Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial.

RATIONALE: Custom-made mandibular advancement devices (MADs) are reported as providing higher efficacy rates compared with thermoplastic heat-moulded MADs but at the price of higher costs and treatment delays. OBJECTIVE: To determine whether a thermoplastic heat-moulded titratable MAD (ONIRIS; ONIRIS SAS, Rueil Malmaison, France) is non-inferior to a custom-made acrylic titratable MAD (TALI; ONIRIS SAS, Rueil Malmaison, France) for obstructive sleep apnoea (OSA). METHODS: We conducted a multicentre, open, randomised controlled trial of patients with OSA refusing or not tolerating continuous positive airway pressure (CPAP). Participants were randomly assigned to a thermoplastic heat-moulded titratable device or a custom-made acrylic device for 2 months with stratification by centre and OSA severity. The non-inferiority primary outcome was a ≥50% reduction in apnoea-hypopnoea index (AHI) or achieving AHI <10 events/hour at 2 months. The non-inferiority margin was preset as a difference between groups of 20% for the primary outcome in the per-protocol analysis. MAIN RESULTS: Of 198 patients (mean age 51 [SD, 12] years; 138 [72.6%] men; mean body mass index 26 [SD, 2.7] kg/m2; mean AHI 26.6/hour [SD, 10.4]), 100 received TALI and 98 ONIRIS. In per-protocol analysis, the response rate was 51.7% in the TALI group versus 53.6% in the ONIRIS group (absolute difference 1.9%; 90% CI: 11% to 15%, within the non-inferiority margin). Effectiveness was the same for severity, symptoms, quality of life and blood pressure reduction. Patients in ONIRIS group reported more side effects and adherence was slightly better with TALI. CONCLUSION: In patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior in the short-term to the custom-made acrylic MAD. TRIAL REGISTRATION NUMBER: NCT02348970.

How is norepinephrine used in intensive care? A field study.

OBJECTIVE: To assess how norepinephrine (NE), an emergency treatment of cardiovascular collapse, is used in intensive care. METHODS: Nurses and physicians of 14 intensive care units of the Bordeaux University Hospital were given questionnaires on the way they say they use NE and on actual NE treatment of patients. RESULTS: The clinical monitoring parameters cited were blood pressure, heart rate and hourly urine flow. Only 25% of the prescribers indicated the systematic use of hemodynamic monitoring. All the prescribers indicated they adapted the treatment to clinical objectives and blood pressure, and 77.5% to hourly urine flow. Initial NE concentrations ranged from 0.5 to 2 mg/ml, diluted in saline or dextrose. Initial prescribed dose ranged from 0.1 to 1 microg/kg/min. Large differences were observed between services and even within units. CONCLUSION: These data clearly show the need for recommendations regarding the use of norepinephrine.

Lithium-ion batteries: runaway risk of forming toxic compounds.

Lithium-ion batteries are stabilized by an ultrathin protective film that is 10-50 nanometers thick and coats both electrodes. Here we artificially simulate the 'thermal-runaway' conditions that would arise should this coating be destroyed, which could happen in a battery large enough to overheat beyond 80 degrees C. We find that under these conditions the reaction of the battery electrolyte with the material of the unprotected positive electrode results in the formation of toxic fluoro-organic compounds. Although not a concern for the small units used in today's portable devices, this unexpected chemical hazard should be taken into account as larger and larger lithium-ion batteries are developed, for example for incorporation into electric-powered vehicles.