Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients.

OBJECTIVE: This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS: 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS: Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION: The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.

Optical trapping of interfaces at ultra-low interfacial tension.

We achieve active control of interfacial phenomena by optically trapping the interface using the gradient forces of a strongly focussed laser beam parallel to the interface. We illustrate our technique in a phase separated colloid-polymer mixture by distorting the interface in a very controlled way. The static structure of the manipulated interface as well as its dynamic relaxation behaviour are analysed. Both the statics and dynamics can be related to the capillary wave height-height correlation functions using the fluctuation dissipation theorem up to surprisingly large deformations of the interface. To underline the novelty and potential of our approach we also show multiple interface distortions and the controlled snap-off of liquid droplets.

[The 5 mental dimensions identified in early maladaptive schemas statistical analysis of Young's schema questionnaire (YSQ-s3)]. / Les 5 dimensions psychiques identifiées à partir des schémas précoces inadaptés: analyses statistiques du questionnaire des schémas (QSY-s3).

INTRODUCTION: Schemas represent a stable vision of oneself. Young's schema questionnaire-s3 (YSQ-s3) presents 90 perceptions of oneself, specifying 18 early maladaptive schemas (EMS). We studied the intensity and inter-relations of these 18 EMS and how they pool together into a specific domain. METHOD: Two hundred and ninety four subjects (294 patients from a French private practice in psychiatry and 12 volunteers) filled in a French version of the YSQ-s3. Item scores range from 1 to 6. Only the scores of 4 "true for me during most of my life" or higher were kept for the statistical analysis. Data analysis was conducted using descriptive statistics, principal component analysis (PCA) and hierarchical clustering analysis (HCA). RESULTS: The EMS mean scores ranged from 3.4 to 12.9 and standard deviations from 5.9 to 9.7. EMS score correlations range from 0.009 to 0.55. The principal component analysis (PCA), that provides linear combinations of each EMS score, yields only one meaningful component. Indeed, the screen plot that provides the eigen values associated with each principal component, suggests keeping only the first component. This component presents a size-effect and represents the "global scores intensity". The hierarchical clustering analysis (HC) fits the 18 EMS in 5 domains (r(2) = 0.4): (1) "avoidance" (with 3 EMS: emotional deprivation, social isolation/alienation, emotional inhibition), (2)"give" (with 1 EMS: self-sacrifice), (3) "take" (with 3 EMS: entitlement/grandiosity, insufficient self-control/self-discipline, approval-seeking/recognition-seeking) (4) "awareness" (with 8 EMS: abandonment/instability, mistrust/abuse, defectiveness/shame, dependence/incompetence, vulnerability to harm or illness, enmeshment/undeveloped self, failure, subjugation) (5) "faith" (with 3 EMS: negativity/pessimism, unrelenting standards/hyper-criticalness, punitiveness). When the HC analysis is applied to the population (n = 294), it yields 6 classes of patients. The mean score of the 5 domains, described above, can describe these classes. DISCUSSION: These 5 domains do not completely fit Young's five "primary infantile needs" domains. Only 2/3 of the EMS are correctly attributed to the "primary infantile needs" domains. The 5 domains seem closely related to the 5 dimensions of the NEO-PI-R or to the 5 domains of personality disorders (criteria b) described in the DSM-5. In our understanding the dimensions "avoidance, give, take" represent 3 types of relationship to others (on behavioral level). The dimension "awareness" represents the fears and losses (on the emotional level) and "faith" represents beliefs and consciousness (on the cognitive level). The intensity of the 5 domains inside each class of patients could guide the clinical interpretation, specifically for personality disorders.

Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone.

OBJECTIVE: To assess, in depressed patients, the clinical benefit of mianserin augmentation of fluoxetine or the the benefit of switching treatment from fluoxetine to mianserin. METHOD: In a 6-week double-blind study we compared the therapeutic efficiency and tolerance of mianserin 60 mg/day (N = 34), mianserin 60 mg/day plus fluoxetine 20 mg/day (N = 32) and continuing fluoxetine 20 mg/day (N = 38) in patients with major depression who did not respond to previous fluoxetine treatment. RESULTS: Intent-to-treat analysis showed that at week 6 the decrease in the Hamilton Depression rating scale score was significantly (P < or = 0.03) greater in the mianserin plus fluoxetine group when compared to the fluoxetine group (effect size 0.665). Switching from fluoxetine to mianserin gave intermediate results. Mianserin augmentation of fluoxetine was well tolerated. CONCLUSION: Mianserin augmentation of fluoxetine in patients non-responders to fluoxetine 20 mg/day increases response to treatment and is well tolerated.

Kinetics of circulating antibodies, immune complex and specific antibody-secreting cells in tuberculosis patients during 6 months of antimicrobial therapy.

OBJECTIVE: During the follow-up of a group of patients with active tuberculosis, the predictive potential of several antibody-based assays was evaluated in monitoring treatment efficacy. DESIGN: Eleven patients with bacteriologically documented pulmonary tuberculosis and two patients with tuberculosis pleurisy were studied over a period of 6 months, from the day before treatment to its completion. The kinetics of the humoral response to Mycobacterium tuberculosis was determined by the number of specific circulating antibody secreting cells (ASC) (ELISPOT assay), as well as the titres of specific circulating antibody and specific antibody present in circulating immune complexes (quantitative ELISA). RESULTS: Follow-up ELISPOT assays, performed after initiation of tuberculosis therapy showed a rapid increase of ASC, during the first week, followed by rapid 3-10 fold decline of ASC in 12 of 13 patients tested. This decline occurred more rapidly than the mycobacterial culture conversion. In contrast, follow-up of ELISA assays did not give relevant information in assessing the outcome of treatment. CONCLUSION: In comparison with direct detection of tubercle bacilli in sputum samples, the rapid clearance of specific circulating ASC occurring early on after the onset of therapy could suggest a potential usefulness of ELISPOT in monitoring therapeutic response.

Airway obstruction in bronchial sarcoidosis: outcome with treatment.

STUDY OBJECTIVE: Airway obstruction (AO) in sarcoidosis is reported to be associated with respiratory symptoms, increased morbidity, and an increased mortality risk. Because AO in sarcoidosis may result from several causes, the therapeutic benefit of corticosteroids is difficult to determine. The aim of this study was to evaluate the therapeutic response of AO attributable to sarcoid granulomas in the bronchial wall. PATIENTS: We selected 11 patients who had sarcoidosis with AO (defined as FEV(1)/vital capacity [VC] < 70%) associated with sarcoid granulomas on an endobronchial biopsy. Exclusion criteria were history of asthma, smoker or ex-smoker, stage 4 disease, evidence of extrinsic compression by enlarged lymph nodes, and localized endobronchial stenosis seen during fiberoptic bronchoscopy. INTERVENTIONS: We compared the results of pulmonary function tests and clinical, radiologic, and biological findings at baseline with those obtained at the time of the last pulmonary function tests available, between the sixth and 12th months of treatment. Eight patients took oral corticosteroids (20 to 60 mg/d initially), one received IV methylprednisolone pulses, another took oral hydroxychloroquine, and the last one received IM methotrexate. MEASUREMENTS AND RESULTS: With treatment, FEV(1) and FEV(1)/VC significantly improved in eight patients (72%), normalized in four patients, and was unchanged in the remaining three patients. The mean FEV(1) increased from 60.8 +/- 10.8% to 76 +/- 13.7% of the predicted value (p < 0.02). VC did not change significantly. FEV(1)/VC increased from 76.1 +/- 6.4% to 87.6 +/- 10.7% of the predicted value (p < 0.01). Dyspnea on exertion and other clinical findings were attenuated in 10 patients; the chest radiograph improved in 9 patients, and normalized in 5 patients. The mean serum angiotensin-converting enzyme level decreased from 112 +/- 48 to 58 +/- 40 IU/mL (p < 0.05), and normalized in four patients. CONCLUSION: The present study indicates that AO caused by sarcoid granulomas in the bronchial wall can be either partially or completely reversed by treatment with a concomitant attenuation of pulmonary symptoms.

Early predictors of two month response with mianserin and selective serotonin reuptake inhibitors and influence of definition of outcome on prediction.

In order to identify clinical and demographic variables that predict response to antidepressants and to analyse prediction of outcome as a function of definition of outcome we analysed pooled data of two independent, multicentre, double blind parallel group studies. Study I compared the efficacy of mianserin with that of fluoxetine in 65, and study II compared mianserin with fluvoxamine in 60 patients with depression. Improvement was defined as at least 20% decrease in MADRS by day 14. Patients were considered as responders if they had greater than 50% decrease and non-responders if they had SSRIs) and a quadratic type treatment by time interaction (P = 0.023) were found. The robustness of the analysis was further improved by inclusion of covariates (age, weight). Early clinical improvement seems to be the best predictor of 2 month response to antidepressants (mianserin, SSRIs). Younger age and lower weight may predict non-response. Quantitative analysis differentiates treatments better than analysis of responder status. As obtenation of complete remission is a realistic objective with current antidepressants, studies longer than 2 months are needed to assess effectiveness of these drugs in the obtenation of complete remission.

[Intrabronchial curietherapy. Experiences at Hôpital Saint-Louis after the treatment of 149 patients]. / Curiethérapie endobronchique. L'expérience de l'Hôpital Saint-Louis après le traitement de 149 patients.

Endobronchial tumour obstruction threatens to occur in cases of carcinoma of the bronchus throughout the course of the disease. Such patients can benefit from relief of the bronchial obstruction by several techniques which are currently available. We have treated 149 patients with endobronchial radiotherapy. Seventy three patients were treated with a view to cure, 47 with a palliative dose and 29 received endobronchial radiation in complement with external irradiation. The treatment was carried out in series repeated every 15 days until a maximum of three treatments, consisting of two sessions at 24 hour intervals delivering at each session and irradiating of 7 Gy with a 1 cm catheter. All the clinical signs were relieved and in 79% of patients there was a symptomatic benefit. One hundred and thirty two patients were evaluated by control endoscopy two months after the treatment and 64 had a complete histological remission. The median survival was 14.4 months for patients treated with intent to cure. Obtaining a histological remission was a gauge for prolonged survival (median survival 26.5 months), 11 (7.4%) had massive hemoptysis and 13 (8%) irradiation pneumonitis, all of which occurred some time after the therapeutic procedure. The results confirm the feasibility and the good results of endobronchial irradiation in this field and encourage the idea of controlled multi-centre trials in order to assess a placed of endobronchial radiotherapy in the therapeutic strategy of bronchial cancer.

Production, analysis and bioactivity of recombinant vasoactive intestinal peptide analogs.

Recombinant vasoactive intestinal polypeptide (VIP) analogs were expressed in Escherichia coli as a fusion protein containing tandemly repeated multiple copies of a synthetic VIP gene joined to glutathione S-transferase. The encoded protein contains VIP units separated by a linker peptide, potentially excisable by a double cleavage with endoprotease factor Xa and hydroxylamine. Expression of different polyVIP genes, from 1 to 32 units, was detected and the production of a 16 VIP polymer was performed. MonoVIP analogs appended by 5 or 10 amino acids at their C terminus were released by factor Xa from this polymerized product. They were then submitted to hydroxylamine cleavage to remove the linker sequence to finally obtain a recombinant VIP analog devoid of any amino acid extension. The biological activity of the recombinant polyVIP and VIP analogs was tested. Although less efficient than the natural neuropeptide, some of these components bound to VIP receptor, activated adenylate cyclase in human colonic adenocarcinoma cells and displayed a relaxation activity on guinea pig tracheal rings.

[Double-blind study of mianserin and fluoxetine in ambulatory therapy of depressed patients]. / Etude en double aveugle de la miansérine et de la fluoxétine chez des patients déprimés traités en ambulatoire.

A double blind controlled trial was carried out in 65 depressed out-patients to compare the efficacy and tolerance of mianserin with fluoxetine. The two compounds present very different pharmacological activities. Mianserin is an antagonist of the alpha 2-adrenergic receptors, while fluoxetine is an inhibitor of recapture specific to serotonin. Requirements for inclusion were: depressive episode of less than 2 months duration, meeting the criteria for one of the sub-types of depression described in DSM III, with a minimum score of 25 on the Montgomery Asberg Depressive Rating Scale (MADRS). The patient's ages ranged from 18 to 65. The only psychotropic medication allowed in association to the treatment was prazepam (up to 40 mg/day). Patients gave their written consent to the study. Assessment, using the Montgomery Asberg Depression Rating Scale (MADRS), the HARD diagram, the check list for somatic symptoms and side-effects was carried out before treatment and at the end of weeks 2, 4, 8. Assessment of anxiety using the Hamilton Anxiety Rating Scale (HARS) and of sleep disturbances using a sleep questionnaire was carried out before treatment and at week 4. The 8 items of the sleep questionnaire covers the complaints listed in criteria for insomnia disorders (307.42 DSM III-R). Clinical Global Impression (CGI), Therapeutic Index (TI), Tolerance Global Impression were assessed at end-point. The 2 groups were strictly comparable in respect to the clinical status at base line (diagnosis, history and duration of the depressive illness, MADRS and HARD diagram scores).(ABSTRACT TRUNCATED AT 250 WORDS)