baseline values. This study evaluated the impact of this bias and integrated time between baseline and follow-up measurements, hypothesizing that the slope of relative pain intensity difference (SRPID) is a more accurate gauge of pain relief that can decrease bias and incorporate the time component of pain relief.A post-hoc analysis of real-time data on an adult population from an urban ED identified 3199 consecutive patients who received an analgesic, had baseline NRS 3 and a follow-up NRS within 2 h. Primary outcome was the percentage of patients with pain relieved from the 50%PID and the 50%SRPID criteria.Results showed that with 50%PID, even pain intensity levels on baseline NRS comprised a higher percentage of patients [60.7%; 95% confidence interval (CI): 58.8-63.0] with pain relief compared to odd pain intensity levels (51.7%; 95% CI: 48.8-54.6; p 0.001), underestimating pain-relieved patients by 9% [95% CI: 0.05-0.13; effect size (ES) = 0.09]. The percentage of pain-relieved subjects with the 50%SRPID criteria was not affected by baseline NRS values (59.7% for whole sample; 95% CI: 58.0-61.4; ES = 0.02).The 50%PID method with an 11-point NRS for assessing adequate pain relief is significantly biased for specific baseline pain intensity level. In the particular context of ED acute pain, the SRPID seems less biased.

Human adenoviruses1 are responsible for respiratory, gastro-enteric and ocular infections2 and can serve as gene therapy vectors3. They form icosahedral particles with 240 copies of the trimeric hexon protein arranged on the planes and a penton complex at each of the twelve vertices. The penton consists of a pentameric base, implicated in virus internalization4, and a protruding trimeric fibre, responsible for receptor attachment5. The fibres are homo-trimeric proteins containing an amino-terminal penton base attachment domain, a long, thin central shaft and a carboxy-terminal cell attachment or head domain. The shaft domain contains a repeating sequence motif with an invariant glycine or proline and a conserved pattern of hydrophobic residues6. Here we describe the crystal structure at 2.4 A resolution of a recombinant protein containing the four distal repeats of the adenovirus type 2 fibre shaft plus the receptor-binding head domain. The structure reveals a novel triple β-spiral fibrous fold for the shaft. Implications for folding of fibrous proteins (misfolding of shaft peptides leads to amyloid-like fibrils) and for the design of a new class of artificial, silk-like fibrous materials are discussed.

Birth is the first haemostatic challenge for a child with haemophilia. Our aim was to examine the association between perinatal risk factors and major neonatal bleeding in infants with haemophilia. This observational cohort study in 12 European haemophilia treatment centres (HTC) incorporated 508 children with haemophilia A or B, born between 1990 and 2008. Risk factors for bleeding were analysed by univariate analysis. Head bleeds occurred in 18 (3·5%) children within the first 28 d of life, including three intraparenchymal bleeds, one subdural haematoma and 14 cephalohaematomas. Intra-cranial bleeds were associated with long-term neurological sequelae in two (0·4%) cases; no deaths occurred. Assisted delivery (forceps/vacuum) was the only risk factor for neonatal head bleeding [Odds Ratio (OR) 8·84: 95% confidence interval (CI) 3·05-25·61]. Mild haemophilia and maternal awareness of her haemophilia carrier status seemed to be protective (OR 0·24; 95%CI 0·05-1·05 and OR 0·34; 95%CI 0·10-1·21, respectively), but due to the low number of events this was not statistically significant. We found no association between neonatal head bleeding and country, maternal age, parity, gestational age or presence of HTC. Maternal awareness of carrier status protected against assisted delivery (unadjusted OR 0·37; 95%CI 0·15-0·90; adjusted OR 0·47 (95%CI 0·18-1·21).

Over the last few decades, clinical follow-up of patients with haemophilia has become more complex as a result of the introduction of new treatment strategies, the presence of comorbidities related to haemophilia or ageing, as well as the emergence of new tools to evaluate the medical and social consequences of haemophilia. This publication describes the parameters and information that should be documented and the tests, examinations and interventions required for optimal follow-up of a patient with haemophilia. In the absence of formal studies, the present recommendations have been established as result of a series of consensus meetings in the frame of the European Haemophilia Therapy Standardization Board (EHTSB). The following 11 domains were identified: Baseline information, Current status, Treatment, Inhibitor status, Bleeding, Joint status and pain, Comorbidities, Dental care, Physical activities, Social participation and Quality of life. For each domain, details are proposed for the relevant parameters to be captured and monitored as well as the relevant tools that facilitate data collection. Adopting these recommendations should help the individual care of patients and, even though this is not the primary objective of this article, it should also help at national and international level to shape a new approach to haemophilia by working towards a more standardized outcome assessment. Greater standardization should have implications for data collection, improvements in treatment evaluation and optimizing resources.

Anatomical changes associated with edentulism are thought to disturb seniors' sleep.(1) To determine sleep quality and daytime sleepiness of edentulous elders. (2) To examine the association between oral health-related quality of life and sleep quality.Data were collected at a 1-year follow-up from 173 healthy edentulous elders who had participated in a randomised controlled trial and randomly received two types of mandibular prosthesis. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI, range 0-21), with higher scores indicating poorer sleep quality. The Epworth Sleepiness Scale (ESS) was used to measure the level of perceived daytime sleepiness, and scores ≥10 indicated sleepiness.The mean global PSQI and ESS scores were 4.7 ± 3.5 and 5.3 ± 3.9. There were no differences in sleep quality or sleepiness between those who wore their dentures at night and those who did not. Elders with frequent denture problems were sleepier during the day than those with fewer problems (p = 0.0034). General health (p = 0.02) and oral health-related quality of life (p = 0.001) are significant predictors of sleep quality.Healthy edentulous elders, independent of nocturnal wearing of their prosthesis, are good sleepers. Maintaining high oral health quality of life could contribute to better sleep.

Summary. Background: The prothrombin (PT) G20210A gene mutation is a common risk factor for venous thrombosis (VT), which is mainly mediated through an increase in factor II (FII) plasma levels. High FII plasma levels may act through an increase in endogenous thrombin potential (ETP) a key step in hemostasis and thrombosis. While FII may be the main contributor to ETP in PT G20210A carriers, the knowledge of other environmental or genetic factors influencing ETP may help to better identify those at risk of VT. Aims: ETP was determined in 472 non-carriers of PT G20210A (PT−) and in 325 unrelated carriers of PT G20210A (PT+) with (symptomatic n = 158) or without (asymptomatic, n = 167) a history of VT. All PT+ were heterozygous and free of other thrombophilic defects.Results: ETP was higher in asymptomatic PT+ than in PT− (2038 ± 371 vs. 1616 ± 267 nmol L−1 min; P

C 20 H 9 INO 9 PRu 3 cristallise dans P2 1 /c avec a = 10,058, b = 14,182 et c = 17,988 A, β = 97,94 °, Z = 4;affinement jusqu'a R = 0,025. Le compose consiste en un agregat tinucleaire ouvert,chapeaute par le coordinat phenylpyridylphosphuro selon un mode μ 3 -η 2 .

Combining supercritical fluid chromatography and Fourier transform infrared spectroscopy has been described in a number of reports. This work is concerned with developing an automated combined micro Fourier transform infrared spectroscopy with a micro extractor SFC interface. The instrument is described in detail. Basically it consists of a computer driven collector drum complete with cooling assembly that is attached to the exit of an SFC extractor which can be controlled as to temperature and pressure. This permits some preliminary fractionation. The interface is then moved to micro FTIR. The computer then is used to position the collected areas successively under the FTIR and multiple scans are made to any desired level. Examples are given of the performance on extracts from asphalts

Deposit formation represents a key impediment to the eventual commercialization of a direct coal-fired gas turbine engine. Deposits result from the thermal decomposition of coal-borne mineral matter followed by impact and adhesion along the hot gas pathway. One strategy for deposit abatement is hot gas cleanup to remove particulate before entering the turbine. An alternative strategy, described in this article, is to modify the mineral matter/ash chemistry to render it non-adherent through the use of additives. In this way, the complexity and expense of hot gas cleanup is obviated. To date, alumina, boehmite, and a variety of kaolin clay additives have been tested in a coal-water mixed fired gas turbine simulator. A washed kaolin clay has proved to be most effective in reducing airfoil deposition. A mechanism involving in situ slag decomposition, crystallization, and spontaneous spalling is proposed.

The U. S. Army requires a portable greywater treatment system to remediate and recycle dirty sink water from its field feeding and sanitation operations. A greywater recycling system is expected to reduce field kitchen demand for fresh water by 55% and wastewater hauling expenses by 80%. Under an Environmental Security Technology Certification Program (ESTCP) funded project, three systems were demonstrated at Fort Lee, Virginia, in August 2004 as part of the Log Warrior Training Exercise. The field test lasted 2 weeks and each of the three systems was operated outdoors treating water created by actual field feeding operations. Water samples were taken before and after treatment. Systems were evaluated for water quality, percent reduction of contaminants, permeate flow rate, weight, and size. There are no firm Environmental Protection Agency (EPA) regulations regarding the quality of recycled greywater for use in ware washing, so for the purposes of this study, the water was considered to be recyclable if it met the EPA secondary treated water quality outlined in the Code of Federal Regulations, 40 CFR 133.1021. This is defined by the following: biological oxygen demand (BOD) of 30 mg/L or less, total suspended solids (TSS) of 30 mg/L or less, pH between 6 and 9. In addition, recyclable water should have a turbidity of 5 nephelometric turbidity units (NTU) or less. The rationale for specifying secondary treated water is twofold: the treated greywater would be considered clean enough if it should be accidentally discharged to surface water such as a lake or stream, and most states with greywater reuse regulations2 base their water quality standards on the secondary treatment standard. In addition, each system s process rate was required to be fast enough to process the entire bulk of greywater before the next meal. The following tables summarize the results and indicate whether the treatment systems passed or failed to meet any of the requirements.

The problem of browning in a number of EVA (ethylene vinyl acetate) encapsulated flat plate photovoltaic modules has led to the questioning of EVA as a suitable material for such applications. By isolating the variables that could possibly lead to EVA browning, such as module construction, types of glass superstrate, additives, and processing conditions, we have been able to determine those significant specific variables that seem to have the most influence on discoloration. When "standard-cure" EVA-based laminates were exposed to accelerated UV aging, measurable yellowing of those laminates was evident after only one to two weeks exposure, and visual discoloration was observed after four to six weeks. Some samples yellowed quickly and some not at all, and there were significant differences in the rates of discoloration between "standard-cure" and "fast-cure" EVA. This paper looks at the results of these studies, especially focusing on the effect of additives in the EVA on the rate of yellowing, and discusses how preliminary results can be used to reformulate EVA encapsulants.

The purpose of this investigation was to better define the problem of field yellowing of EVA‐based PV encapsulant, through laboratory study of probable chemical mechanisms and the development of stabilization strategies for protecting EVA from discoloration. EVA from fielded modules was analyzed for vinyl acetate content, unsaturation, and additive levels. These test results were then compared to results from Xenon Arc Weather‐Ometer aged glass/EVA/glass laminates made in the laboratory. Variables evaluated in Weather‐Ometer aged laminates included ‘‘standard‐cure’’ A9918P EVA, ‘‘fast‐cure’’ 15295P EVA, low iron glass superstrate containing cerium oxide, and systematic elimination or addition of specific additives. Six significant findings were revealed: 1) Improved ‘‘standard‐cure’’ and ‘‘fast‐cure’’ type EVA encapsulants, formulations X9903P and X15303P, respectively, showed little or no yellowing after extended Weather‐Ometer exposure; 2) The use of ‘‘fast‐cure’’ EVA reduced discoloration when compared with ‘‘standard‐cure’’ A9918P EVA; 3) Glass superstrate containing cerium oxide resulted in a reduced rate of EVA discoloration; 4) ‘‘Fast‐cure’’ EVA used with glass superstrate containing cerium oxide showed no visible yellowing after 32 weeks in the Weather‐Ometer—a period estimated to be roughly equivalent to 20–30 years of exposure in the Southwest; 5) Severely discolored EVA samples from the field showed no measurable loss of acetate group and little detectable unsaturation; and 6) EVA encapsulant with a Tefzel cover exhibited no yellowing after extended Weather‐Ometer exposure.

There are several new developments with regard to semiology, diagnosis, physiopathology and the treatment of restless leg syndrome (RLS). We present here the hypothesis that motor manifestations of the RLS are synchronous to slowing of the cortical activity as measured by the spectral analysis of the EEG. When the subject is resting in bed with his leg outstretched, slowing of the EEG is observed, which could be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic or aperiodic accordingly. On the contrary, periodic leg movements in sleep (PLMS) occur in close temporal relationship with periodic arousal. These results raised the hypothesis that leg movements (RLS and PLMS) may appear at a critical level of cortical activation. This level is reached during sleepiness in the awake subject or during periodic micro-arousal when the subject is asleep. Other results suggest that these periodic changes in the level of cortical activation may also modulate other abnormal motor behavior in sleep such as rhythmic masticatory muscles activity as seen in sleep bruxism. The same mechanism may also be involved in setting the duration of apneic episodes during slow-wave sleep.

Electrical dental anesthesia has recently been suggested as an alternative to local anesthetics for the control of pain related to certain dental acts. This article updates the evidence which supports the efficiency, indications and contra-indications of such a procedure. Although this technique has certain advantages, its use is limited by: 1) how cooperative the patient may be; 2) the time required to explain the procedure to the patient and that which is required to produce the needed clinical effect; and, 3) how efficient it may be relative to the patient in question and the dental treatment rendered.

The structure of hexacarbonyldi-μ-mercaptobenzothiazolato(μS,N)dimanganese, [Mn(CO)3mbt]2, has been solved using three-dimensional X-ray data. The compound crystallizes in the space groupC2/c, with unit-cell constantsa = 14.38(2),b = 11.84(2),c = 13.90(2) A, and β = 94.70(8) °. Least-squares refinement of the positional and anisotropic thermal parameters gives a finalR value of 0.048 for 2090 independent reflections. The results are compared with those obtained with the previously reported isomorphous complex of rhenium, and the structural arrangement is discussed in terms of metalic corrosion inhibition.

BDF1 mice were inoculated with 10(6) leukaemic cells and, together with control mice, were given a single oral dose of cyclophosphamide-14C of 100 mg/kg body weight. In the leukaemic mice we observed an increased 14C concentration in the plasma, bone marrow, liver, lungs, spleen, kidney and particularly fat where the level was 2-4 times higher than in control mice. Conversely, during the same period, significantly less 14C was detected in the stomach and small intestine of the leukaemic mice. These results were obtained 6 days after tumour transplantation (median survival time 7.7 days) whereas no differences were observed when the studies were carried out 4 days after tumour transplantation. These findings indicate an increase in the gastrointestinal absorption and in the tissue storage fo cyclophosphamide in L-1210 leukaemic mice at an advanced stage of the disease.

A reduced response of a tumour to chemotherapy may be due to the host's drug metabolism. To test this hypothesis, we measured the metabolism of a model drug, para-aminosalicylate (PAS). Volunteers and cancer patients ingested a single oral dose (2 g) of PAS and we measured the plasma disappearance curve of the drug and its metabolite. In 7 patients suffering from lymphosarcoma, acute or chronic leukaemia and resistant to cancer chemotherapy, we observed low plasma PAS concentrations, an increase in PAS acetylation and an increased number (and a higher frequency) of abnormal liver-function tests. In 14 patients with malignant blood disease, yet responding well to chemotherapy, the metabolism of PAS is similar to that of healthy controls of the same age and sex. The plasma half-life of PAS is similar in sensitive and resistant patients, but slightly longer than in volunteers. Finally, in urine collected 120 min after drug administration, we observed the same results as in plasma. In conclusion, cancer patients resistant to chemotherapy do not metabolize the model drug PAS as volunteers or sensitive patients do, and this might be relevant to the terminal stage of the disease.

The authors report the case of an anomalous right coronary artery arising from the pulmonary artery. The patient was an active 18 years old boy who had a continuous murmur with diastolic accentuation, the cause of which was determined at angiography. There were electrical and echocardiographic signs of moderate left ventricular dilatation and thallium scintigraphy showed a myocardial perfusion defect. These were the only detectable consequences of this rare malformation. Normal coronary circulation was reestablished surgically, the indication being the risk of sudden death which has been previously reported rather than acute myocardial ischemia.

In a randomized, double-blind, cross-over study with plasma drug assays, 16 patients (11 men, 5 women; mean age 48.56 +/- 3.61 years) presenting with hypertrophic obstructive cardiomyopathy confirmed by echocardiography, left ventriculography and left intraventricular gradient measurement were treated with verapamil 480 mg/day or propranolol 320 mg/day. Both treatments produced functional improvement (p less than 0.01) which was more distinct with verapamil (NS). No changes in cardiothoracic index, echocardiographic parameters and Sokolow's index were observed. Mean total heart work during exercise, which was 1,197.27 +/- 135.89 watts before treatment, increased to 1,260.91 +/- 146.60 watts under propranolol (NS) and to 1,344.09 +/- 171.06 watts under verapamil (NS). Maximum heart rate during exercise, which was 162.3 +/- 3.46 beats/min before treatment, was reduced to a greater extent by propranolol (122.1 +/- 6.6 beats/min; p less than 0.001) than by verapamil (147.7 less than 5.08 beats/min; p +/- 0.01). The two treatments did not significantly modify ventricular arrhythmia, arterial and capillary pulmonary pressures, mean aortic pressure and left ventricular end-systolic pressure. Cardiac index, unchanged under verapamil, fell from 2.98 +/- 0.16 1 X min-1 X m-2 to 2.60 +/- 0.11 1 X min-1 X m-2 under propranolol (p less than 0.05). The left intraventricular gradient present in 5 patients at rest and during exercise, was reduced by both drugs. The gradient under isoprenaline (n = 16), which was 162.07 +/- 18.77 mmHg before treatment, fell to 93.86 +/- 24.48 mmHg with propranolol (p less than 0.05) and to 128.86 +/- 18.22 mmHg with verapamil (p less than 0.05). Left ventricular ejection fraction, mean circumferential fibre shortening speed and compliance coefficient remained unchanged under both drugs (NS). Left ventricular diastolic function, evaluated by radioisotope angiography in the last 9 patients, was most often improved by verapamil (NS). Verapamil was better tolerated generally and by the heart than propranolol. No correlation was observed between plasma verapamil levels and clinical results. Low plasma propranolol levels were often noted in non-responders, suggesting a need for treatment with high doses. It is concluded that at the dosage level used in this study propranolol and verapamil were equally effective, but there were individual variations in best response to one or the other of these two drugs.

Since it is known that the metabolism of acetaminophen is involved in its hepatotoxicity and that drug metabolizing enzyme activity is decreased in tumor bearing animals, it was of interest to study the influence of L-1210 leukaemia on acetaminophen hepatotoxicity in BDF-1 male mice. A single oral dose of acetaminophen, 125 mg/kg, was given at the fifth day of the mice survival period (7.7 days) and the animals killed twenty-four hours later. As revealed by serum glutamic-pyruvic transaminase, serum glutamic-oxaloacetic transaminase and lactic dehydrogenase, acetaminophen was less hepatotoxic in leukaemic mice than in control mice by comparison with their own saline group; on the other hand the difference between control and leukaemic mice treated with acetaminophen was significant only for glutamic-pyruvic transaminase. Moreover, we found higher unchanged acetaminophen concentrations in plasma, liver, kidneys, brain and fat of the leukaemic mice as compared to controls, less conjugated metabolites in plasma and liver, decreased in vitro aniline hydroxylation and ethylmorphine N-demethylation. Finally, following acetaminophen administration, reduced hepatic glutathione was depleted to a much lesser extent in the tumor bearing animals than in controls. In conclusion, the L-1210 leukaemia seems to modify the acetaminophen hepatotoxicity and this effect might be explained by decreased acetaminophen biotransformation into toxic metabolites or intermediates.

Although the jaw reflexes are analogous in many ways to the corresponding limb reflexes, important differences do exist. The myotatic reflex appears to contribute more stiffness to the jaw-closing muscles than to limb muscles. The jaw tends to swing up and down during locomotion, and, to maintain a stable position in relationship to the skull, it is necessary that the muscles be made stiff by tonic contraction and/or through a powerful servoreflex. The short conduction pathway and rapid contraction of jaw muscles allow reflex effects to act with little phase lag and to provide efficient compensation. If limb muscle reflexes were equally powerful, their effects could be of more nuisance than help in overcoming expected loads because they occur so late. Perhaps the lack of Renshaw cell inhibition of trigeminal MNs and the potentiation of the jaw jerk reflex by chin vibration are features designed to maintain the strength of the myotatic reflex during locomotion. The jaw-opening reflex (including exteroceptive suppression of jaw-closer muscle activity) is bilaterally symmetrical rather than bilaterally reciprocal, as are the analogous spinal flexor withdrawal reflexes. Bilateral braking is necessary to stop closure, because the mandible crosses the midline, whereas withdrawal of a limb often needs to be compensated for by extension of the other to maintain balance. It has recently been shown in animals that limb and jaw reflex responses are highly context dependent: the size and direction of limb reflexes depend on the phase of locomotion (Forssberg et al., 1977), and the gain of the jaw-opening reflex is increased during the closing phase of mastication (Lund et al., 1981).