Clinical trial of an oral vestibular shield for the control of snoring

1. Comparative aspects of iodine conservation in mammals were studied on the basis of published data on kidney and thyroid weights and function. 2. Very small mammals possessed an efficient reabsorption of iodide to compensate for the high glomerular filtration rate (GFR). 3. Humans and mammals of a similar and larger size had "lost" the ability to reabsorb iodide efficiently. 4. Very large mammals are protected against renal loss of iodide due to the relatively low GFR. 5. Thyroid weights in relation to body weight were highest in humans suggesting that humans and other mammals of a similar size are especially susceptible to iodine deficiency.     

Clinical significance.

This article initiates the special section on clinical significance. Within a brief précis and overview, the 4 methodological articles and the integrative commentary of the special section are introduced. A call for the inclusion of the assessment of clinical significance in treatment evaluations is extended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical significance of insulin resistance

Insulin resistance has emerged in the last 20 years as a concept familiar to clinicians in many specialties. No easily performed laboratory test is available to assess insulin action in routine clinical practice. Several rare syndromes of severe insulin resistance are recognized but most clinicians will encounter insulin resistance as a manifestation of common diseases. Physiological and treatment induced changes in insulin sensitivity influence insulin doses required in insulin-dependent diabetes mellitus. In non-insulin-dependent diabetes mellitus insulin resistance is fundamental to pathogenesis but it is also influenced by standard dietary and pharmacological treatment, and probably mediated by changes in prevailing glycaemia. Antihypertensive agents appear to have diverse effects on the insulin resistance of essential hypertension though the long term significance of these remains unclear. The importance of insulin as a risk factor for coronary heart disease and the concept of an insulin resistance syndrome as a common precursor of conditions with increased vascular risk remains controversial.     

Clinical significance of virus diseases

After introductory explanations the following topics are treated: acute respiratory diseases, virus infections of the central nervous system and virus infections of the intestine. In the last paragraph the present state of virus-diagnostic possibilities is described. From this is derived that the routine use of modern virus diagnostics brings great advantages for the clinician. The intensive construction of virological laboratories for the treatment of patients is emphasized.     

Acoustic analysis of snoring sound in patients with simple snoring and obstructive sleep apnoea

Snoring, a symptom which may indicate the presence of the obstructive sleep apnoea syndrome (OSA), is also common in the general population. Recent studies have suggested that the acoustic characteristics of snoring sound may differ between simple snorers and OSA patients. We have studied a small number of patients with simple snoring and OSA, analysing the acoustic characteristics of the snoring sound. Seventeen male patients, 10 with OSA (apnoea/hypopnoea index (AHI) 26.2 events x h(-1)) and seven simple snorers (AHI 3.8 events x h(-1)), were studied. Full night polysomnography was performed and the snoring sound power spectrum was analysed. Spectral analysis of snoring sound showed the existence of two different patterns. The first pattern was characterized by the presence of a fundamental frequency and several harmonics. The second pattern was characterized by a low frequency peak with the sound energy scattered on a narrower band of frequencies, but without clearly identified harmonics. The seven simple snorers and two of the 10 patients with OSA (AIH 13 and 14 events x h(-1), respectively) showed the first pattern. The rest of the OSA patients showed the second pattern. The peak frequency of snoring was significantly lower in OSA patients, with all but one OSA patient and only one simple snorer showing a peak frequency below 150 Hz. A significant negative correlation was found between AHI and peak and mean frequencies of the snoring power spectrum (p<0.0016 and p<0.0089, respectively). In conclusion, this study demonstrates significant differences in the sound power spectrum of snoring sound between subjects with simple snoring and obstructive sleep apnoea patients.     

Management of simple snoring in adults

The management of simple snoring in adults is reviewed. Snoring is associated with oscillations of the soft palate and adjacent structures, as a consequence of a critically reduced pharyngeal cross-sectional area under conditions of sleep-induced flow limitation. Anatomical and physiological factors resulting in upper airway collapse and snoring are reviewed. The conservative treatment of snoring encompasses weight loss, alcohol and sedatives avoidance, as well as smoking cessation. Nasal obstruction should be relieved, either medically or surgically. If these measures fail, polysomnography should be performed. Patients with obstructive sleep apnoea should be offered nasal continuous positive airway pressure therapy. Uvulopalatopharyngoplasty can be proposed to nonapnoeic snorers, with a good chance of success, as far as reported snoring is concerned. Unfortunately, this has not been confirmed by objective recordings, and long-term results have not been adequately studied.     

Clinical significance of surgeon's residual bradycardia

In connection with the observation of new quantitative electronic dates we undertook bradycardia résiduelle from Sureau a critical value in account. The investigations result from non-digital method. We didn't find statistical significant coherence between bradycardie résiduelle and Apgar-score past 1, 5, 10 and 60 minuts p.p., the pHf and the delta pHf. Also in relation to the neurological investigations of the corresponding children we hadn't statistical significant correlations. The causes for this perception are discussed.     

Clinical significance of hyperuricemia in psoriasis

After analysis of 1146 psoriasis patients, high incidence of asymptomatic hyperuricemia (18.8%) and elevated average levels of uric acid in these patients' blood were confirmed (346.8 +/- 2.4 mumol/l). More severe forms of uric acid disbolism lead to aggravated skin affections (psoriatic erythrodermia, exudative psoriasis), arthritis, occur in familial predisposition to psoriasis. Advanced psoriasis patients are at risk to develop apparent gout.     

Clinical significance of L-arginine--nitric oxide system

The ELISA was standardized to detect monoclonal antibodies of dengue virus proteins E and NS1. One indirect ELISA was applied, using C6-36 cells inoculated with the A-15 strain, isolated during the dengue 2 epidemic in 1981 as an antigen source. These cells were fixed in ELISA plates at a 200,000 cell/well concentration. A cell control in similar conditions was used. Specific monoclonal antibodies to both proteins were used to standardize the system. Studies at different incubation periods, to determine the highest expression moment of these proteins in the cell membrane, were carried out. The results show a full response at 72 hours postinoculation for both proteins; a 14.7 ng/mL sensitivity was obtained for the detection of NS1, and of 1.43 ng/mL for E protein. This system allows the monoclonal antibodies primary screening to dengue 2 virus E and NS1 proteins.     

Comparisons of oral devices for snoring

A study was performed on 19 types of oral appliances for snoring/obstructive sleep apnea. The appliances were categorized into two groups, mandibular advancers and tongue advancers. A set of limited criteria was developed by which an appliance could be evaluated, and the criteria were weighted. Evaluations were then performed on the appliances, and they were rated according to satisfaction of criteria. The rating table should help a dentist in selecting an appliance that will be accepted by the patient and effective in treating snoring/obstructive sleep apnea.     

Clinical significance of the measurement of erythropoietin

In this paper the present status of clinical usefulness of erythropoietin measurement is presented. The limitations and difficulties due to lack of the precision using current in vivo bioassay in polycythemic mouse are stated and the informations that can be obtained by determination of serum erythropoietin level in anemias and polycythemias are demonstrated.     

Peculiar snoring in patients with multiple system atrophy: its sound source, acoustic characteristics, and diagnostic significance

The author assesses the current state of knowledge of the neuroendocrinological mechanisms in the induction of maternal behavior in animals in the immediate prepartum (nesting behavior) and in the post-partum, and of the mechanisms involved in the maintenance of this behavior (principally, feed-back from offsprings). Oxytocine (OT) appears very important for the induction of maternal behavior because of central targets of the parvocellular system of the hypothalamus. In fact, we have observed that parturition produces modifications in the RNAm of OT and of OT receptors: both in number and Bmax. An artificial induction of the behavior, outside parturition, is possible to a certain extent after a central, intra-cisternal, administration of OT. Other neuro-hormones have an important role: the modification of the balance of oestroprogestatives at the end of gestancy is absolutely necessary, vasopressin, endogeneous opioids which have a facilitatory effect, may be by an indirect stimulation of OT. Maternal behavior may also be artificially induced by a cervico-vaginal stimulation of a female virgin. Olfactive mechanisms are vital for behavioral specificity, which varies among different races. In primates, the developement of the neocortex is associated with the supremacy of social factors, but it is probable that similar neuroendocrinological mechanisms operate.     

Clinical significance of human sperm-zona pellucida binding

OBJECTIVE: To assess the relationship between sperm morphology and motion parameters and sperm-zona pellucida (ZP) binding capacity under hemizona assay (HZA) conditions and to determine the discriminatory power of the HZA for the prediction of in vitro sperm fertilizing ability. DESIGN: Prospectively designed study. SETTING: Academic tertiary centers. PATIENT(S): One hundred ninety-six couples undergoing IVF therapy participated in this study. INTERVENTION(S): Hemizona assay and IVF results were determined for each couple. MAIN OUTCOME MEASURE(S): Computerized sperm motion analysis, sperm morphology (strict) criteria), and HZA results were correlated with fertilization outcome. RESULT(S): Among sperm parameters from the original ejaculates, morphology was the best predictor of sperm-ZP binding ability; hyperactivated motility was the best predictor of HZA results after swim-up separation of the motile sperm fractions. The HZA index provided the highest discriminatory power for fertilization success/failure, with an overall accuracy of 86%. CONCLUSION(S): Sperm morphology and hyperactivated motility showed a high correlation with the capacity of sperm to achieve tight binding to the ZP. The excellent positive and negative predictive values of the HZA for fertilization outcome provide additional support for the use of this functional bioassay in the decision-making process within the assisted reproduction setting.