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Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the Fatigue Severity Scale (FSS, preplanned primary outcome), another fatigue measure, sleep quality, somnolence, pain, disability, and quality of life in multiple sclerosis (MS) patients with obstructive sleep apnea-hypopnea (OSAH). Methods: In a randomized, double-blind trial (NCT01746342), MS patients with fatigue, poor subjective sleep quality, and OSAH (apnea-hypopnea index of ⩾ 15 events per hour/sleep), but without severe OSAH (apnea-hypopnea index > 30, and 4% oxygen desaturation index > 15 events/hour or severe somnolence), were randomized to fixed CPAP or sham CPAP for 6 months. Outcome assessments were performed at 3 and 6 months. Results: Of 49 randomized patients, 34 completed the protocol. Among completers, FSS did not improve with CPAP compared to sham at 6 months. FSS tended to improve ( p = 0.09), and sleepiness (Epworth Sleepiness Scale) improved significantly ( p = 0.03) at 3 months with CPAP compared to sham, but there were no other improvements with CPAP at either study evaluation. Conclusion: In non-severe OSAH patients, CPAP did not significantly improve the primary outcome of FSS change at 6 months. In secondary analyses, we found a trend to improved FSS, and a significant reduction in somnolence with CPAP at 3 months.

Background: The Canadian GILENYA® Go ProgramTM provides education and support to people with relapsing-remitting multiple sclerosis during fingolimod treatment. Methods: Data were collected and analyzed from the time of the first individual enrolled in March 2011 to March 31, 2014. Individuals were excluded if they withdrew from the program prior to receiving the first dose, or had not completed the first dose observation (FDO) at the time of data cut-off. Reports of adverse effects were validated with a database of adverse events reported to Novartis Pharmaceuticals Canada Inc. Results: A total of 2,399 individuals had completed FDO at the end of the three-year observation period. Mean age was 41.2 years; 75.2% were female. The most recent prior therapies reported were interferon-β agents (50.2%), glatiramer acetate (31.1%), natalizumab (14.2%), no prior therapy (3.3%), and other agent (1.1%). Reasons for switching to fingolimod were lack of efficacy (34.9%), side effects (34.6%), and dissatisfaction with injections/infusion (30.4%). Continuation rates with fingolimod at 12, 24 and 30 months were 80.7%, 76.6% and 76.0%, respectively. The discontinuation rate due to reported lack of efficacy during the three-year period was 1.3%. There was 94.4% adherence to the scheduled ophthalmic examination. Conclusions: The GILENYA® Go ProgramTM captures data for virtually all fingolimod-treated patients in Canada, enabling the evaluation of fingolimod use in routine practice. Ongoing patient support and reminders to take the medication, in conjunction with physicians’ and/or patients’ perception of the efficacy and tolerability of fingolimod, resulted in a high rate of continuation during longer-term therapy.

Background: The Gilenya® Go ProgramTM offers education and support services, including coordination of first dose observation (FDO) and follow-up contact to reinforce monitoring recommendations and compliance in fingolimod-treated relapsing-remitting multiple sclerosis (RRMS) patients. Methods: Data were analyzed for patients enrolled in the Canadian Gilenya® Go ProgramTM from March 2011 to January 2016. The retention to fingolimod therapy, reasons for treatment discontinuation and incidence of adverse events (AEs) during treatment are reported. Results: At data cut-off, 3956 patients had completed FDO; 3201 patients were being actively treated. Mean age at enrolment was 41.0 years; 74.9% patients were female. The overall fingolimod exposure was 7869 patient-years. Most recent previous therapies (n=3746) included interferons (43.3%) and glatiramer acetate (29.6%). Most common reasons for switching to fingolimod (n=3674) was lack of efficacy (31.8%). Retention to therapy at data cut-off was 81.3%. AEs (45.2%) were the most common reason (n=334) for treatment discontinuation and included low lymphocyte count/abnormal hematology values (13.8%), gastrointestinal disturbances (6.9%), and elevated liver enzyme levels (7.8%). Adherence to recommended ophthalmic examination was 92.4%. Conclusions: In real-world clinical practice in Canada, adherence to both fingolimod treatment and monitoring was high. The Gilenya® Go Program™ helps to meet the safety monitoring recommendations for fingolimod-treated RRMS patients.

The gel test is born in 1984. Its evolution can be described in three steps: development of a marketable product by the Diamed company improvement of this product, and development of new products based on the same process by competitors. Its main application is the antiglobulin test applied to antibody detection and identification, for which results are more reliable with this test, especially in routine. It can also be used in blood grouping, mainly for specific needs. Other applications are still being developed. Finally, the gel test has contributed to a change in practice at the immunohematological laboratory and has opened the door to further new technologies.

most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS.this was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs.two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P0.05) and fewer neuropsychological issues (P0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment.identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs.

Background: Previous reports suggest that some atypical antipsychotics may have obsessogenic as well as antiobsessional effects. Given their higher affinity for serotonin 5HT 2 receptors than dopamine Dz receptors, it has been speculated that atypical antipsychotics may induce obsessive-compulsive (OC) symptoms, even at low doses, due to high 5HT 2 antagonism, whereas improvement in OC symptoms is thought to occur only at high doses due to high D 2 antagonism. Method: In this open case series, the dose-response relationship of atypical antipsychotic augmentation in the treatment of obsessive compulsive disorder (OCD), and the dose-severity relationship in atypical anti psychotic-induced OC symptoms were examined. Three patients were identified who had either refractory OCD or OC symptoms following administration of atypical antipsychotics such as olanzapine and risperidone. Results: Case 1: A linear dose-response relationship between increasing doses of olanzapine and improvement in OC symptoms was observed in an OCD patient resistant to 5-HT reuptake inhibitors. 2: OC symptoms induced by low doses of risperidone (1 mg) were reversed by increasing the doses of risperidone (3 mg) in a bipolar disorder patient suggesting an inverse dose-severity relationship. 3: No inverse dose-severity relationship was noted between olanzapine induced OC symptoms and its dosage in an asymptomatic OCD patient. Tretment-emergence OC symptoms responded to increasing the doses of maintanance clomipramine treatment. Conclusions: Controlled studies are needed to investigate the dose-response or dose-severity relationships between OCD and atypical antipsychotics.

A new process for the detection of red cell (RBC) antigen antibody reactions is described. It is applicable to most of the tests performed in blood group serology. The procedures are standardized and easy, and they provide clear and stable reactions that improve the interpretation of results. The process uses special microtubes filled with a mixture of gel, buffer, and reagent. Depending on the test to be carried out, the test uses a neutral gel containing no reagents (reagents are added to top of gel) or a specific gel containing reagents (e.g., antiglobulin serum or anti-A, -B, -D, etc.). A suspension of RBCs (for typing or the direct antiglobulin test) or a mixture of RBCs and serum (for reverse ABO typing or antibody characterization) is centrifuged through the gel under precise conditions. In negative reactions, the RBCs pass through the gel and pellet in the bottom of the tube, whereas, in positive reactions, they are trapped in the gel and the reaction may be read for hours afterwards. The test is easy to perform, sensitive, and reproducible. The antiglobulin tests can be performed without washing of the RBCs. There should be a reduction of risk from biohazardous materials.

Fatigue is recognized as one of the most disabling and common symptoms of MS. However, no universal consensus has been reached regarding a formal definition for fatigue, and its mechanisms and causes are not understood. This review summarizes important research in this field and recommends a multidisciplinary approach to managing MS patients with fatigue. Such an approach should include proven pharmaceutical and non-pharmaceutical treatments.

Previous work has demonstrated potentially adaptive cortical plasticity that increases with brain injury in patients with multiple sclerosis. However, animal studies showing use-dependent changes in motor cortex organization suggest that functional changes also may occur in response to disability. We therefore wished to test whether brain injury and disability lead to distinguishable patterns of activation with hand movement in patients with multiple sclerosis. By employing a passive as well as an active movement task, we also wished to test whether these changes were independent of voluntary recruitment and thus mor likely to reflect true functional reorganization. Fourteen patients [Extended Disability Status Score (EDSS) 0-7.5] with relapsing- remitting multiple sclerosis were selected on the basis of pathology load and hand functional impairment for three study groups: group 1, low diffuse central brain injury (DCBI) as assessed from relative N-acetylaspartate concentration (a marker of axonal integrity) and normal hand function (n = 6); group 2, greater DCBI and normal hand function (n = 4); and group 3, greater DCBI and impaired hand function (n = 4). Functional MRI (fMRI) was used to map brain activation with a four-finger and both one-finger passive and active flexion-extension movement tasks for the three groups. Considering all the patients, we found increased activity in ipsilateral premotor and ipsilateral motor cortex (IMC) and in the ipsilateral inferior parietal lobule with increasing global disability (as assessed from the EDSS score). These changes appear to define true functional reorganization, as fMRI activations in IMC (r = 0.87, P < 0.001) and in the contralateral motor cortex (r = 0.67, P < 0.007) were highly correlated between active and passive single finger movements. We attempted to disambiguate any distinct effects of disability and brain injury by direct contrasts between patients differing predominantly in one or the other. To make these contrasts as powerful as possible, we used impairment of finger tapping as a measure of disability specific to the hand tested. A direct contrast of patients matched for DCBI, but differing in hand disability (group 3 - group 2) showed greater bilateral primary and secondary somatosensory cortex activation with greater disability alone. A contrast matched for hand disability, but differing in DCBI (group 2 - group 1) showed a different pattern of changes with relative ipsilateral premotor cortex and bilateral supplementary motor area activity. We conclude that the pattern of brain activity with finger movements changes both with increasing DCBI and with hand disability in patients with multiple sclerosis, and that these changes are distinct. Those related directly to disability may reflect responses to altered patterns of use. As injury- and disability-related activation changes are found even with passive finger movements, they may reflect true brain reorganization.

PURPOSE: Although MR findings in multiple sclerosis (MS) are well known, the relationship between MR-detected lesions and clinical activity has not been studied in the spinal cord. The purpose of this study was to determine whether serial MR imaging provides evidence of disease activity unsuspected on clinical examination and to determine whether it is useful in monitoring patients with MS primarily affecting the spinal cord. METHODS: Twenty-five consecutive patients with MS and with signs and symptoms of myelopathy underwent a full neurologic examination and contrast-enhanced MR imaging of the spinal cord at intervals of 0, 2, 6, and 12 months. Disability was rated according to Kurtzke's functional systems and the expanded disability status scale (EDSS). Clinical status of myelopathy (improved, deteriorated, or stable) was also assessed. Hyperintense lesions were counted on T2-weighted images and a weighted lesion load was calculated for each patient. The number of enhancing lesions was also determined. RESULTS: We found a moderate correlation between lesion load and sensory function and EDSS. Seventy percent of patients with new clinical manifestations of myelopathy had one or more enhancing lesions. Agreement between MR findings and clinical examination in evincing disease activity was found in 60% of follow-up examinations. MR images showed lesion progression in seven (44%) of 16 occurrences of clinical deterioration and in 21 (35%) of 60 occurrences of clinical improvement or stability. CONCLUSION: Serial MR imaging provides evidence of disease activity unsuspected on clinical examination and could be useful in monitoring patients with MS primarily affecting the spinal cord.

In spite of its significant morbidity, dysthymic disorder has been under-researched, therefore effective treatment options are limited. This article presents data suggesting that dysthymia can be treated effectively with psychopharmacologic agents. A double-blind, placebo-controlled 7-week drug trial comparing imipramine to ritanserin, a serontonin-2 antagonist, indicated that both drugs were significantly more effective than placebo in alleviating dysthymia symptoms. Imipramine was slightly more effective than ritanserin, as indicated by ratings on the Hamilton Depression Rating Scale and the Zerssen Self-Rating Scale; however, imipramine also produced more side effects. On the basis of this study, we continued an open protocol for treating dysthymic patients with a specific serotonin reuptake inhibitor, fluoxetine. This open-label study indicated that fluoxetine was successful in reducing the dysthymia symptoms, particularly in the subaffective sub-type. These studies confirm the need for further research into the treatment options for patients suffering from dysthymia.

The gel test is born in 1984. Its evolution can be described in three steps: development of a marketable product by the Diamed company improvement of this product, and development of new products based on the same process by competitors. Its main application is the antiglobulin test applied to antibody detection and identification, for which results are more reliable with this test, especially in routine. It can also be used in blood grouping, mainly for specific needs. Other applications are still being developed. Finally, the gel test has contributed to a change in practice at the immunohematological laboratory and has opened the door to further new technologies.

The objective of this study was to determine if moclobemide is an effective treatment for depression and if it is well tolerated by patients. A randomized, double-blind placebo-controlled trial was conducted in a tertiary ambulatory clinic which treats depression. Fifty-five patients participated. They fit the DSM-III-R criteria for major depressive episode, scored at least 18 on the 17 item Hamilton Rating Scale for Depression (HRSD), were between the ages of 18 and 65, and were not suffering from a major medical illness. After a one week washout period, patients were randomly selected to receive placebo, amitriptyline or moclobemide for up to six weeks. Moclobemide is a well-tolerated medication at therapeutic doses; it is globally as effective as amitriptyline in the treatment of major depression.

A 78-year-old woman presented with a right basal ganglia infarct 6 weeks after a left herpes zoster ophthalmicus. MR angiography showed focal segmental stenosis of the proximal segments of the anterior, middle, and posterior cerebral arteries. Varicella DNA was detected in the CSF by polymerase chain reaction (PCR). Treated with dexamethasone and acyclovir without improvement, she died 1 month later. There was focal endarteritis in the left anterior, middle, and posterior cerebral arteries at autopsy. Varicella DNA was detected by PCR of extracts from these vessels but not from the arteries on the right side. This study provides further evidence that the vasculopathy after herpes zoster ophthalmicus results from direct viral invasion of the vessel wall.NEUROLOGY 1996;47: 569-570

Previous studies reported that a 2- to 3-week course of IV cyclophosphamide plus adrenocorticotropic hormone (ACTH) induction can temporarily halt progressive MS for a period of 12 months in the majority of patients treated, after which reprogression occurs. The Northeast Cooperative Multiple Sclerosis Treatment Group was formed to determine whether outpatient pulse cyclophosphamide therapy could affect reprogression and whether there were differences between a modified induction regimen and the previously published regimen. Two hundred fifty-six progressive MS patients were randomized into four groups to receive IV cyclophosphamide/ACTH via the previously published versus a modified induction regimen, with or without outpatient IV cyclophosphamide boosters (700 mg/m2 every other month for 2 years). There were blinded evaluations performed every 6 months. Results demonstrate that (1) there were no differences between the modified and the published induction regimens either in terms of initial stabilization or subsequent progression; (2) without boosters, the majority of patients continued to progress; and (3) in patients receiving boosters, there was a statistically significant benefit at 24 months and 30 months (p = 0.04). Time to treatment failure after 1 year was also significantly prolonged in the booster versus the nonbooster group (p = 0.03). Age was the most important variable that correlated with response to therapy in that amelioration of disease progression occurred primarily in patients 40 years of age or younger. Boosters had a significant benefit on time to treatment failure in patients ages 18 to 40, p = 0.003, but not in patients ages 41 to 55, p = 0.97.(ABSTRACT TRUNCATED AT 250 WORDS)

The propagation of the fast magnetosonic wave is studied, taking into account the effect of the two-ion hybrid layer. Using a one-dimensional model, which includes density and magnetic field gradients, the wave equation is solved in the cold plasma approximation. The existence of radial eigenmodes confined between the two-ion hybrid layer and the low field side wall is predicted. Comparison with experimental data obtained on the TFR tokamak confirms the theoretical conclusions. Toroidal eigenmodes are observed even in the mode conversion regime when the antenna is on the low magnetic field side.

The Orsay storage ring free-electron laser has been operated in the short–wave-length side (blue) of the visible spectral range from 4630 A to 4860 A. General conclusions on storage ring free-electron laser are derived after our successive operations of a tunable laser over almost the entire visible spectral range.

The optical klystron, previously successfully optimized for the realization of a FEL on the ACO storage ring at Orsay, has been used as a nonlinear medium for producing harmonics of an external 1.06 μm Nd:YAG laser focused into it. Detailed experimental data are reported. A comparison with theoretical calculations shows very good qualitative and quantitative agreement between the experimental data and the theory.

Absolute and relative energy spread measurements have been made on the ACO storage ring using two different methods. The first one consists of a spectral analysis of the electron bunch length based on the proportionality of the longitudinal bunch length versus energy spread. The second one constitutes a direct measurement using the on axis synchrotron radiation emitted by an optical klystron. The two measurement techniques present a very high signal/noise ratio allowing time resolved records. Examples are presented of the energy spread time evolution in the FEL oscillator and of harmonic generation experiments.

The impedance of a warm inhomogeneous magnetoplasma capacitor is calculated without calling for the WKB approximation. In the particular case of a parabolic density profile, the wave equation which accounts for wave conversion at the hybrid layers is solved in terms of series. The expression for the capacitor impedance is shown to reduce to a simple continued fraction. Illustrative examples are given for the Tonks-Dattner and the Buchsbaum-Hasegawa resonances.

The optical klystron previously successfully optimized for the realization of an FEL on the ACO storage ring has been used as a non-linear medium aimed at producing harmonics of an external laser. For the first time we have demonstrated experimentally this effect by looking at the third harmonic of a 1.06 μm Nd:YAG laser focused into it. An enhancement of 102 to 103 of the spontaneous emission at 355 nm has been recorded.

We report the first observation of the emission of coherent light by an electron beam bunched at 1.06 \ensuremath{\mu}m by a Nd-doped yttrium aluminum garnet laser focused into an optical klystron. An enhancement of ${10}^{2}$ to ${10}^{3}$ over its spontaneous emission level at 355 nm has been observed in these experiments performed at the ACO storage ring at Orsay.

Density fluctuation observation can be obtained by scattering of electromagnetic radiation. New developments and applications are presented. By heterodyne detection the scattered signal is shown to be the time variation of a space Fourier transform of the density. The antenna beam, that especially defines the sensitivity, is experimentally investigated. The time variation is used in two occurrences, to check quantum efficiency uniformity on detectors area, and in an air turbulence where the interspectrum is obtained between two scattering devices looking at different regions. Calibration formulas are given for quantitative measurement of density fluctuation spectrum. Observations are also reported on a tokamak plasma, on the drift wave spectrum, and on a new second order group of oscillations that were observed during ion cyclotron radio-frequency heating. The analysis shows this new group is a forced oscillation by beating of the drift waves with the high-frequency heating wave, and its amplitude provides a measurement of the HF wave electric field.

The Stanford SCA/FEL system is being modified to be used as a versatile source of photons for a wide range of biomedical and materials science experiments. Characteristics of the FEL beams to be provided are presented, as well as results of recent experiments on energy recovery. A new high brightness injector will be developed and tested, and the possibility of UV operation of an FEL has been assessed, assuming either fundamental or third harmonic output.

A modification of the operating point of the machine is reported. Smaller transverse sizes of the electron beam have been achieved producing a higher optical gain, and a laser tunability ranging from 5700 to 6400 A. The dependence of the temporal and spectral structure of the laser beam versus detuning and Q-switch frequency is discussed.

A Monte Carlo numerical simulation code provides spontaneous and coherent emission results, including the effect of electron beam emittance and energy spread and of external laser field properties. Comparisons are made with spectra recently obtained with the ACO optical klystron. Noise characteristics of the spontaneous emission are discussed. Coherent emission is compared with the predictions of analytical models.

A single particle is subjected to the combined action of a static uniform magnetic field and an electromagnetic wave. The equations of motion are solved using the perturbation method up to second order. In the results, two different types of second-order effects appear: (i) the always present non-resonant effects, resulting in a ponderomotive drift and a nonlinear cyclotron frequency shift, and (ii) the resonant effects appearing at the half-integer harmonics of the gyrofrequency and leading to perpendicular heating and diffusion.

The FEL installed on the storage ring ACO at Orsay has been operated down to a wavelength of 463 nm, at a ring energy of 200 MeV. This is probably the lowest wavelength attainable on ACO with TiO 2 SiO 2 dielectric mirrors because of the near-UV TiO 2 broad absorption band. A careful analysis of the optical gain, taking into account the measured beam characteristics, shows a spectral dependence scaling as λ 1,1 , with a maximum at λ = 650 nm close to 0.4%. Therefore the ACO FEL may be tuned over almost the whole visible spectrum at the expense of time consuming mirror changes. Due to the poor transmission of these very high reflectivity mirrors the average extracted power is only a few mW throughout the visible region. However the maximum intracavity peak power (at low frequency Q -switching) reaches about 0.5 MW. The next step will be to test new Al 2 O 3 SiO 2 coated mirrors in the near-UV spectral range.

A review of the free electron laser experiments and harmonic generation experiments performed on the Anneau de Collision d'Orsay is presented. The perspectives for coherent radiation sources in storage rings is also presented with a highlight from two optimized machines under construction

The pathogenesis of the neuroleptic malignant syndrome is currently unclear, and no specific morphological abnormalities in the CNS of victims of neuroleptic malignant syndrome have been described. The authors report a case of neuroleptic malignant syndrome with recent foci of necrosis in the anterior and lateral hypothalamic nuclei. They discuss the role of tricyclic antidepressants, monoamine oxidase inhibitors, and neuroleptics in the development of this syndrome. They conclude that although the pathogenesis of the neuroleptic malignant syndrome is still not clear, necrosis of the hypothalamic nuclei may be pathognomonic for this syndrome.

Coherent emission of light in the uv or vuv range can be obtained from an undulator or optical klystron by harmonic generation using an external laser. We show that if the input is a multimode laser (instead of an ideal monochromatic coherent wave) the kinetics of growth of the rms beam modulation is completely different from the one described by the usual Webster formula, and we find a simple analytical expression for a Gaussian input (large number of modes). Numerical calculations show that with 3 modes the result is already close to the Gaussian case, and that the frequency bandwidth increases as the square root of the harmonic number.

High power experiments in the Ion Cyclotron Range of Frequency are performed in several laboratories /1,2,3/ or are planned in large devices /4,5,6/. It is of great importance to know the effect of the electromagnetic field on the particle confinement when the RF frequency is equal to the cyclotron frequency or an harmonic of a population contained in the plasma. A first approach of this problem has been considered by T. Stix /7/ who solved the Fokker Planck equation for an hydrogen population which experiences resonant heating at its cyclotron frequency. This analytic treatment does not take into account the anisotropy in the distribution function nor diffusion in the real space. More recently Whang and Morales /8/ have presented results obtained with a Monte Carlo code for the heating of an hydrogen population. They have shown the enhanced diffusion of the minority population due to the RF field. We present here a somewhat more general Monte Carlo Code. In a first part we describe the Code itself. In a second part we will emphasise the importance of the electric field value compared to the effect of collisions. In a third part, we will discuss the role of high Z impurities as a possible candidate to explain the wave absorption when the hydrogen resonance is outside of the machine /9/.

A computerized study of past infectious events and neurological parameters revealed the existence of a history of repeated respiratory-tract infections (RRI) beginning in childhood, in 52% of 251 multiple sclerosis (MS) patients studied. The 251 MS patients were divided into two groups: those without a past history of RRI were designated as "MS type I", and those with a history of infectious problems before the onset of MS as "MS type II". Significant differences in the neurological symptoms, the treatment received and some general parameters were found between the groups, which suggested a correlation between the evolution of MS and the presence or not of RRI in these patients. When compared to the MS type I group, a significantly higher percentage of MS type II patients reported visual problems (P less than or equal to 0.01), paresthesia (P less than or equal to 0.01), loss of sensitivity (P less than or equal to 0.03), pain (P less than or equal to 0.004), motor problems (P less than or equal to 0.016) and sexual dysfunction in males (P less than or equal to 0.02). The mean number of attacks in the first 5 years of the disease was significantly more frequent in MS type II patients, 6.2 compared to 2.9 (P less than or equal to 0.02). A significantly higher percentage of MS type II patients also received oral corticosteroids (P less than or equal to 0.02) or ACTH (P less than or equal to 0.003). Although the age of onset of MS was the same for both groups, MS type II patients were significantly younger than MS type I patients, the mean age being 36 years compared to 41 years (P less than or equal to 0.001). Only 12% of patients in the MS type II group compared to 30% in the MS type I group had the disease for more than 15 years (P less than or equal to 0.001). As is usual with MS, the majority of the patients in both groups were females, 79.3% in the MS type II compared to 63.4% in the MS type I group. These findings suggest that MS patients with a past history of RRI (MS type II) have a different evolution of their disease from MS type I patients and that in general the disease is more severe. The past infectious history of patients would thus appear of putative value, in addition to neurological criteria, in assessing the probable future evolution of the disease.

A double-blind study was carried out on 40 agoraphobic and socially phobic patients, matched, then randomly assigned to one of four treatment groups; phenelzine-exposure, phenelzine-no exposure, placebo-exposure, and placebo-no exposure. Exposure consisted of encouraging the patient to face the phobic situation a predetermined number of times. Assessments, made at the beginning and end of 8 weeks of therapy and 8 weeks thereafter, showed that the phobia ratings of groups decreased significantly. The combined exposure group improved significantly more than the combined no exposure group during treatment. At 8 weeks follow-up there was some deterioration in the phenelzine-exposure and placebo-no exposure groups. Exposure, with or without phenelzine, was the superior treatment modality. The antiphobic effect of phenelzine was not supported, although it seemed to reduce subjective anxiety during exposure experiences. The possibility that effect of phenelzine is dose-related is discussed.

Patients with multiple sclerosis (MS) from the two Montreal MS clinics, were divided into two groups: one group of 61 patients (MS type I) who had no clinical history of susceptibility to recurrent respiratory tract infections and a second group of 58 patients (MS type II) who had persistent susceptibility to such infections since childhood. All patients were typed for the HLA tissue antigens. The HLA antigen frequencies of the total MS patient population, and of MS type I and MS type II patients were compared to those of a normal control population and each other. The HLA-DR2 and B7 antigen frequencies were significantly increased compared to the normal controls for all MS patients. MS type I patients had an increased frequency for HLA-Bw42 and DRw8 antigens; the frequency of HLA-A29 was lower than in the controls and MS type II patients. MS type II patients had a significantly increased frequency for DR3 and some HLA-DR3-associated phenotypes (A1 + DR3; B8 + DR3; A1 + B8 + DR3) as compared to controls and MS type I patients. These results are consistent with the existence of genes linked to the HLA antigens, such as immune response genes, which control the resistance or susceptibility of the patients to infection, and suggest that these HLA antigens could be associated with a difference in the evolution of MS, as observed in the MS type I and II patients [21].

The present study compared the behavioral performance of 30 children with attention deficit disorder with hyperkinesis (HK) on electrophysiological, biochemical, behavioral, and psychometric measurements. HK children were partitioned into cells of 10 and were then treated with placebo, methylphenidate, and adrenocorticotropic hormone fractions (ACTH4-9 analog), respectively, in a double-blind randomized cell sequence according to body weight. The results revealed that HK children on methylphenidate manifested a significantly greater vasomotor reactivity, behavioral improvement, and learning receptivity than did HK children taking ACTH4-9 analog and/or placebo. Future research implications with ACTH4-9 and HK children are discussed.

In this paper we describe the different goals of the Orsay optical Klystron : free electron laser, coherent harmonic generation, tool for beam diagnostics, source for spin polarized photoemission of solids, optical experiments on clusters and holography.© (1986) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A wave damping and heating model is presented. It permits to treat a wide range of plasma parameters and complex ion species composition. Applied to JET parameters, two selected wave scenarii are found to allow a great flexibility, in particular with respect to complex gas composition. A major results is the possibility of single pass absorption.