Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies?

The purpose of this study was to analyse the validity and the economic efficiency of a portable monitor of respiratory parameters (PMRP), used in a home setting for the diagnosis of sleep apnoea/hypopnoea syndrome (SAHS). Eighty nine patients with suspected SAHS were studied in two settings: in the sleep laboratory using full-polysomnography (full-PSG); and at the patient's home using a PMRP. In the home setting, 50 patients were assisted by a technician and 39 set up the equipment themselves. SAHS (apnoea/hypopnoea index (AHI) >10 events x h(-1) by means of full-PSG) was diagnosed in 75 of the 89 patients. An acceptable agreement was obtained between the AHI measured by full-PSG and PMRP, according to the Bland and Altman method of concordance (mean bias 2.56; 95% confidence interval 3.25). Sensitivity and specificity of PMRP were adequate for diagnostic purposes; however, their values rely on the prior PMRP-AHI cut-off point selected with reference to full-PSG-AHI >10. The clinical therapeutic decision taken after PMRP agreed with that taken with full-PSG in 79 patients (89%). Although 10% of the studies with an individual set-up needed repetition, both of the domiciliary modalities (with and without a technician's intervention) were, economically, about three times more efficient than full-PSG. In conclusion, we believe that patients with a suspected sleep apnoea/hypopnoea syndrome should initially be studied in a home setting with a portable monitor of respiratory parameters, since it is a reliable method with an acceptable cost-effective profile.     

Analysis of the effect of polypyrrole synthesis conditions on its capacity to reduce hexavalent chromium

This paper reports the capacity of polypyrrole to reduce toxic hexavalent chromium (Cr(VI)). The influence of using different electrolytes during the polymer's synthesis has been studied. To improve the reduction of Cr(VI), the parameters considered were the polypyrrole morphology and the amount of conducting polymer. Polypyrrole obtained by cyclic voltammetry at a low sweep rate using KBr as supporting electrolyte showed better performance for Cr(VI) reduction compared to coatings obtained by constant potential or cyclic voltammetry at high sweep rates.     

Mumps orchitis; review of 8 cases]

The occurrence of secondary hypogonadism is a common finding in males who seek help with erectile dysfunction, although the relationship to diminished testosterone is unclear. Two possibilities exist regarding both the genesis and maintenance of the hypogonadotropic hypogonadal state. First, a defect in hypothalamic function, resulting in downregulation as well as in alterations of anterior pituitary function; second, estradiol inhibition of gonadotropin release, both of which result in decreased testosterone production. As testosterone levels decrease and estradiol levels increase, the ratio of free testosterone to estradiol reaches a critical point and the estrogenic gonadotropin suppressive effects predominate. This ratio may signal the biological point of no return and could become one of the criteria for defining the separation of the transitional hypogonadal state from the final 'end stage' hypogonadotropic hypogonadal state. As the aging process continues, there is a relative accumulation of fatty tissue, and aromatization accelerates the conversion of testosterone to estradiol. This additional secondary estradiol inhibition results in the maintenance of the testosterone deficient state, and the aging process continues uncontested.     

Neonatal sciatic palsy: etiology and outcome of 21 cases

INTRODUCTION: Sciatic nerve paralysis is a rare entity in the newborn. Few reference in specialized tests indicate that in the majority of cases the sciatic palsy has been observed after misplaced injections into the buttocks. The prognosis is variable and appears to be better after umbilical vessel catheterization for injection of medications than after misplaced muscular injections. In case of recovery it takes place within 3 to 12 months. OBJECTIVE: The objective of the present study is to know the evolution of neonatal sciatic palsy and to determine their injury noxe in regard to perinatal factors, and their relationship with long-time outcome, and to look for prognostic clues of clinical utility. MATERIAL AND METHODS: We evaluated perinatal factors of newborn children with sciatic nerve paralysis, followed for more than 18 months of clinical evolution, in a neuropediatric centre. RESULTS: Twenty one newborn with such criteria were evaluated. Gestational age was within 32 and 42 weeks (median 38.2). The birth weight was between 2,100 and 4,100 g (median 2,973). The majority of cases obtained total recovery (16 of 21). The time of recovery was 4 to 14 months (median 8.8). Free ambulation was obtained by all cases (at 10 to 24 months). No apparent cause was observed in the majority of cases. Cesarean delivery was more frequent specially in cases with permanent consequences. CONCLUSION: Long-time prognostic of neonatal sciatic palsy is generally good. In our series all the cases with consequences were associated to cesarean delivery. The duration of cesarean intervention and the anesthesic hypotony of the newborn could be implicated in the sciatic nerve injury of poor outcome.     

Obstetric analgesia using continuous epidural perfusion of bupivacaine, adrenaline, and fentanyl

OBJECTIVES: To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth. PATIENTS AND METHODS: Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out. RESULTS: Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable. CONCLUSIONS: Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.     

New species of Aeromonas isolated in Cuba

One hundred and fifty-five strains of Aeromonas isolated in the stools of children under 5 years presenting with acute diarrheal disease were studied. Using the Aerokey II system for the identification of species, 47 strains were identified as Aeromonas caviae, 58 as Aeromonas hydrophila, 23 as Aeromonas veronii biovar sobria, 14 as Aeromonas trota, 9 as Aeromonas veronii biovar veronii, 2 as Aeromonas jandaei and 2 as Aeromonas shubertii, Emphasis is placed on the advantages of this method which allowed for the classification of new species not identified previously in our country.     

Cathepsin L2, a novel human cysteine proteinase produced by breast and colorectal carcinomas

We have identified and cloned a new member of the papain family of cysteine proteinases from a human brain cDNA library. The isolated cDNA codes for a polypeptide of 334 amino acids that exhibits all of the structural features characteristic of cysteine proteinases, including the active site cysteine residue essential for peptide hydrolysis. Pairwise comparisons of this amino acid sequence with the remaining human cysteine proteinases identified to date showed a high percentage of identity (78%) with cathepsin L; the percentage of identity with all other members of the family was much lower (<40%). On the basis of these structural characteristics, we have tentatively called this novel protein cathepsin L2. The cDNA encoding the mature cathepsin L2 was expressed in Escherichia coli, and after purification, the recombinant protein was able to degrade the synthetic peptide benzyloxycarbonyl-L-phenylalanyl-L-arginine-7-amido-4-methylcoumarin, which is commonly used as a substrate for cysteine proteinases. Cathepsin L2 proteolytic activity on this substrate was abolished by trans-epoxysuccinyl-L-leucylamido-(4-guanidino)butane, an inhibitor of cysteine proteinases, thus providing additional evidence that the isolated cDNA encodes a functional cysteine proteinase. Northern blot analysis of polyadenylated RNAs isolated from a variety of human tissues demonstrated that cathepsin L2 is predominantly expressed in the thymus and testis. This finding is in marked contrast with the wide tissue distribution of most cysteine proteinases characterized to date, including cathepsin L, and suggests that cathepsin L2 may play a specialized role in the thymus and testis. Expression analysis of cathepsin L2 in human tumors revealed a widespread expression in colorectal and breast carcinomas but not in normal colon or mammary gland or in peritumoral tissues. Cathepsin L2 was also expressed by colorectal and breast cancer cell lines as well as by some tumors of diverse origin, including ovarian and renal carcinomas. These results open the possibility that this novel enzyme may be involved in tumor processes, as already reported for other cysteine proteinases, including cathepsin L.     

Densification of silicon nitride ceramics under sinter-HIP conditions

The influence of several sinter-HIP variables on the densification behaviour of silicon nitride-based ceramics has been investigated. The processing conditions were studied for Si₃N₄ powder mixtures containing controlled amounts of Y₂O₃+Al₂O₃ or Y₂O₃+MgO. The specimens were subjected to sinter-HIP cycles under argon or nitrogen atmospheres at various temperatures and pressures. The final density of the powder compacts exhibited a strong dependence not only on the applied pressure, the composition and the processing temperature, but also on the pressurization rate and the initial pressurization time. The microstructural changes induced by the application of high pressure were followed by transmission electron microscopy. On examination by TEM, large concentrations of dislocations, generated inside some-Si₃N₄ grains, were observed. Characterization of these dislocations showed thatb=0001 is their most frequently found Burgers vector. Also, two relaxation mechanisms, tending to release the stored energy of deformation in the-Si₃N₄ grains, namely grain penetration (a form of strain-induced boundary migration) and grain fragmentation (the formation of subgrains due to rearrangement of dislocations into low energy configurations), have been identified. The intergranular phases formed were characterized by energy dispersive X-ray spectroscopic analysis, X-ray diffraction and electron diffraction. The influence of different sinter-HIP cycles on the transformation of silicon nitride without additives was also investigated by X-ray diffractometry.     

Deploying deep learning approaches to left ventricular non-compaction measurement

The Journal of Supercomputing - Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by abnormal trabeculations in the left ventricle cavity. Although traditional computer...