Sample records for apnoea syndrome driving

  1. Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

    DEFF Research Database (Denmark)

    Alonderis, A.; Barbee, F.; Bonsignore, M.


    ; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). Results: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas...

  2. Sleep apnoea and driving risk: the need for regulation

    Directory of Open Access Journals (Sweden)

    Walter T. McNicholas


    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a highly prevalent chronic respiratory disorder with prevalence among adult males of ≥10%. The most common daytime symptom associated with OSAS is excessive sleepiness, which in more severe manifestations can result in sleepiness at the wheel while driving and probably contributes to the substantial increase in accident risk among patients with OSAS. Fortunately, current evidence indicates that successful therapy of OSAS, particularly with continuous positive airway pressure, can bring the accident risk down to levels similar to an equivalent general population. The recognition of the increased driving accident risk in OSAS prompted the Transport and Mobility Directorate of the European Commission to establish a working group on this topic in 2012, which ultimately led to a revision of Annex III of the EU Driving Licence Directive, which is subject to mandatory implementation by European Union member states by December 2015. This directive specifies that patients with moderate or severe OSAS associated with significant daytime sleepiness should be prohibited from driving until effective therapy is established. These new regulations are designed to balance the legitimate objective of public safety with not penalising OSAS patients who are complying with effective therapy. Successful implementation of regulations on driving in OSAS patients must also include measures to educate relevant stakeholders including patients, medical personnel, traffic police and employers in the transport industry. The key objective is to encourage patients with possible OSAS to seek diagnosis and treatment and not to inhibit OSAS patients from coming forward.

  3. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.


    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  4. Metabolic aspects of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    M. R. Bonsignore


    Full Text Available Insulin resistance is often associated with obstructive sleep apnoea syndrome (OSAS and could contribute to cardiovascular risk in OSAS. Sleep loss and intermittent hypoxia could contribute to the pathogenesis of the metabolic alterations associated with obesity, a common feature of OSAS. The biology of the adipocyte is being increasingly studied, and it has been found that hypoxia negatively affects adipocyte function. In November 2007, the European Respiratory Society and two EU COST Actions (Cardiovascular risk in OSAS (B26 and Adipose tissue and the metabolic syndrome (BM0602, held a Research Seminar in Düsseldorf, Germany, to discuss the following: 1 the effects of hypoxia on glucose metabolism and adipocyte function; 2 the role of inflammatory activation in OSAS and obesity; 3 the alarming rates of obesity and OSAS in children; 4 the harmful effects of the metabolic syndrome in OSAS; 5 the effects of OSAS treatment on metabolic variables; and 6 the relationship between daytime sleepiness and hormonal and inflammatory responses. Insulin resistance in skeletal muscle, the role of the endocannabinoid system and novel pharmacological approaches to treat insulin resistance were also discussed. As obesity and hypoxia could be the basic links between OSAS and adipocyte dysfunction, further research is needed to translate these new data into clinical practice.

  5. Maxillary morphology in obstructive sleep apnoea syndrome. (United States)

    Seto, B H; Gotsopoulos, H; Sims, M R; Cistulli, P A


    The aim of this case-control study was to test the hypothesis that maxillary morphology differs between obstructive sleep apnoea (OSA) patients and non-snoring, non-apnoeic subjects. Forty randomly selected patients [36 M, 4 F; mean age 49 +/- 2 (SEM) years] with varying degrees of OSA (mean Apnoea/Hypopnoea Index 32 +/- 4/hour) were compared with 21 non-snoring, non-apnoeic control subjects (18 M, 3 F; mean age 40 +/- 2 years). An intra-oral assessment of the occlusion was carried out, particularly for the presence or absence of posterior transverse discrepancies. Maxillary dental arch width was assessed by standardized lateral inter-tooth measurements (inter-canine, inter-premolar, and inter-molar) from dental models. Palatal height and maxillary depth were also measured. The maxillary dental arch was described by a 4th order polynomial equation. The ratios of maxillary to mandibular width (max/mand) and maxillary to facial width (max/facial) were determined from standardized postero-anterior cephalometric radiographs in a subgroup of patients (n = 29) and all controls. Twenty patients (50 per cent) had evidence of posterior transverse discrepancies compared with one control subject (5 per cent; P polynomial equation was greater in the patients than in the controls (P < 0.05), indicative of greater arch tapering. Patients had smaller maxillary to mandibular and maxillary to facial width ratios (P < 0.01). These results suggest that OSA patients have narrower, more tapered, and shorter maxillary arches than non-snoring, non-apnoeic controls. Further work is required to determine the relevance of these findings in the pathophysiology of OSA.

  6. Severe obstructive sleep apnoea syndrome in an adult patient with Laron syndrome. (United States)

    Dagan, Y; Abadi, J; Lifschitz, A; Laron, Z


    A 68 year old patient with Laron syndrome (primary growth hormone (GH) resistance-insensitivity due to a molecular defect of the GH receptor) and severe obstructive sleep apnoea syndrome is described. Treatment with continuous positive air pressure therapy resulted in improved nocturnal sleep, daytime alertness and cognitive functions.

  7. Metabolic disturbances in patients with obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    I. A. Harsch


    Full Text Available The metabolic disturbances in patients with obstructive sleep apnoea syndrome (OSAS include insulin resistance and elevated levels of pro-inflammatory cytokines and vascular adhesion molecules, as well as an elevation of hormones derived from the adipose tissue as leptin. These phenomena might, in part, be an explanation for the excess morbidity and mortality of OSAS patients concerning cardiovascular disease. Several of these factors have been described as being independently associated with OSAS and not only related to its comorbidities, including obesity. A promising approach to studying the metabolic phenomena in these OSAS patients would be to monitor patients before and during the course of continuous positive airway pressure therapy, as nocturnal sleep disturbances are treatable and may revert the impact of OSAS on the metabolic phenomena; however, patients do frequently (and unfortunately maintain their body weight. Although not confirmed by all investigations, a tendency towards an improvement in some of the above-mentioned metabolic parameters has been reported in several studies in obstructive sleep apnoea syndrome patients and may be reflected by the decreased occurrence of new cardiovascular events, the reduction of systolic blood pressure and the improvement of left ventricular systolic function.

  8. Can you die from obstructive sleep apnoea syndrome (OSAS)?

    LENUS (Irish Health Repository)

    O'Carroll, G


    Studies suggest an independent association between Obstructive Sleep Apnoea Syndrome (OSAS) and cardiovascular death. The purpose of our study is to examine doctors\\' awareness of this association and to determine whether this correlates with recording of OSAS on death certificates. We contacted the Central Statistics Office (CSO) and obtained relevant mention of OSAS on death certificates. We surveyed doctors on their view of OSAS-related deaths, CSO data from 2008-2011 reveal two deaths with OSAS documented as a direct cause and 52 deaths with OSAS as a contributory cause. Seventy-five doctors\\' surveyed (41%) believe OSAS can be a direct cause of death and 177 (96%) believe OSAS can be an indirect cause of death. Only 22 (12%) had putdown OSAS as a cause of death. OSAS is seldom recorded on death certificates. This is at odds with epidemiological forecasts and contrary to an opinion poll from a selection of doctors.

  9. Obstructive sleep apnoea syndrome in children and anaesthesia

    Directory of Open Access Journals (Sweden)

    A Rudra


    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

  10. Obstructive Sleep Apnoea Syndrome and Weight Loss: Review

    Directory of Open Access Journals (Sweden)

    Douglas C. Cowan


    Full Text Available Obstructive sleep apnoea (OSA syndrome is common, and obesity is a major risk factor. Increased peripharyngeal and central adiposity result in increased pharyngeal collapsibility, through increased mechanical loading around the upper airway, reduced tracheal traction on the pharynx, and reduced neuromuscular activity, particularly during sleep. Significant and sustained weight loss, if achieved, is likely to be a useful therapeutic option in the management of OSA and may be attempted by behavioural, pharmacological, and surgical approaches. Behavioural therapy programs that focus on aspects such as dietary intervention, exercise prescription patients and general lifestyle counselling have been tested. Bariatric surgery is an option in the severely obese when nonsurgical measures have failed, and laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass are the most commonly employed techniques in the United Kingdom. Most evidence for efficacy of surgery comes from cohort studies. The role of sibutramine in OSA in the obese patients has been investigated, however, there are concerns regarding associated cardiovascular risk. In this paper the links between obesity and OSA are discussed, and the recent studies evaluating the behavioural, pharmacological and surgical approaches to weight loss in OSA are reviewed.

  11. Obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome. (United States)

    Hill, Elizabeth A


    Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is characterised by repeated cycles of upper airway obstruction during sleep, leading to diurnal symptoms. Individuals with Down syndrome are predisposed to OSAHS due to overlap between the Down syndrome phenotype and OSAHS risk factors. Recent large studies using subjective and objective measures estimate that OSAHS affects around 40% of adults with Down syndrome, in contrast to 2-4% of the general adult population. The "double-hit" of comorbid Down syndrome and OSAHS may accelerate cognitive decline in adults with Down syndrome. However, with the appropriate care and support, OSAHS can be treated effectively in this group using continuous positive airway pressure (CPAP) therapy, improving daytime function and behaviour. Symptoms of OSAHS should be routinely monitored in this population, with testing and treatment available to all adults with Down syndrome; however, this is not currently commonplace, and health inequalities are evident.

  12. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, P; Riha, R L


    Epidemiological studies have revealed a high prevalence of sleep-disordered breathing in the community (up to 20%). A subset of these patients has concurrent symptoms of excessive daytime sleepiness attributable to their nocturnal breathing disorder and is classified as having obstructive sleep...... apnoea/hypopnoea syndrome (4-5% of the middle-aged population). There is strong evidence for an association of sleep apnoea with cardiovascular and cerebrovascular morbidity, as well as adverse public health consequences. Treatment and diagnosis have remained largely unchanged over the past 25 yrs....... In moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome, treatment with continuous positive airway pressure has been shown to be effective. Questions remain as to how to screen patients with sleep-disordered breathing. Should time-consuming diagnostic procedures with high sensitivity and specificity...

  13. Inflammatory cardiovascular risk markers in obstructive sleep apnoea syndrome.

    LENUS (Irish Health Repository)

    Ryan, Silke


    Obstructive sleep apnoea syndrome (OSAS) represents a highly prevalent disease and is recognized as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood, but given the complexity of the disorder, a multifactorial etiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis in general and they mediate many of the stages of atheroma formation. Circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These markers include cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and selectins, cytokines such as tumour necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), chemokines such as IL-8, and C-reactive protein (CRP). There is increasing evidence that inflammatory processes also play a central role in the cardiovascular pathophysiology of OSAS. This is supported by cell culture and animal studies identifying a preferential activation of inflammatory pathways by intermittent hypoxia (IH), the hallmark of OSAS. A number of studies have selectively examined the expression of inflammatory factors in OSAS patients with different conclusions. These different findings may have been contributed to by a number of methodological factors such as small subject numbers, inadequately matched study populations, particularly in terms of body mass index (BMI), and inclusion of patients with pre-existing cardiovascular or metabolic diseases. This review will focus on the potential role of various inflammatory markers in OSAS with a critical analysis of the current literature.

  14. Decision making is affected in obstructive sleep apnoea syndrome. (United States)

    Daurat, Agnès; Ricarrère, Matthieu; Tiberge, Michel


    We assessed decision making in 20 patients newly diagnosed with obstructive sleep apnoea (OSA) and 20 healthy controls with the Iowa Gambling Task (IGT), which evaluates the ability to learn to sacrifice immediate rewards in favour of long-term gains. A standard neuropsychological battery was administered. Switching scores tended to be lower in patients. Patients persisted in selecting risky decks throughout the IGT, whereas controls behaved normally. Performance was correlated with hypoxaemia. Brain regions underlying decision making may be affected by OSA-related hypoxaemia.

  15. Genetic aspects of hypertension and metabolic disease in the obstructive sleep apnoea-hypopnoea syndrome

    DEFF Research Database (Denmark)

    Riha, R.L.; Diefenbach, K.; Jennum, P.;


    phenotyping, which has hampered genetic dissection of these diseases; in addition, sleep-disordered breathing has not been factored into most studies dealing with essential hypertension or metabolic syndrome. Genome-wide scans have yielded inconsistent results in all three disorders under discussion......Though it has long been recognised that there is a hereditary component to the obstructive steep apnoea/hypopnoea syndrome (OSAHS), identifying its genetic basis remains elusive. Hypertension and metabolic syndrome, Like OSAHS, are polygenic disorders, physiologically complex and the product...

  16. A comparative study on oxidative stress role in nasal breathing impairment and obstructive sleep apnoea syndrome. (United States)

    Passali, D; Corallo, G; Petti, A; Longini, M; Passali, F M; Buonocore, G; Bellussi, L M


    Obstructive sleep apnoea syndrome (OSAS) is a sleep disorder that leads to metabolic abnormalities and increased cardiovascular risk. This study aimed to define the expression and clinical significance of biomarkers involved in oxidative stress in patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in three groups of subjects. The study involved the recruitment of three groups of subjects, 10 patients with obstructive sleep apnoea syndrome with AHI > 30; 10 patients suffering from snoring at night with AHI oxidative and antioxidant (plasma thiol groups) biomarkers in blood and urine samples. No statistical differences in age, sex distribution or body mass index were present between the three groups (p > 0.05). There were significant differences in AHI among the three groups of patients (p 0.05) between the levels of biomarkers of oxidative stress in the three populations studied. The results of our study show that the nose can play a role in the pathogenesis of OSAS through the production of biomarkers of oxidative stress.

  17. Management of the obstructive sleep apnoea syndrome: More knowledge required for an optimal choice of treatment modality

    NARCIS (Netherlands)

    Hoekema, A


    In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to

  18. The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia.

    LENUS (Irish Health Repository)

    Miller, Stanley D W


    Melnick Needles syndrome (MNS), Treacher Collins syndrome (TCS) and Pierre Robin syndrome (PRS) are congenital abnormalities with characteristic facial appearances that include micrognathia. A 20-year-old girl with MNS, a 16-year-old boy with TCS and a 12-year-old girl with PRS attended the sleep apnoea clinic at our institution at different times. Diagnostic sleep studies were initially performed on all three patients to confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS). They subsequently commenced nasal CPAP (nCPAP) treatment and their progress was followed. A limited sleep study on the patient with MNS demonstrated moderate\\/severe OSAS with an AHI of 33 events\\/h. Commencement of nCPAP resulted in symptomatic improvement. Overnight oximetry in the patient with TCS showed repeated desaturation to SpO2<90%. Subsequent treatment by nCPAP almost completely abolished the desaturation events. Overnight polysomnography in the patient with PRS demonstrated severe OSAS with an AHI of 49 events\\/h. After 3 years of nCPAP therapy, this patient requested discontinuation of treatment. Subsequent polysomnography without nCPAP revealed an AHI of <5 events\\/h. The use of nCPAP in the patients with MNS and TCS resulted in effective control of their sleep abnormalities. Mandibular growth and enlargement of the posterior airway space led to resolution of OSAS in the patient with PRS. There is a definite role for nCPAP therapy in patients with congenital micrognathia and OSAS. The use of nCPAP may obviate the need for more invasive corrective surgery for OSAS and is not necessarily a life-long requirement.

  19. Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review. (United States)

    Jokubauskas, L; Baltrušaitytė, A


    Obstructive sleep apnoea syndrome (OSAS) is a clinical risk factor for sleep bruxism (SB). Both OSAS and SB are reported to be associated with sleep-related arousal reactions, although no clear causative link has been established. An electronic literature search was conducted of the MEDLINE, ScienceDirect, Wiley Online Library, SAGE Journals and EBSCOhost databases covering the period January 2006 and September 2016. Sequential screenings at the title, abstract and full-text levels were performed. The review included observational studies in the English language with a clearly established aim to assess the relationship between OSAS and SB using full-night PSG. The seven-item quality-assessment tool for experimental bruxism studies was used to assess the methodology across the studies. After a comprehensive screening of titles, abstracts and full texts, only three studies that met the pre-defined criteria were finally included in this systematic review. Two studies gave evidence that OSAS is associated with the occurrence of SB events: (i) SB events frequently occur during micro-arousal events consequent on apnoea-hypopnoea (AH) events and (ii) most SB events occur in temporal conjunction with AH events termination. However, one study did not report a strong association between AH and SB events. It can be concluded that there are not enough scientific data to define a clear causative link between OSAS and SB. However, they appear to share common clinical features. Further studies should focus on the intermediate mechanisms between respiratory and SB events.

  20. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation.

    LENUS (Irish Health Repository)

    Garvey, J F


    There is increasing evidence that intermittent hypoxia plays a role in the development of cardiovascular risk in obstructive sleep apnoea syndrome (OSAS) through the activation of inflammatory pathways. The development of translational models of intermittent hypoxia has allowed investigation of its role in the activation of inflammatory mechanisms and promotion of cardiovascular disease in OSAS. There are noticeable differences in the response to intermittent hypoxia between body tissues but the hypoxia-sensitive transcription factors hypoxia-inducible factor-1 and nuclear factor-kappaB appear to play a key role in mediating the inflammatory and cardiovascular consequences of OSAS. Expanding our understanding of these pathways, the cross-talk between them and the activation of inflammatory mechanisms by intermittent hypoxia in OSAS will provide new avenues of therapeutic opportunity for the disease.

  1. Obstructive sleep apnoea in Treacher Collins syndrome: prevalence, severity and cause. (United States)

    Plomp, R G; Bredero-Boelhouwer, H H; Joosten, K F M; Wolvius, E B; Hoeve, H L J; Poublon, R M L; Mathijssen, I M J


    This cohort study in 35 patients (13 children) evaluates the prevalence, severity and anatomical cause of obstructive sleep apnoea syndrome (OSAS) in patients with Treacher Collins syndrome. Ambulatory polysomnography was performed cross-sectionally to determine OSAS prevalence and severity. All upper airway related surgical interventions were evaluated retrospectively. In 11 patients, sleep endoscopy, and flexible and rigid endoscopy were applied to determine the level of anatomical obstruction of the upper airway. The overall prevalence of OSAS in Treacher Collins patients was 46% (54% in children; 41% in adults). Thirty-eight upper airway related surgical interventions were performed in 17 patients. Examination of the upper airway revealed various anatomical levels of obstruction, from the nasal septum to the trachea. Most significant obstruction was found at the level of the oro/hypopharynx. OSAS in Treacher Collins patients is an important problem so all patients should be screened for OSAS by polysomnography. Endoscopy of the upper airways was helpful in determining the level of obstruction. Surgical treatment at one level will not resolve OSAS in most patients because OSAS in Treacher Collins has a multilevel origin. Non-invasive ventilation (continuous positive airway pressure or bilevel positive airway pressure) or tracheotomy should be considered as a treatment modality.

  2. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel


    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.


    Directory of Open Access Journals (Sweden)

    Vaddadi Sailendra


    Full Text Available BACKGROUND The drop in oxygen saturation during sleep is more than during exercise and patients of COPD who spend more time in sleeping. Significant sleep desaturation and the sleep disturbances are greater in overlap syndrome than in OSA alone. The present study is conducted in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to find the prevalence of obstructive sleep apnoea in the patients with COPD. AIMS The present study was a cross-sectional study prospectively carried out with an aim to evaluate the breathing disorders during sleep in patients with COPD and to correlate these disorders with the stage of the disease. SETTINGS AND DESIGN The study Cohort was constituted by patients of COPD registered into Chest OPD or admitted in Indoor units of Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, from July 2014 to May 2016. A total of thirty six consecutive COPD patients who consented to be enrolled into the study were classified into Mild, Moderate and Severe stages based on the Indian Guidelines for the management of COPD. METHODS AND MATERIAL Spirometric evaluation and bronchial reversibility testing was conducted in all the patients. Arterial Blood Gas Analysis was done using ABL3 arterial blood gas analyser (Radiometer, Copenhagen. POLYSOMNOGRAPHY Patients were hooked to Compumedics ProFusion Polysomnographic Machine (Compumedics Private Limited 2001, USA, by standard gold cups/electrodes. Thereafter, the patients were subjected to a full night sleep study (Overnight polysomnography. The electrode and sensor connection system utilises E-series EEG/PSG system in order to record the PSG study. The impedance of electrodes was checked and set to <10. A total of 20 leads were utilised for the study. The various parameters monitored included Electroencephalogram (EEG, Electro-oculogram (EOG, Electrocardiogram (ECG, chin and leg Electromyogram (EMG

  4. Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device. (United States)

    Winck, M; Drummond, M; Viana, P; Pinho, J C; Winck, J C

    Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11.1±5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index>2/h). Mean SB index was 5.12±3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7±9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R=0.755, p=0.019 and R=0.737, p=0.023 respectively, Pearson correlation). Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R=-0.632 and R=-0.611, p>0.05, Pearson correlation). This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting.

  5. [Impact of sleep hygiene on patients with obstructive sleep apnoea syndrome]. (United States)

    Guedes Bahia, Mariana; Soares, Vera; Carlos Winck, João


    The purpose of this study was to evaluate the impact of a Sleep Hygiene brochure on a population of 36 patients recently diagnosed with Obstructive Sleep Apnoea Syndrome and beginning treatment. One expects that: 1) the information about Sleep Hygiene offered in the brochure would change some of the patients' habits toward sleep; and that, 2) this intervention in the form of a free informative brochure would have an echo in terms of a better subjective evaluation of sleep complaints. The sleep habits and the sleep complaints were evaluated in the pre-test. Those variables were re-evaluated in the post-test and at that time the patients filled in a scale of satisfaction with the information about Sleep Hygiene, in terms of its contribution to improving their sleep complaints. There were no significant differences in the level of compliance to Sleep Hygiene between the two periods, although the majority of the patients considered that Sleep Hygiene did improve their sleep difficulties. The low level of compliance may be due to the fact that patients already had reasonable Sleep Hygiene habits, and also to the fact that the scale was not sufficiently discriminative. In addition, the self-discipline that Sleep Hygiene involves may have collided with other demands such as the adaptation to treatment with CPAP (Continuous Positive Air Pressure). In a following study, it would be interesting to find if the levels of sleep hygiene compliance would change if they were implemented after the initial adaptation to CPAP, which would imply a longitudinal study. It would be helpful to keep reminding the patients of Sleep Hygiene importance, offering new and update brochures to the patients during consultations.

  6. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?

    LENUS (Irish Health Repository)

    Ryan, S


    Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease and is recognised as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood but a multifactorial aetiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis at all stages of atheroma formation. Increased levels of various circulating markers of inflammation including tumour necrosis factor alpha (TNFalpha), interleukin 6 (IL6), IL-8 and C-reactive protein (CRP) have been reported as associated with future cardiovascular risk. There is increasing evidence of elevated inflammatory markers in OSAS with a significant fall after effective treatment with continuous positive airway pressure. This evidence is particularly strong for TNFalpha, whereas studies on IL6 and CRP have yielded conflicting results possibly due to the confounding effects of obesity. Cell culture and animal studies have significantly contributed to our understanding of the underlying mechanisms of the association between OSAS and inflammation. Intermittent hypoxia, the hallmark of OSAS, results in activation of pro-inflammatory transcription factors such as nuclear factor kappa B (NF-kappaB) and activator protein (AP)-1. These promote activation of various inflammatory cells, particularly lymphocytes and monocytes, with the downstream consequence of expression of pro-inflammatory mediators that may lead to endothelial dysfunction. This review provides a critical analysis of the current evidence for an association between OSAS, inflammation and cardiovascular disease, discusses basic mechanisms that may be responsible for this association and proposes future research possibilities.

  7. Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea (United States)

    Masa, Juan F; Corral, Jaime; Caballero, Candela; Barrot, Emilia; Terán-Santos, Joaquin; Alonso-Álvarez, Maria L; Gomez-Garcia, Teresa; González, Mónica; López-Martín, Soledad; De Lucas, Pilar; Marin, José M; Marti, Sergi; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Miranda, Erika; Mokhlesi, Babak; García-Ledesma, Estefanía; Sánchez-Quiroga, M-Ángeles; Ordax, Estrella; González-Mangado, Nicolás; Troncoso, Maria F; Martinez-Martinez, Maria-Ángeles; Cantalejo, Olga; Ojeda, Elena; Carrizo, Santiago J; Gallego, Begoña; Pallero, Mercedes; Ramón, M Antonia; Díaz-de-Atauri, Josefa; Muñoz-Méndez, Jesús; Senent, Cristina; Sancho-Chust, Jose N; Ribas-Solís, Francisco J; Romero, Auxiliadora; Benítez, José M; Sanchez-Gómez, Jesús; Golpe, Rafael; Santiago-Recuerda, Ana; Gomez, Silvia; Bengoa, Mónica


    Background Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. Methods Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. Results A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of −6 (95% CI −7.7 to −4.2) mm Hg versus −2.8 (95% CI −4.3 to −1.3) mm Hg, (p<0.001) and serum bicarbonate of −3.4 (95% CI −4.5 to −2.3) versus −1 (95% CI −1.7 to −0.2 95% CI)  mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long

  8. Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

    Energy Technology Data Exchange (ETDEWEB)

    Oezdemir, Hueseyin; Mahmutyaziciglu, Kamran; Davsancimath, Halit; Guendogdu, Sadi [Department of Radiology, Medical School, Zonguldak Karaelmas University, Kozlu, 67600, Zonguldak (Turkey); Altin, Remzi; Kart, Levent [Department of Pulmonology, Medical School, Zonguldak Karaelmas University (Turkey); Soeguet, Ayhan; Tomac, Nazan [Department of Paediatrics, Medical School, Zonguldak Karaelmas University (Turkey); Cinar, Fikret; Uzun, Lokman [Department of Otolaryngology, Medical School, Zonguldak Karaelmas University, (Turkey)


    Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS). To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity. The study population consisted of 39 children, aged 4-12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded. Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=-0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH. (orig.)

  9. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.

    LENUS (Irish Health Repository)

    Ryan, Silke


    Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty-one patients (19 male, 49+\\/-10years) with the established diagnosis of OSAS [apnoea\\/hypopnoea index (AHI): 52+\\/-22] and who had a successful CPAP titration were commenced on CPAP therapy (10+\\/-2cmH2O), and randomized to 4weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side-effects. There was no difference in compliance (M versus P: 5.1+\\/-1.9h versus 5.0+\\/-1.7h; P=0.701) and AHI (2.6+\\/-2.7 versus 3.0+\\/-2.9; P=0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask=57%, pillow=43%; P=0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and >\\/=10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.

  10. Unusual presentation of obstructive sleep apnoea syndrome due to a giant mandible osteoma: case report and literature review. (United States)

    Tarsitano, A; Marchetti, C


    Osteomas are benign lesions composed of mature compact and/or cancellous bone that grow continuously. Their pathogenesis is unknown. It has been considered to be a neoplasm, a developmental or reactive osteogenic lesion resulting from muscle traction on the periosteum, or due to trauma. Herein, we report an unusual case of giant osteoma of the mandible depressing the lateral pharyngeal wall, interfering with normal respiration during the night. The uniqueness of this case is related to snoring and sleep apnoea symptoms. In fact, he presented to our Department because daytime sleepiness hindered his work, and not for the evident facial swelling. We reported our experience in diagnosis, treatment and follow-up of this uncommon disease. Polysomnography, CT scan and 3-D PAS volume analysis are useful tools to study in detail the aetiology of apnoea and assess outcomes.

  11. Effects of naloxone on apnoea duration during sleep in infants at risk for SIDS. (United States)

    Haidmayer, R; Kerbl, R; Meyer, U; Kerschhaggl, P; Kurz, R; Kenner, T


    The effects of intravenous injections of the opiate antagonist naloxone (0.005-0.4 mg/kg body weight) on respiratory pattern, apnoea duration and frequency were investigated in six infants with severe sleep apnoea syndrome. Since several authors found elevated plasma- and CSF-levels of endogenous opioids (endorphines) in infants with sleep apnoea syndrome, we wanted to determine whether the impairment of the control mechanisms of respiration during sleep is due to an effect of endogenous opioids. Independent of the dose, naloxone did not exert any effect on respiratory pattern and occurrence of periodic apnoea. We were unable to prove that endorphines play a major role in pathogenesis of sleep apnoea syndrome in infancy and possibly in sudden infant death syndrome (SIDS). We speculate that elevated levels of endorphines reported by some investigators rather seem to be a consequence of hypoxic stress than a cause for sleep apnoeas.

  12. Sleep apnoea and metabolic dysfunction

    Directory of Open Access Journals (Sweden)

    Maria R. Bonsignore


    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent condition often associated with central obesity. In the past few years, several studies have analysed the potential independent contribution of OSA to the pathogenesis of metabolic abnormalities, including type 2 diabetes, the metabolic syndrome and non-alcoholic fatty liver disease. New perspectives in OSA patient care have been opened by the promotion of lifestyle interventions, such as diet and exercise programmes that could improve both OSA and the metabolic profile. The rich clinical literature on this subject, together with the growing amount of data on pathophysiological mechanisms provided by animal studies using the chronic intermittent hypoxia model, urged the organising Committee of the Sleep and Breathing meeting to organise a session on sleep apnoea and metabolic dysfunction, in collaboration with the European Association for the Study of Diabetes. This review summarises the state-of-the-art lectures presented in the session, more specifically the relationship between OSA and diabetes, the role of OSA in the metabolic consequences of obesity, and the effects of lifestyle interventions on nocturnal respiratory disturbances and the metabolic profile in OSA patients.

  13. Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome (United States)

    Sánchez-de-la-Torre, Alicia; Abad, Jorge; Durán-Cantolla, Joaquín; Mediano, Olga; Cabriada, Valentín; Masdeu, María José; Terán, Joaquín; Masa, Juan Fernando; de la Peña, Mónica; Aldomá, Albina; Worner, Fernando; Valls, Joan; Barbé, Ferran; Sánchez-de-la-Torre, Manuel


    Background The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea–hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level. Methods We included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA. Results The men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002). Conclusions This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted. PMID:27416494


    Institute of Scientific and Technical Information of China (English)

    贾海玉; 牛云枫; 曹中朝


    Objective;To investigate the influence of sleep apnoea syndrome(SAS) on 24 - hour ambulatory blood pressure (ABP) in order to provide evidence in hypertension treatment with nasal continuous positive airway pressure (nCPAP) in SAS patients. Methods; 30 SAS patients with no cardiovascular complication and 30 normal volunteers were enrolled in the study. Polysomography (PSG) during sleep,24 hours ABP and some vasoactive substances, nitric oxide (NO) and endothelin (ET) , were monitored in SAS and control groups before and after nCPAP treatment. Results: Before the treatment, ET, dMSP, RDI, LAT, nMSP, dMDP, nMDP, dMAP and nMAP were higher in SAS patients compared with the controls;however, NO, NO/ET and LSaO2 were lower than that of the controls.. Except for dMSP, all other parameters were improved after nCPAP. Conclutions: SAS patients may have the tendency of hypertension which can be prevented and treated with nCPAP.%目的:探讨睡眠呼吸暂停综合征(SAS)对24h动态血压的影响,为经鼻持续气道正压通气(nCPAP)治疗SAS引起的高血压提供依据.方法:选择无心血管疾病的SAS病人和正常对照组各30例进行多导睡眠图(PSG)、24h动态血压(ABPM)及血管活性物质一氧化氮(NO)和内皮素(ET)的监测;同时对SAS病人施以nC-PAP治疗,并进行上述指标的监测.结果:nCPAP治疗前,SAS病人ET、白天平均收缩压(dMSP)高于正常对照(P<0.05);呼吸紊乱指数(RDI)、最长呼吸暂停时间(LAT)、夜间平均收缩压(nMSP)、白天平均舒张压(dMDP)、夜间平均舒张压(nMDP)、白天平均动脉压(dMAP)、夜间平均动脉压(nMAP)明显高于正常对照(P<0.01);24h血压曲线呈非勺型;NO低于正常对照(P<0.05);NO/ET、最低血氧饱和度(LSaO2)较正常对照明显降低(P<0.01);SAS病人dMAP、nMAP与LSaO2呈负相关(Beta=-0.561 P<0.05;Beta=-0.388 P<0.05),RDI与nMAP呈显著正相关(Beta =0.512 P<0.01).nCPAP治疗后,除dMSP无变化外(P>0.05),上

  15. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. (United States)

    DE Corso, E; Fiorita, A; Rizzotto, G; Mennuni, G F; Meucci, D; Giuliani, M; Marchese, M R; Levantesi, L; Della Marca, G; Paludetti, G; Scarano, E


    Nowadays, drug-induced sleep endoscopy (DISE) is performed widely and its validity and reliability has been demonstrated by several studies; in fact, it provides clinical information not available by routine clinical inspection alone. Its safety and utility are promising, but still needs to be improved to reach the level of excellence expected of gold standard tests used in clinical practice. Our study compares the results of clinical and diagnostic evaluation with those of sleep endoscopy, evaluating the correlation between clinical indexes of routine clinical diagnosis and sites of obstruction in terms of number of sites involved, entity of obstruction and pattern of closure. This study consists in a longitudinal prospective evaluation of 138 patients who successfully underwent sleep endoscopy at our institution. Patients were induced to sleep with a low dose of midazolam followed by titration with propofol. Sedation level was monitored using bispectral index monitoring. Our results suggest that the multilevel complete collapse was statistically significantly associated with higher apnoea hypopnea index values. By including partial sites of obstruction greater than 50%, our results also suggest that multilevel collapse remains statistically and significantly associated with higher apnoea hypopnoea index values. Analyzing BMI distribution based on number of sites with complete and partial obstruction there was no significant difference. Finally, analyzing Epworth Sleepiness Score distribution based on number of sites with complete obstruction, there was a statistically significant difference between patients with 3-4 sites of obstruction compared to those with two sites or uni-level obstruction. In conclusion, our data suggest that DISE is safe, easy to perform, valid and reliable, as previously reported. Furthermore, we found a good correlation between DISE findings and clinical characteristics such as AHI and EPS. Consequently, adequate assessment by DISE of all

  16. Quality of sexual life in men with obstructive sleep apnoea. (United States)

    Ak, Mehmet; Balikci, Adem; Haciomeroglu, Bikem; Zincir, Serkan; Cinar, Alper; Congologlu, Emel; Bozkurt, Ali; Ozgen, Fuat; Ozsahin, Aytekin


    The study investigated the quality of sexual life of male obstructive sleep apnoea patients. Apnoea and non-apnoea participants were assessed with Golombok Rust Inventory of Sexual Satisfaction (GRISS) and Structured Clinical Interview for DSM-IV (SCID) before the sleep test. Folicule Stimulating Hormone (FSH), Luteinising Hormone (LH), prolactin, testosterone and oestrogen levels were also evaluated. The apnoea group had a higher BMI and lower LH and testosterone levels than the non-apnoea group. There were no differences between the apnoea, non-apnoea groups and within the apnoea groups (mild, moderate and high apnoea) in terms of sexual satisfaction. Although there was a change in the hormonal levels of obstructive sleep apnoea patients, the sexual life of apnoea patients was not affected at the clinical level.

  17. Mandibular advancement appliance for obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petri, Niels; Svanholt, Palle; Solow, Beni


    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non-advancement...

  18. The genetics of obstructive sleep apnoea.

    LENUS (Irish Health Repository)

    Kent, Brian D


    PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.

  19. Cough in obstructive sleep apnoea. (United States)

    Chan, Kevin; Ing, Alvin; Birring, Surinder S


    Obstructive Sleep Apnoea (OSA) has recently been reported to be a cause of chronic cough. It should be considered when cough remains unexplained following investigations and treatments for common causes. The presence of nocturnal cough, snoring and gastro-oesophageal reflux may be helpful in identifying patients who require further investigation. Daytime somnolence is often absent. Continuous positive airway pressure (CPAP) therapy has been reported to be effective in alleviating cough. Therapy for gastro-oesophageal reflux disease, if present, should be optimised. The mechanism of the association between OSA and cough is not clear, but airway inflammation, gastro-oesophageal reflux disease, increased cough reflex sensitivity and tracheobronchomalacia are possible explanations. Further studies should identify clinical predictors of OSA-cough, establish mechanisms and the optimal therapy.

  20. Quantifying the ventilatory control contribution to sleep apnoea using polysomnography. (United States)

    Terrill, Philip I; Edwards, Bradley A; Nemati, Shamim; Butler, James P; Owens, Robert L; Eckert, Danny J; White, David P; Malhotra, Atul; Wellman, Andrew; Sands, Scott A


    Elevated loop gain, consequent to hypersensitive ventilatory control, is a primary nonanatomical cause of obstructive sleep apnoea (OSA) but it is not possible to quantify this in the clinic. Here we provide a novel method to estimate loop gain in OSA patients using routine clinical polysomnography alone. We use the concept that spontaneous ventilatory fluctuations due to apnoeas/hypopnoeas (disturbance) result in opposing changes in ventilatory drive (response) as determined by loop gain (response/disturbance). Fitting a simple ventilatory control model (including chemical and arousal contributions to ventilatory drive) to the ventilatory pattern of OSA reveals the underlying loop gain. Following mathematical-model validation, we critically tested our method in patients with OSA by comparison with a standard (continuous positive airway pressure (CPAP) drop method), and by assessing its ability to detect the known reduction in loop gain with oxygen and acetazolamide. Our method quantified loop gain from baseline polysomnography (correlation versus CPAP-estimated loop gain: n=28; r=0.63, ppolysomnography, enabling identification of likely responders to therapies targeting ventilatory control.

  1. Comparison of a novel non-contact biomotion sensor with wrist actigraphy in estimating sleep quality in patients with obstructive sleep apnoea. (United States)

    Pallin, Michael; O'Hare, Emer; Zaffaroni, Alberto; Boyle, Patricia; Fagan, Ciara; Kent, Brian; Heneghan, Conor; de Chazal, Philip; McNicholas, Walter T


    Ambulatory monitoring is of major clinical interest in the diagnosis of obstructive sleep apnoea syndrome. We compared a novel non-contact biomotion sensor, which provides an estimate of both sleep time and sleep-disordered breathing, with wrist actigraphy in the assessment of total sleep time in adult humans suspected of obstructive sleep apnoea syndrome. Both systems were simultaneously evaluated against polysomnography in 103 patients undergoing assessment for obstructive sleep apnoea syndrome in a hospital-based sleep laboratory (84 male, aged 55 ± 14 years and apnoea-hypopnoea index 21 ± 23). The biomotion sensor demonstrated similar accuracy to wrist actigraphy for sleep/wake determination (77.3%: biomotion; 76.5%: actigraphy), and the biomotion sensor demonstrated higher specificity (52%: biomotion; 34%: actigraphy) and lower sensitivity (86%: biomotion; 94%: actigraphy). Notably, total sleep time estimation by the biomotion sensor was superior to actigraphy (average overestimate of 10 versus 57 min), especially at a higher apnoea-hypopnoea index. In post hoc analyses, we assessed the improved apnoea-hypopnoea index accuracy gained by combining respiratory measurements from polysomnography for total recording time (equivalent to respiratory polygraphy) with total sleep time derived from actigraphy or the biomotion sensor. Here, the number of misclassifications of obstructive sleep apnoea severity compared with full polysomnography was reduced from 10/103 (for total respiratory recording time alone) to 7/103 and 4/103 (for actigraphy and biomotion sensor total sleep time estimate, respectively). We conclude that the biomotion sensor provides a viable alternative to actigraphy for sleep estimation in the assessment of obstructive sleep apnoea syndrome. As a non-contact device, it is suited to longitudinal assessment of sleep, which could also be combined with polygraphy in ambulatory studies.

  2. Mitochondrial abnormalities drive cell death in Wolfram syndrome 2

    Institute of Scientific and Technical Information of China (English)

    Tomotake Kanki; Daniel J Klionsky


    @@ Wolfram syndrome (WFS; MIM 222300) is an autosomal recessive disorder with highly variable clinical manifestations. It is characterized by di-abetes insipidus, diabetes mellitus, optic atrophy, and deafness (thus, known as DIDMOAD syndrome) [1].

  3. Flextube reflectometry and pressure-recordings for level diagnosis in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Faber, C E; Grymer, L; Hilberg, O;


    The objective of this study was to compare sound reflections in a flexible tube (flextube reflectometry) with pressure-catheter recordings (ApneaGraph) for identifying the predominant obstructive level of the upper airway during sleep. Seventeen males with suspected obstructive sleep apnoea...... syndrome (OSAS) were included in the study. The mean (standard deviation = SD) number of flextube narrowings per hour recording was 50.2 (20.4) and the mean (SD) RDI (respiratory disturbance index = apnoeas and hypopnoeas per hour recording) determined by the ApneaGraph was 45.7 (20.2). The mean difference...... (SD) between the number of flextube narrowings per hour recording and the RDIs determined by the ApneaGraph was not statistically significantly different from 0. There was no statistically significant correlation between the percentage of retropalatal narrowing of the total narrowing (retropalatal...

  4. Managing obstructive sleep apnoea in children: the role of craniofacial morphology

    Directory of Open Access Journals (Sweden)

    Maria Fernanda Rabelo Bozzini

    Full Text Available Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy.

  5. Screening for Sleep Apnoea in Mild Cognitive Impairment: The Utility of the Multivariable Apnoea Prediction Index

    Directory of Open Access Journals (Sweden)

    Georgina Wilson


    Full Text Available Purpose. Mild cognitive impairment (MCI is considered an “at risk” state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI, a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG. Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI. Receiver-operating characteristics (ROC curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: r=0.47, P=0.017. However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.

  6. Screening for sleep apnoea in mild cognitive impairment: the utility of the multivariable apnoea prediction index. (United States)

    Wilson, Georgina; Terpening, Zoe; Wong, Keith; Grunstein, Ron; Norrie, Louisa; Lewis, Simon J G; Naismith, Sharon L


    Purpose. Mild cognitive impairment (MCI) is considered an "at risk" state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA) is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI), a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG). Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI). Receiver-operating characteristics (ROC) curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: r = 0.47, P = 0.017). However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC) in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.

  7. Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep

    Directory of Open Access Journals (Sweden)

    D. Pevernagie


    Full Text Available The concept of central sleep apnoea or hypoventilation encompasses hypercapnic central hypoventilation, such as obesity hypoventilation syndrome and eucapnic or hypocapnic central sleep apnoea. Among subjects with eucapnic or hypocapnic central sleep apnoea, several therapeutic options are available for those with Cheyne–Stokes respiration (CSR. CSR is frequent in patients with New York Heart Association stage III and IV chronic heart failure, and in various neurological disorders. In these patients, treatment modalities include optimising cardiac condition and drugs, such as theophylline, acetazolamide and/or oxygen. Ventilatory support, such as nasal continuous positive airway pressure (CPAP, bi-level pressure support, or adaptive servo-ventilation (ASV, has been shown to improve CSR in patients with cardiac failure; however, convincing evidence that nasal CPAP improves life expectancy in these patients is lacking. Nevertheless, the treatment of associated obstructive sleep-disordered breathing is indicated per se, as it may improve cardiac function. There is currently no proof that bi-level ventilation is superior to nasal CPAP. The few available studies that have focused on ASV have shown satisfactory control of CSR in cardiac failure patients. While ASV is not a first-line treatment choice, it appears to be superior to oxygen, CPAP and bi-level pressure ventilation in controlling the apnoea/hypopnea index and probably sleep fragmentation. As yet there are no data on mortality and, as such, firm conclusions cannot be drawn as to the role of ASV in the management of cardiac failure patients suffering from CSR. Obesity-related hypoventilation has increased dramatically over recent decades due to the epidemic increase in obesity in the developed countries. Obesity hypoventilation syndrome predisposes to the development of pulmonary hypertension and cor pulmonale. Noninvasive home ventilation is increasingly applied in obese patients with

  8. Morbidity and mortality in children with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob


    Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA.......Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA....

  9. The effect of adenotonsillectomy for childhood sleep apnoea on cardiorespiratory control

    Directory of Open Access Journals (Sweden)

    Mathias Baumert


    Full Text Available The efficacy of adenotonsillectomy for relieving obstructive sleep apnoea symptoms in children has been firmly established, but its precise effects on cardiorespiratory control are poorly understood. In 375 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either adenotonsillectomy (n=194 or a strategy of watching waiting (n=181, respiratory rate, respiratory sinus arrhythmia and heart rate were analysed during quiet, non-apnoeic and non-hypopnoeic breathing throughout sleep at baseline and at 7 months using overnight polysomnography. Children who underwent early adenotonsillectomy demonstrated an increase in respiratory rate post-surgery while the watchful waiting group showed no change. Heart rate and respiratory sinus arrhythmia were comparable between both arms. On assessing cardiorespiratory variables with regard to normalisation of clinical polysomnography findings during follow-up, heart rate was reduced in children who had resolution of obstructive sleep apnoea syndrome, while no differences in their respiratory rate or respiratory sinus arrhythmia were observed. Adenotonsillectomy for obstructive sleep apnoea increases baseline respiratory rate during sleep. Normalisation of apnoea–hypopnoea index, spontaneously or via surgery, lowers heart rate. Considering the small average effect size, the clinical significance is uncertain.

  10. Apnoea testing to confirm brain death in clinical practice. (United States)

    van Donselaar, C A; Meerwaldt, J D; van Gijn, J


    In six patients an apnoea test was carried out to confirm brain death according to a protocol recommended in the USA. After ten minutes' apnoea the pCO2 did not reach the target value of 7.98 kPa (60 mm Hg) in any of these patients. This was caused by the low initial value and the slow increase of the pCO2. Moreover, we could not confirm the belief that the necessary duration of the apnoea test can be predicted by assuming a rise of the pCO2 of 0.33 kPa (2.5 mm Hg) per minute. PMID:3093640

  11. Apnoea testing to confirm brain death in clinical practice.


    van Donselaar, C. A.; Meerwaldt, J D; van Gijn, J


    In six patients an apnoea test was carried out to confirm brain death according to a protocol recommended in the USA. After ten minutes' apnoea the pCO2 did not reach the target value of 7.98 kPa (60 mm Hg) in any of these patients. This was caused by the low initial value and the slow increase of the pCO2. Moreover, we could not confirm the belief that the necessary duration of the apnoea test can be predicted by assuming a rise of the pCO2 of 0.33 kPa (2.5 mm Hg) per minute.

  12. Apnoea testing to confirm brain death in clinical practice. (United States)

    van Donselaar, C A; Meerwaldt, J D; van Gijn, J


    In six patients an apnoea test was carried out to confirm brain death according to a protocol recommended in the USA. After ten minutes' apnoea the pCO2 did not reach the target value of 7.98 kPa (60 mm Hg) in any of these patients. This was caused by the low initial value and the slow increase of the pCO2. Moreover, we could not confirm the belief that the necessary duration of the apnoea test can be predicted by assuming a rise of the pCO2 of 0.33 kPa (2.5 mm Hg) per minute.

  13. Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials. (United States)

    Hemmingsson, E


    Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.

  14. Wheelchair ergonomic hand drive mechanism use improves wrist mechanics associated with carpal tunnel syndrome. (United States)

    Zukowski, Lisa A; Roper, Jaimie A; Shechtman, Orit; Otzel, Dana M; Hovis, Patty W; Tillman, Mark D


    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression.

  15. A pilot study to evaluate simulated driving performance and cognitive function in healthy subjects and patients with restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Chen D


    Full Text Available Dan Chen,1 Paula Shaw,2 Daniel M Canafax,1,3 James Catesby Ware4 1XenoPort, Inc., Santa Clara, CA, USA; 2Charles River Northwest, Tacoma, WA, USA; 3Theravance Inc., South San Francisco, CA, USA; 4Division of Sleep Medicine, Eastern Virginia Medical School, Norfolk, VA, USA Objective: Symptoms of restless legs syndrome (RLS usually occur during the evening and night time, resulting in disrupted sleep and subsequent daytime fatigue. This study compared simulated driving performance, alertness, and cognitive function between healthy subjects and patients with a diagnosis of RLS. Methods: Fifteen healthy subjects and 15 untreated RLS subjects were enrolled and completed two driving tests. The first test occurred at 4 PM followed by the second test at 8 AM the next morning. Outcome measures included lane position variability (LPV, speed variability, frequency of simulated crashes (off-road events or collision, and brake reaction time. Other assessments included visual analog scale (VAS of alertness and the Brief Assessment of Cognition (BAC. Results: Overall, RLS patients and healthy subjects performed similarly on driving assessments. Two subjects within each group experienced off-road events. RLS patients had less alertness on the VAS than healthy subjects before and after driving assessments. Both groups scored similarly on the cognitive function assessments. Conclusion: Despite reported diminished alertness, RLS patients did not demonstrate impairment in driving or cognitive performance. Keywords: restless legs syndrome, simulated driving performance, cognitive function

  16. 鼻镜下经口动力系统与传统手术治疗儿童OSAHS的对比研究%Comparative Study of Obstructive Sleep Apnoea Syndrome Breathing in Children Treated with Dynamical Cutterbar via Nasal Endoscope and Rout Curettage of Adenoids

    Institute of Scientific and Technical Information of China (English)

    谷彬; 王东海


    目的 比较鼻内镜监视下经口动力系统和传统手术方式治疗儿童阻塞性呼吸睡眠暂停综合征的临床疗效及对心理行为的改善情况.方法 将370例患者随机分为传统手术组160例(A组),鼻内镜监视下经口动力系统组210例(B组),对经两种手术方法治疗的患儿术后的临床症状和心理行为异常等情况进行分析和比较.结果 A组术后平均随访14个月,B组平均随访16个月.两组手术后对患儿临床症状均有改善.B组在睡眠打鼾、鼻塞、鼻漏、听力、上课注意力不集中、多动等症状改善方面明显优于A组(P<0.05).结论 鼻内镜下经口动力系统腺样体切除及扁桃体部分切除术对儿童阻塞性呼吸睡眠暂停综合征的治疗效果明显优于传统手术方法.%Objective The aim of this study was to compare the clinical effectiveness and the improvement of the mentality and behavior of obstructive sleep apnoea syndrome breathing( OSAHS )in children of dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy ( group B 210cases ) and rout curettage of adenoids( group A 160cases ). Methods Clinical date of 370 patients who had accepted the surgery therapy in two ways,were retrospectively analyzed. To compare their clinical symptoms and the improvement of the mentality and behavior of OSAHS in children. Results The post-operation patients of two groups have significantly different in the symptomatic improvement. It showed that group B had significantly greater improvements in aspects of Sleep snoring, nasal obstruction, rhinorrhea, hearing, inattention in class,and restlessness than that in group A. Conclusion Dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy by mouth is the best way to cure OSAHS in children in present time.

  17. Novel method for detection of Sleep Apnoea using respiration signals

    DEFF Research Database (Denmark)

    Nielsen, Kristine Carmes; Kempfner, Lykke; Sørensen, Helge Bjarup Dissing


    Polysomnography (PSG) studies are considered the “gold standard” for the diagnosis of Sleep Apnoea (SA). Identifying cessations of breathing from long-lasting PSG recordings manually is a labour-intensive and time-consuming task for sleep specialist, associated with inter-scorer variability. In t...

  18. The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients. (United States)

    Koutsourelakis, Ioannis; Minaritzoglou, Aliki; Zakynthinos, Georgios; Vagiakis, Emmanouil; Zakynthinos, Spyros


    Although there is a strong correlation between oral/oro-nasal breathing and apnoea/hypopnoea index in patients with obstructive sleep apnoea and normal nasal resistance at wakefulness, it remains unknown whether the pharmacological prevention of potential nasal obstruction during sleep could decrease oral/oro-nasal breathing and increase nasal breathing and subsequently decrease the apnoea/hypopnoea index. This study evaluated the effect of a combination of a nasal decongestant with corticosteroid on breathing route pattern and apnoea/hypopnoea index. 21 patients with obstructive sleep apnoea (mean apnoea/hypopnoea index 31.1 events per hour) and normal nasal resistance at wakefulness were enrolled in a randomised crossover trial of 1 weeks' treatment with nasal tramazoline and dexamethasone compared with 1 weeks' treatment with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with attendant measurement of breathing route pattern. Nasal tramazoline with dexamethasone was associated with decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, and mean decrease of apnoea/hypopnoea index by 21%. The change in nasal breathing epochs was inversely related to the change in apnoea/hypopnoea index (Rs=0.78; pnasal tramazoline with dexamethasone in OSA patients with normal nasal resistance at wakefulness can restore the preponderance of nasal breathing epochs and modestly improve apnoea/hypopnoea index.

  19. Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD (United States)

    He, Bai-Ting; Lu, Gan; Xiao, Si-Chang; Chen, Rui; Steier, Joerg; Moxham, John; Polkey, Michael I; Luo, Yuan-Ming


    Background The mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome. Methods EMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance. Results Thirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, pCOPD alone (29.5±13.3% to 23.0±8.9% of maximal, pCOPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (pCOPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance. PMID:27807016

  20. Sexual function in male patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petersen, Marian; Kristensen, Ellids; Berg, Søren


    OBJECTIVE: Our objective was to investigate general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA) and compare the results with normative data. MATERIALS AND METHODS: We investigated 308 male patients (age 30-69) admitted to a sle...... that although sexual dysfunction is more prevalent in OSA patients than in the general population, it is a complex problem relating more to age, obesity, social factors and comorbidity than to the severity of OSA....... of sexuality were worse in patients with (untreated) OSA when compared with normative data. Both aspects were dependent on age, obesity, social factors and concomitant medication but not on the severity of OSA as reflected by the apnoea-hypopnoea index or subjective sleepiness. CONCLUSION: We conclude...

  1. Road traffic accidents in patients with obstructive sleep apnoea. (United States)

    Liam, C K; How, L G; Tan, C T


    Three patients involved in road traffic accidents were suspected to have obstructive sleep apnoea (OSA). Two of them fell asleep while riding motorcycles and one patient fell asleep behind the wheel of a truck causing it to overturn. The diagnosis of OSA in each case was suspected based on a history of loud snoring, restless sleep, and excessive daytime somnolence and was confirmed by sleep studies.

  2. Sleep Apnoea in Infants and Children

    Directory of Open Access Journals (Sweden)

    Dr. Dario Galante


    Full Text Available For nearly 3,000 years, it has been recognized that apparently healthy infants could die suddenly and unexpectedly during their sleep .Throughout most of history, it was believed that these infants somehow suffocated, implying that these babies died a respiratory death. Nearly one infant per thousand live births continues to die suddenly and unexpectedly from sudden infant death syndrome (SIDS

  3. Sleep apnoea in heart failure: To treat or not to treat? (United States)

    Naughton, Matthew T; Kee, Kirk


    Heart failure (HF) and sleep apnoea are common disorders which frequently coexist. Two main types of apnoea occur: one is obstructive which, through recurring episodes of snoring, hypoxaemia, large negative intra-thoracic pressures and arousals from sleep leading to downstream inflammatory and autonomic nervous system changes, is thought to be a causative factor to the development of systemic hypertension and HF. The other type of apnoea, Cheyne-Stokes respiration with central sleep apnoea (CSR-CSA), is characterized by an oscillatory pattern of ventilation with a prevailing hyperventilation-induced hypocapnia, often in the absence of significant hypoxaemia and snoring, and is thought to be a consequence of advanced HF-related low cardiac output, high sympathetic nervous system activation and pulmonary congestion. CSR-CSA may be a compensatory response to advanced HF. Rostral fluid shift during sleep may play an important role in the pathogenesis of both obstructive sleep apnoea (OSA) and CSA. Studies of positive airway pressure (PAP) treatment of OSA and CSA in HF have shown short-term improvements in cardiac and autonomic function; however, there is no evidence of improved survival. Loop gain may provide useful marker of continuous PAP (CPAP) responsiveness in patients with central apnoea. A greater understanding of the pathophysiology of the interaction between obstructive and central apnoea and the various types of HF, and the mechanisms of therapies, such as PAP, is required to develop new strategies to overcome the disabling symptoms, and perhaps improve the mortality, that accompany HF with sleep apnoea.

  4. Anterior mandibular positioning device for treatment of snoring and obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Faber, Christian; Grymer, Luisa; Hjorth, Tine


    The aim of this study was to determine the severity of side effects and the influence on snoring and the AHI (apnoea-hypopnoea index = number of apnoeas and hypopnoeas per hour recording) of an anterior mandibular positioning device (AMP device) for treatment of snoring and obstructive sleep apno...

  5. Cervical column morphology in adult patients with obstructive sleep apnoea. (United States)

    Sonnesen, Liselotte; Petri, Niels; Kjaer, Inger; Svanholt, Palle


    Cervical column morphology was examined in adult patients with obstructive sleep apnoea (OSA) and compared with the cervical morphology of an adult control group with neutral occlusion, normal craniofacial morphology, and no history of sleep apnoea. The sleep apnoea group consisted of 91 patients, 16 females aged 29-59 years (mean 49.4 years) and 75 males aged 27-65 years (mean 49.0 years). All patients were diagnosed with OSA by overnight polysomnography. The control group consisted of 21 subjects, 15 females aged 23-40 years (mean 29.2 years) and 6 males aged 25-44 years (mean 32.8 years). From each individual, a visual assessment of the cervical column was performed on the radiograph. Differences in the cervical column morphology, between the genders and the groups were assessed by Fisher's exact test and the effect of age by logistic regression analysis. In the OSA group, 46.2 per cent had fusion anomalies of the cervical column and 5.5 per cent a posterior arch deficiency. Fusion anomalies occurred in 26.4 per cent as fusions between two cervical vertebrae. Block fusions occurred in 12.1 per cent and occipitalization in 14.3 per cent. A posterior arch deficiency occurred in 2.2 per cent as a partial cleft of C1 and in 3.3 per cent as dehiscence of C3 and C4. No statistical gender differences were found in the occurrence of morphological characteristics of the cervical column. The fusion anomalies of the cervical column occurred significantly more often in the OSA group. The results indicate that the morphological deviations of the upper cervical vertebrae play a role in the phenotypical subdivision and diagnosis of OSA.

  6. Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012. (United States)

    Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K


    (1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients

  7. The validity of the static charge sensitive bed in detecting obstructive sleep apnoeas. (United States)

    Polo, O; Brissaud, L; Sales, B; Besset, A; Billiard, M


    The demand for polysomnographic recordings associated with respiratory control exceeds the capacity of the few existing sleep disorder centres and therefore a simple and inexpensive method is needed for screening and diagnosing sleep-related breathing disorders. The static charge sensitive bed (SCSB) permits long-term recordings of body movements, respiratory movements and the ballistocardiogram (BCG) without electrodes or cables being attached to the subject. The aim of the present study was to test the validity of this particular method in detecting obstructive sleep apnoeas without airflow measurements. Simultaneous SCSB and spirometer recordings were compared in fourteen sleep apnoea patients and six controls. The mean sensitivity of the SCSB method to detect the obstructive apnoeas was 0.92-0.98. The specificity to detect 2 min apnoea epochs was 0.61-0.68 in the apnoea group, while in the control group it was 0.99-1.00. According to this study, the SCSB detects the obstructive events without always distinguishing between severe periodic hypopnoeas and obstructive apnoeas. The sensitivity of the SCSB makes it valuable for screening subjects suspected of having obstructive sleep apnoeas. Further studies will concentrate on a more detailed analysis of the various respiratory, BCG and body movement patterns, which may lead to additional information on the severity of the upper airway obstruction.

  8. Promoter-Bound Trinucleotide Repeat mRNA Drives Epigenetic Silencing in Fragile X Syndrome


    Colak, Dilek; Zaninovic, Nikica; Cohen, Michael S.; Rosenwaks, Zev; Yang, Wang-Yong; Gerhardt, Jeannine; Disney, Matthew D.; Jaffrey, Samie R.


    Epigenetic gene silencing is seen in several repeat-expansion diseases. In fragile X syndrome, the most common genetic form of mental retardation, a CGG trinucleotide–repeat expansion adjacent to the fragile X mental retardation 1 (FMR1) gene promoter results in its epigenetic silencing. Here, we show that FMR1 silencing is mediated by the FMR1 mRNA. The FMR1 mRNA contains the transcribed CGG-repeat tract as part of the 5′ untranslated region, which hybridizes to the complementary CGG-repeat ...

  9. Obstructive Sleep Apnoea: A Roar in the Snore

    Directory of Open Access Journals (Sweden)

    Gopinadh Anne


    Full Text Available Sleeping is an important physiological role in our day to day life. A good laugh and a long sleep are the best cures in the doctor′s book. Sleep disorders of the upper airway result from any condition or disease that causes its partial or complete obstruction when a patient assumes a supine position and goes to sleep. Sleep disorders, particularly untreated obstructive sleep apnoea (OSA can be associated with motor vehicle accidents, poor work performance in the office or workplace, and also makes a person prone to occupational accidents and reduced quality of life. Comprehensive management of upper airway sleep disorders requires an interdisciplinary approach. A prosthodontist can play a significant role as the team member in the interdisciplinary approach for the management of upper airway sleep disorders. The present article focuses on the history, clinical examination, investigations, and management of OSA.

  10. Obstructive sleep apnoea, motor vehicle accidents, and work performance. (United States)

    Sanna, Antonio


    The obstructive sleep apnoea (OSA) shows a very high prevalence in the middle-age work force population and, between all diseases and medical conditions, is the major risk factor for motor vehicle accidents (MVAs). OSA can be diagnosed and treated, with resultant reduction in MVAs to those seen in the healthy population. It is increasing evidence that it is a major risk factor for occupational accidents also in fields different from the professional transport and for work disability. It is likely that the treatment of OSA results in the reduction of occupational accidents and work performance improvement with expected benefits in work processes and business in general. It is therefore advisable to develop strategies for screening and treatment of OSA in workers. The risk assessment of OSA in workers may also help to reduce the burden on national health care systems.

  11. T, B, and NKT Cells in Systemic Inflammation in Obstructive Sleep Apnoea

    Directory of Open Access Journals (Sweden)

    Joanna Domagała-Kulawik


    Full Text Available Background. Obstructive sleep apnoea syndrome (OSAS brings risk of serious complications. The study objective was to assess elements of the cellular immune response in the course of OSAS. Methods. Peripheral blood (PB lymphocytes: T, B, NK, NKT-like, Th, Tc, and HLA DR+ T cells were evaluated by flow cytometry of 48 OSA patients; the concentration of adiponectin, interleukin 1β, and TNFα was measured by ELISA method. The OSA complication score was developed and used for statistical analysis. Results. The proportion of B cells and Th/Tc ratio were significantly lower in the BP of OSA patients when compared with control subjects (median 7.9 versus 10.9%, 0.9 versus 1.5, p<0.05. The proportion of Tc, NK, NKT-like, and HLADR positive T cells were elevated in OSA patients when compared with healthy subjects (36.4 versus 26.8, 15.5 versus 8.5, 5.7 versus 3.0, and 8.4 versus 4.5%, p<0.05, resp. and were more pronounced in patients with metabolic syndrome. The grade of OSA complication score correlated with systemic inflammation markers and the proportion of B cells. The value of adiponectin/BMI ratio correlated significantly with SpO2 (r=0.31, p<0.05, CRP (r=-0.35, p<0.05, TNFα concentration (r=-0.36, p<0.05, and proportion of B cells (r=0.32, p<0.05. Conclusion. Lymphocytes B, Tc, NK, NKT-like, and adiponectin are involved in systemic immune response in OSA patients possibly predisposing them to cardiovascular and metabolic complications.

  12. Promoter-bound trinucleotide repeat mRNA drives epigenetic silencing in fragile X syndrome. (United States)

    Colak, Dilek; Zaninovic, Nikica; Cohen, Michael S; Rosenwaks, Zev; Yang, Wang-Yong; Gerhardt, Jeannine; Disney, Matthew D; Jaffrey, Samie R


    Epigenetic gene silencing is seen in several repeat-expansion diseases. In fragile X syndrome, the most common genetic form of mental retardation, a CGG trinucleotide-repeat expansion adjacent to the fragile X mental retardation 1 (FMR1) gene promoter results in its epigenetic silencing. Here, we show that FMR1 silencing is mediated by the FMR1 mRNA. The FMR1 mRNA contains the transcribed CGG-repeat tract as part of the 5' untranslated region, which hybridizes to the complementary CGG-repeat portion of the FMR1 gene to form an RNA·DNA duplex. Disrupting the interaction of the mRNA with the CGG-repeat portion of the FMR1 gene prevents promoter silencing. Thus, our data link trinucleotide-repeat expansion to a form of RNA-directed gene silencing mediated by direct interactions of the trinucleotide-repeat RNA and DNA.

  13. Toward a deeper characterization of the social phenotype of Williams syndrome: The association between personality and social drive. (United States)

    Ng, Rowena; Järvinen, Anna; Bellugi, Ursula


    Previous research has robustly established a Williams syndrome (WS) specific personality profile, predominantly characterized a gregarious, people-oriented, and tense predisposition. Extending this work, the aims of the current, cross-sectional study were two-fold: (1) to elucidate the stability of personality characteristics in individuals with WS and typically developing (TD) comparisons across development, and (2) to explore the personality attributes that may be related to the respective profiles of social functioning characterizing the two groups, which is currently poorly understood. The sample comprised of participants with WS and TD matched on chronological age. The test battery included the Multidimensional Personality Questionnaire (MPQ) and the Salk Institute Sociability Questionnaire (SISQ), an index of real-life social behavior. The main results showed that compared to the TD individuals, the WS group were consistently rated higher in Social Closeness, and this trait remained stable across development. Interpersonal behaviors were best predicted by Social Closeness in WS and by Social Potency in TD. Regression analysis highlighted that while a central motive underlying the increased drive toward social interaction in individuals with WS pertains to a desire to form affectionate relationships, TD individuals by contrast are motivated by a desire to exert social influence over others (leadership, social-dominance) and Well-Being (positive emotional disposition). In conclusion, these findings provide novel insight into social motivational factors underpinning the WS social behavior in real life, and contribute toward a deeper characterization of the WS affiliative drive. We suggest potential areas for behavioral intervention targeting improved social adjustment in individuals with WS.

  14. Endogenous ethanol 'auto-brewery syndrome' as a drunk-driving defence challenge. (United States)

    Logan, B K; Jones, A W


    The concentration of ethanol in blood, breath or urine constitutes important evidence for prosecuting drunk drivers. For various reasons, the reliability of the results of forensic alcohol analysis are often challenged by the defence. One such argument for acquittal concerns the notion that alcohol could be produced naturally in the body, hence the term 'auto-brewery' syndrome. Although yeasts such as Candida albicans readily produce ethanol in-vitro, whether this happens to any measurable extent in healthy ambulatory subjects is an open question. Over the years, many determinations of endogenous ethanol have been made, and in a few rare instances (Japanese subjects with very serious yeast infections) an abnormally high ethanol concentration (> 80 mg/dl) has been reported. In these atypical individuals, endogenous ethanol appeared to have been produced after they had eaten carbohydrate-rich foods. A particular genetic polymorphism resulting in reduced activity of enzymes involved in hepatic metabolism of ethanol and a negligible first-pass metabolism might explain ethnic differences in rates of endogenous ethanol production and clearance. Other reports of finding abnormally high concentrations of ethanol in body fluids from ostensibly healthy subjects suffer from deficiencies in study design and lack suitable control experiments or used non-specific analytical methods. With reliable gas chromatographic methods of analysis, the concentrations of endogenous ethanol in peripheral venous blood of healthy individuals, as well as those suffering from various metabolic disorders (diabetes, hepatitis, cirrhosis) ranged from 0-0.08 mg/dl. These concentrations are far too low to have any forensic or medical significance. The notion that a motorist's state of intoxication was caused by endogenously produced ethanol lacks merit.

  15. Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study. (United States)

    Alonso-Álvarez, María Luz; Terán-Santos, Joaquin; Navazo-Egüia, Ana Isabel; Martinez, Mónica Gonzalez; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Cordero-Guevara, José Aurelio; Kheirandish-Gozal, Leila; Gozal, David


    The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; pobese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (pobesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up.

  16. Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial. (United States)

    Mendelson, Monique; Lyons, Owen D; Yadollahi, Azadeh; Inami, Toru; Oh, Paul; Bradley, T Douglas


    Overnight fluid shift from the legs to the neck and lungs may contribute to the pathogenesis of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA). We hypothesised that exercise training will decrease the severity of OSA and CSA in patients with coronary artery disease (CAD) by decreasing daytime leg fluid accumulation and overnight rostral fluid shift.Patients with CAD and OSA or CSA (apnoea-hypopnoea index >15 events per h) were randomised to 4 weeks of aerobic exercise training or to a control group. Polysomnography, with measurement of leg, thoracic and neck fluid volumes and upper-airway cross-sectional area (UA-XSA) before and after sleep, was performed at baseline and follow-up.17 patients per group completed the study. Apnoea-hypopnoea index decreased significantly more in the exercise group than in the control group (31.1±12.9 to 20.5±9.4 versus 28.1±13.5 to 27.0±15.1 events per h, p=0.047), in association with a greater reduction in the overnight change in leg fluid volume (579±222 to 466±163 versus 453±164 to 434±141 mL, p=0.04) and by a significantly greater increase in the overnight change in UA-XSA in the exercise group (p=0.04).In patients with CAD and sleep apnoea, exercise training decreases sleep apnoea severity via attenuation of overnight fluid shift and an increase in UA-XSA.

  17. A single qualitative study can show same findings as years of quantitative research: Obstructive sleep apnoea as an example

    Directory of Open Access Journals (Sweden)

    Howard Tandeter


    Full Text Available Background Many years of quantitative research led to our present knowledge of the symptoms and associated features (S&AF of the obstructive sleep apnoea (OSA syndrome. Aims 1. To prove that a qualitative research approach may identify symptoms and associated features of OSA in less time/effort than that used in a quantitative approach; 2. To describe the experience of patients with OSA and the effects of the syndrome on their quality of life and that of their spouses and families (issues that quantitative methods fail to recognize. Methods We used a narrative inquiry methodology (qualitative research. The sample was selected using the “snowball sampling technique". The sample included 10 patients with moderate to severe OSA who had good adherence to CPAP and significant clinical improvement after treatment, and 3 of the patient’s spouses. Results The following issues were identified: A long pre-diagnosis phase of OSA (20 years in one of the patients; Characteristic S&AF of the syndrome as experienced by patients and their spouses; The need for increased awareness of both the public and the medical establishment in regards to this disorder; Premature ejaculation (not reported previously and nightmares (non-conclusive in the literature were identified and improved with CPAP therapy. Conclusion With the use of quantitative research methods it took decades to discover things that we found in one simple qualitative study. We therefore urge scientists to use more often these qualitative methods when looking for S&AF of diseases and syndromes.

  18. Recommendations for the management of patients with obstructive sleep apnoea and hypertension

    DEFF Research Database (Denmark)

    Parati, Gianfranco; Lombardi, Carolina; Hedner, Jan


    This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of car...... to consider the occurrence of hypertension in patients with respiratory problems at night....

  19. Obstructive sleep apnoea is frequent in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Banghoej, Anne Margareta; Nerild, Henriette Holst; Kristensen, Peter Lommer;


    AIM: Obstructive Sleep Apnoea (OSA) is frequent in patients with type 2 diabetes. The aim of this study is to evaluate prevalence of OSA in patients with type 1 diabetes. METHODS: In a cross-sectional design, all patients with type 1 diabetes attending the outpatient clinic were offered screening...

  20. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, Morten; Nielsen, O W; Lip, G Y H;


    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. Firs...

  1. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

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    Del Ben Maria


    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  2. Effects of surgical correction of class III malocclusion on the pharyngeal airway and its influence on sleep apnoea. (United States)

    Canellas, J V Dos S; Barros, H L M; Medeiros, P J D; Ritto, F G


    The objective of this study was to evaluate, through cone beam computed tomography, the immediate changes in pharyngeal airway space (PAS) after orthognathic surgery in class III patients, and to determine the influence of surgery on the development of obstructive sleep apnoea hypopnoea syndrome (OSAHS). A prospective study was conducted; 33 patients were divided into three groups: mandibular setback surgery (nine patients), bimaxillary surgery (18 patients), and maxillary advancement surgery (six patients). PAS measurements obtained pre- and postoperatively were compared using the t-test. All patients were assessed clinically for OSAHS before surgery and at 6 months postoperative using the Berlin questionnaire and a combined clinical assessment, which included the assessment of OSAHS symptoms, Epworth Sleepiness Scale score, and body mass index. Patients undergoing isolated mandibular setback surgery demonstrated a decrease in total PAS volume, in hypopharynx volume, and in minimum cross-sectional area of the pharynx immediately after surgery (P<0.05). The clinical analysis did not reveal signs or symptoms of OSAHS in any of the 33 patients. Although patients who underwent mandibular setback surgery alone demonstrated a volume reduction in the PAS and a decrease in minimum cross-sectional area, these reductions were not accompanied by signs or symptoms of OSAHS.

  3. At least one in three people with Type 2 diabetes mellitus referred to a diabetes centre has symptomatic obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Storgaard, H; Mortensen, B; Almdal, T;


    obstructive sleep apnoea. Our data suggest higher age, a compromised plasma lipid profile and a more obese phenotype in patients with Type 2 diabetes who have obstructive sleep apnoea, highlighting the need to focus on screening and treatment of obstructive sleep apnoea in these patients.......%. Patients with symptomatic obstructive sleep apnoea had significantly higher BMI, poorer glycaemic control and lower plasma HDL cholesterol levels as compared with patients unlikely to have obstructive sleep apnoea. The groups were not different with respect to sex, age, diabetes duration, blood pressure......, diabetic complications or medication use. In multiple regression analyses, age, BMI and HDL cholesterol levels were all significant, independent predictors of obstructive sleep apnoea. CONCLUSIONS: At least one third of people with Type 2 diabetes referred to a diabetes clinic in Denmark has symptomatic...

  4. Subjective assessment of facial aesthetics after maxillofacial orthognathic surgery for obstructive sleep apnoea. (United States)

    Islam, Shofiq; Aleem, Fahd; Ormiston, Ian W


    We aimed to evaluate the subjective perception of facial appearance by patients after maxillofacial surgery for obstructive sleep apnoea (OSA), and explored the possible correlation between satisfaction and surgical outcome. A total of 26 patients, 24 men and 2 women (mean (SD) age 45 (7) years), subjectively assessed their facial appearance before and after operation using a visual analogue scale (VAS). To investigate a possible association between postoperative facial appearance and surgical outcome, we analysed postoperative scores for the apnoea/hypopnoea index (AHI) and Epworth sleepiness scale (ESS). Postoperatively, 14 (54%) indicated that their facial appearance had improved, 4 (15%) recorded a neutral score, and 8 (31%) a lower score. The rating of facial appearance did not correlate with changes in the AHI or ESS following surgery. This study supports the view that most patients are satisfied with their appearance after maxillofacial orthognathic surgery for OSA. The subjective perception of facial aesthetics was independent of the surgical outcome.

  5. Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea. (United States)

    De Corso, E; Bastanza, G; Della Marca, G; Grippaudo, C; Rizzotto, G; Marchese, M R; Fiorita, A; Sergi, B; Meucci, D; Di Nardo, W; Paludetti, G; Scarano, E


    Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of

  6. Sleep disturbances and behavioural problems in adults with Prader-Willi syndrome

    NARCIS (Netherlands)

    Maas, A.P.H.M.; Sinnema, M.; Didden, H.C.M.; Maaskant, M.A.; Schrander-Stumpel, C.T.R.M.; Curfs, L.M.G


    Background Individuals with Prader-Willi syndrome (PWS) are at risk of sleep disturbances, such as excessive daytime sleepiness (EDS) and sleep apnoea, and behavioural problems. Sleep disturbances and their relationship with other variables had not been researched extensively in adults with PWS. Met

  7. Drive Stands (United States)

    Federal Laboratory Consortium — The Electrical Systems Laboratory (ESL)houses numerous electrically driven drive stands. A drive stand consists of an electric motor driving a gearbox and a mounting...

  8. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    Directory of Open Access Journals (Sweden)

    Shruti Redhu


    Full Text Available Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

  9. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. (United States)

    Stradling, J R; Crosby, J H


    One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age

  10. An affected core drives network integration deficits of the structural connectome in 22q11.2 deletion syndrome

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    František Váša


    Full Text Available Chromosome 22q11.2 deletion syndrome (22q11DS is a genetic disease known to lead to cerebral structural alterations, which we study using the framework of the macroscopic white-matter connectome. We create weighted connectomes of 44 patients with 22q11DS and 44 healthy controls using diffusion tensor magnetic resonance imaging, and perform a weighted graph theoretical analysis. After confirming global network integration deficits in 22q11DS (previously identified using binary connectomes, we identify the spatial distribution of regions responsible for global deficits. Next, we further characterize the dysconnectivity of the deficient regions in terms of sub-network properties, and investigate their relevance with respect to clinical profiles. We define the subset of regions with decreased nodal integration (evaluated using the closeness centrality measure as the affected core (A-core of the 22q11DS structural connectome. A-core regions are broadly bilaterally symmetric and consist of numerous network hubs — chiefly parietal and frontal cortical, as well as subcortical regions. Using a simulated lesion approach, we demonstrate that these core regions and their connections are particularly important to efficient network communication. Moreover, these regions are generally densely connected, but less so in 22q11DS. These specific disturbances are associated to a rerouting of shortest network paths that circumvent the A-core in 22q11DS, “de-centralizing” the network. Finally, the efficiency and mean connectivity strength of an orbito-frontal/cingulate circuit, included in the affected regions, correlate negatively with the extent of negative symptoms in 22q11DS patients, revealing the clinical relevance of present findings. The identified A-core overlaps numerous regions previously identified as affected in 22q11DS as well as in schizophrenia, which approximately 30–40% of 22q11DS patients develop.

  11. Polycystic ovarian syndrome

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    Nina Madnani


    Full Text Available Polycystic ovarian syndrome (PCOS is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

  12. Changes in rodent abundance and weather conditions potentially drive hemorrhagic fever with renal syndrome outbreaks in Xi'an, China, 2005-2012.

    Directory of Open Access Journals (Sweden)

    Huai-Yu Tian


    Full Text Available Increased risks for hemorrhagic fever with renal syndrome (HFRS caused by Hantaan virus have been observed since 2005, in Xi'an, China. Despite increased vigilance and preparedness, HFRS outbreaks in 2010, 2011, and 2012 were larger than ever, with a total of 3,938 confirmed HFRS cases and 88 deaths in 2010 and 2011.Data on HFRS cases and weather were collected monthly from 2005 to 2012, along with active rodent monitoring. Wavelet analyses were performed to assess the temporal relationship between HFRS incidence, rodent density and climatic factors over the study period. Results showed that HFRS cases correlated to rodent density, rainfall, and temperature with 2, 3 and 4-month lags, respectively. Using a Bayesian time-series Poisson adjusted model, we fitted the HFRS outbreaks among humans for risk assessment in Xi'an. The best models included seasonality, autocorrelation, rodent density 2 months previously, and rainfall 2 to 3 months previously. Our models well reflected the epidemic characteristics by one step ahead prediction, out-of-sample.In addition to a strong seasonal pattern, HFRS incidence was correlated with rodent density and rainfall, indicating that they potentially drive the HFRS outbreaks. Future work should aim to determine the mechanism underlying the seasonal pattern and autocorrelation. However, this model can be useful in risk management to provide early warning of potential outbreaks of this disease.

  13. IL-5 drives eosinophils from bone marrow to blood and tissues in a guinea-pig model of visceral larva migrans syndrome

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    L. H. Faccioli


    Full Text Available This study was undertaken to evaluate the role of IL-5 in eosinophil migration and in the maintenance of eosinophilia in a guinea-pig model of visceral larva migrans syndrome. The results show that the infection of animals with Toxocara canis induced an early increase in serum IL-5 levels that might be essential for eosinophil differentiation and proliferation and for the development of eosinophilia. When infected guinea-pigs were treated with mAb anti-IL-5 (TRFK-5 given at the same time or 1 or 3 days after infection, there was a high percentage of reduction of eosinophil counts 18 days after infection. However, when the mAb was administered during the peak of eosinophilia, there was high inhibition in blood, no inhibition in bronchoalveolar lavage fluid (BALF or peritoneum and an increase in eosinophil numbers in bone marrow. Thus, a basic level of IL-5 may be essential to drive eosinophils from bone marrow to blood and tissues, and for the maintenance of eosinophilia in infected animals. We may also conclude that when eosinophils have already migrated to the lungs, TRFK-5 has no power to inhibit eosinophilia, which is also under control of local lung cells producing IL-5. In this way, only one later TRFK-5 treatment may not be sufficient to modify the lung parenchyma microenvironment, since T. canis antigens had already stimulated some cell populations to produce IL-5.

  14. Pre-oxygenation and apnoea in pregnancy: changes during labour and with obstetric morbidity in a computational simulation. (United States)

    McClelland, S H; Bogod, D G; Hardman, J G


    Using the Nottingham Physiology Simulator, we investigated the effects on pre-oxygenation and apnoea during rapid sequence induction of labour, obesity, sepsis, pre-eclampsia, maternal haemorrhage and multiple pregnancy in term pregnancy. Pre-oxygenation with 100% oxygen was followed by simulated rapid sequence induction when end-tidal nitrogen tension was less than 1 kPa, and apnoea. Labour, morbid obesity and sepsis accelerated pre-oxygenation and de-oxygenation during apnoea. Fastest pre-oxygenation was in labour, with 95% of the maximum change in expired oxygen tension occurring in 47 s, compared to 97 s in a standard pregnant subject. The labouring subject with a body mass index of 50 kg x m(-2) demonstrated the fastest desaturation, the time taken to fall to an arterial saturation prolonged pre-oxygenation and tolerance to apnoea. Maternal haemorrhage and multiple pregnancy had minor effects. Our results inform the risk-benefit comparison of the anaesthetic options for Caesarean section.

  15. Effects of simulated obstructive sleep apnoea on the human carotid baroreceptor-vascular resistance reflex. (United States)

    Cooper, V L; Bowker, C M; Pearson, S B; Elliott, M W; Hainsworth, R


    Obstructive sleep apnoea (OSA), which is characterized by periodic inspiratory obstruction, is associated with hypertension and possibly with changes in the baroreceptor reflex. In this investigation we induced changes in inspiratory resistance and in inspiratory oxygen and carbon dioxide content, which simulate some of the changes in OSA, to determine whether this caused changes in the gain or setting of the carotid baroreflex. In eight healthy subjects (aged 21-62 years) we changed the stimulus to carotid baroreceptors, using neck chambers and graded pressures of -40 to +60 mmHg, and assessed vascular resistance responses in the brachial artery from changes in blood pressure (Finapres) divided by brachial artery blood flow velocity (Doppler ultrasound). Stimulus-response curves were defined during (a) sham (no additional stimulus), (b) addition of an inspiratory resistance (inspiratory pressure -10 mmHg), (c) breathing asphyxic gas (12% O(2), 5% CO(2)), and (d) combined resistance and asphyxia. Sigmoid or polynomial functions were applied to the curves and maximum differentials (equivalent to peak gain) and the corresponding carotid pressures (equivalent to 'set point') were determined. The sham test had no effect on either gain or 'set point'. Inspiratory resistance alone had no effect on blood pressure and did not displace the curve. However, it reduced gain from -3.0 +/- 0.6 to -2.1 +/- 0.4 units (P sleep apnoea.

  16. Atypical patterns in portable monitoring for sleep apnoea: features of nocturnal epilepsy? (United States)

    Parrino, Liborio; Milioli, Giulia; Grassi, Andrea; De Paolis, Fernando; Riccardi, Silvia; Colizzi, Elena; Bosi, Marcello; Terzano, Mario Giovanni


    Atypical cardiorespiratory patterns can be found during routine clinical use of portable monitoring for diagnosis of sleep-disordered breathing (SDB). Over 1,000 consecutive portable recordings were analysed to study the potential ictal nature of stereotyped cardiorespiratory and motor patterns. Snoring, airflow, thoracic effort, pulse rate, body position, oxygen saturation and activity of the anterior tibialis muscles were quantified. Recordings showing stereotyped polygraphic patterns recurring throughout the night, but without the features of sleep apnoea (apnoea/hypopnoea index <5 events·h(-1)), were selected for investigation. Once included in the study, patients underwent attended nocturnal video polysomnography. A total of 15 recordings showing repeated polygraphic patterns characterised by a sequence of microphone activation, respiratory activity atypical for sleep and wakefulness, heart rate acceleration and limb movements, followed by body position change, were selected for investigation. Once included in the study, patients underwent attended nocturnal video polysomnography that showed frontal epileptic discharges triggering periodic electroencephalographic arousals, autonomic activation and stereotyped motor patterns. A diagnosis of nocturnal frontal lobe epilepsy (NFLE) was established for all patients. NFLE should be taken into consideration in patients with stereotyped and recurrent behavioural features during portable monitoring carried out for diagnosis of SDB.

  17. Cholesterol Metabolism and Weight Reduction in Subjects with Mild Obstructive Sleep Apnoea: A Randomised, Controlled Study

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    Maarit Hallikainen


    Full Text Available To evaluate whether parameters of obstructive sleep apnoea (OSA associate with cholesterol metabolism before and after weight reduction, 42 middle-aged overweight subjects with mild OSA were randomised to intensive lifestyle intervention (N=23 or to control group (N=18 with routine lifestyle counselling only. Cholesterol metabolism was evaluated with serum noncholesterol sterol ratios to cholesterol, surrogate markers of cholesterol absorption (cholestanol and plant sterols and synthesis (cholestenol, desmosterol, and lathosterol at baseline and after 1-year intervention. At baseline, arterial oxygen saturation (SaO2 was associated with serum campesterol (P<0.05 and inversely with desmosterol ratios (P<0.001 independently of gender, BMI, and homeostasis model assessment index of insulin resistance (HOMA-IR. Apnoea-hypopnoea index (AHI was not associated with cholesterol metabolism. Weight reduction significantly increased SaO2and serum cholestanol and decreased AHI and serum cholestenol ratios. In the groups combined, the changes in AHI were inversely associated with changes of cholestanol and positively with cholestenol ratios independent of gender and the changes of BMI and HOMA-IR (P<0.05. In conclusion, mild OSA seemed to be associated with cholesterol metabolism independent of BMI and HOMA-IR. Weight reduction increased the markers of cholesterol absorption and decreased those of cholesterol synthesis in the overweight subjects with mild OSA.

  18. Real Time Apnoea Monitoring of Children Using the Microsoft Kinect Sensor: A Pilot Study. (United States)

    Al-Naji, Ali; Gibson, Kim; Lee, Sang-Heon; Chahl, Javaan


    The objective of this study was to design a non-invasive system for the observation of respiratory rates and detection of apnoea using analysis of real time image sequences captured in any given sleep position and under any light conditions (even in dark environments). A Microsoft Kinect sensor was used to visualize the variations in the thorax and abdomen from the respiratory rhythm. These variations were magnified, analyzed and detected at a distance of 2.5 m from the subject. A modified motion magnification system and frame subtraction technique were used to identify breathing movements by detecting rapid motion areas in the magnified frame sequences. The experimental results on a set of video data from five subjects (3 h for each subject) showed that our monitoring system can accurately measure respiratory rate and therefore detect apnoea in infants and young children. The proposed system is feasible, accurate, safe and low computational complexity, making it an efficient alternative for non-contact home sleep monitoring systems and advancing health care applications.

  19. Real Time Apnoea Monitoring of Children Using the Microsoft Kinect Sensor: A Pilot Study (United States)

    Al-Naji, Ali; Gibson, Kim; Lee, Sang-Heon; Chahl, Javaan


    The objective of this study was to design a non-invasive system for the observation of respiratory rates and detection of apnoea using analysis of real time image sequences captured in any given sleep position and under any light conditions (even in dark environments). A Microsoft Kinect sensor was used to visualize the variations in the thorax and abdomen from the respiratory rhythm. These variations were magnified, analyzed and detected at a distance of 2.5 m from the subject. A modified motion magnification system and frame subtraction technique were used to identify breathing movements by detecting rapid motion areas in the magnified frame sequences. The experimental results on a set of video data from five subjects (3 h for each subject) showed that our monitoring system can accurately measure respiratory rate and therefore detect apnoea in infants and young children. The proposed system is feasible, accurate, safe and low computational complexity, making it an efficient alternative for non-contact home sleep monitoring systems and advancing health care applications. PMID:28165382

  20. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health

    Directory of Open Access Journals (Sweden)

    Chamara Visanka Senaratna


    Full Text Available Abstract Background Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors. Methods We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI. Results Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all. Sleep apnoea was significantly associated with older age (p < 0.001, unemployment (p < 0.001, asthma (p = 0.011, chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002, diabetes (p < 0.001, hypercholesterolemia (p < 0.001, hypertension (p < 0.001, heart attack (p < 0.001, heart failure (p < 0.001, angina (p < 0.001, depression (p < 0.001, post-traumatic stress disorder (p

  1. [Stiff baby syndrome is a rare cause of neonatal hypertonicity]. (United States)

    Rønne, Maria Sode; Nielsen, Preben Berg; Mogensen, Christian Backer


    Stiff baby syndrome (hyperekplexia) is a rare genetic disorder. The condition can easily be misdiagnosed as epilepsy or severe sepsis because of hypertonicity and seizure-like episodes and has an increased risk of severe apnoea and sudden infant death. Tapping of the nasal bridge inducing a startle response is the clinical hallmark. We report cases of two sisters born with stiff baby syndrome with hypertonicity, exaggerated startle reaction and cyanosis. The syndrome has a good prognosis if treated with clonazepam and both cases were developmental normal after one year.

  2. Assessment of the calcification of the nuchal ligament and osteophytes of the cervical spine in obstructive sleep apnoea subjects and snorers. (United States)

    Ando, E; Shigeta, Y; Nejima, J; Yamanaka, H; Hirai, S; Ogawa, T; Clark, G T; Enciso, R


    The previous reports suggest that obstructive sleep apnoea (OSA) is related to metabolic syndrome, mineral metabolism disorders and cardiovascular disease. In addition, a possible relationship between obesity and the calcification of ligaments has been implied. However, the potential link between OSA and the calcification of ligaments has not been directly studied. In this present study, to investigate the potential link between OSA and the calcification of ligaments, we examined the prevalence of the calcification of ligaments in OSA patients and the relationship between these findings and OSA severity. Eighty consecutive patients (60 males, 20 females) diagnosed as OSA or a heavy snorer based on full-night polyso-mnography were retrospectively recruited from May 2006 to July 2008. Each patient underwent cephalometric imaging examination before the arrangement of an oral appliance. One calibrated observer (YS) reviewed the cephalometric images for the presence of calcification of the nuchal ligament and osteophytes of the cervical spine. The prevalence of calcification of the nuchal ligament in OSA patients and snorers was 46.3% (males: 52%, females: 30%) There was a significant positive correlation between the severity of OSA (AHI) and the calcification of the nuchal ligament before and after adjusting for BMI. The prevalence of the calcification of the nuchal ligament in OSA subjects and snorers was higher than in previous studies with non-OSA subjects. In addition, it is suggested that the severity of OSA correlates with the presence of calcification of the nuchal ligament.

  3. Obstructive sleep apnoea syndrome and HLA in the North of Portugal. (United States)

    Silva, Luís; Lopes, João; Ramalheira, João; Cunha, Daniela; Carvalho, Cláudia; Bettencourt, Andreia; Bras, Sandra; Costa, Sandra; Silva, M Berta; Martins-da-Silva, António


    Introduccion. El sindrome de apnea obstructiva del sueño (SAOS) es una enfermedad frecuente, compleja y poligenica, con diversas etiologias que interaccionan originando un fenotipo unico. El SAOS puede ocurrir a cualquier edad del individuo y se presume la existencia de agregacion familiar. Han sido descritos diversos factores de predisposicion, como la edad, el sexo y la obesidad. La relacion entre los polimorfismos del antigeno leucocitario humano (HLA) y trastornos del sueño esta confirmada, tanto en poblaciones europeas como no europeas. No obstante, las relaciones descritas entre los alelos HLA y SAOS no han sido coherentes y carecen de valor informativo para la clasificacion del trastorno del sueño. Objetivo. Explorar la asociacion genetica del HLA con el SAOS en una poblacion del norte de Portugal y evaluar el papel de la obesidad en el contexto del HLA en el SAOS. Pacientes y metodos. Se estudio una cohorte de 131 pacientes con SAOS. Los pacientes fueron atendidos en una clinica del sueño ambulatoria donde se valoraron los antecedentes clinicos, se les practico una polisomnografia nocturna, una prueba de latencia multiple del sueño (si lo exigio el diagnostico diferencial), analiticas y estudios demograficos. A efectos comparativos, se utilizo una poblacion de control de 223 personas sanas. Se efectuo el genotipado del HLA-DRB1 con la reaccion en cadena de la polimerasa mediante cebadores de secuencia especifica. Resultados. En esta cohorte, el alelo HLA-DRB1*03 fue identificado como un factor de predisposicion para el SAOS (24% del SAOS frente a 15% de la poblacion de control; p = 0,025; odds ratio = 1,861; intervalo de confianza al 95% = 1,081-3,205). No hubo diferencias significativas en lo referente a otros alelos HLA-DBR1*. Conclusion. El HLA-DRB1*03 es un factor de predisposicion para el SAOS en la poblacion portuguesa.

  4. Drugged Driving (United States)

    ... Parents & Educators Children & Teens Search Connect with NIDA : Google Plus Facebook LinkedIn Twitter YouTube Flickr RSS Menu ... misuse of prescription drugs can make driving a car unsafe—just like driving after drinking alcohol. Drugged ...

  5. Electric drives

    CERN Document Server

    Boldea, Ion


    ENERGY CONVERSION IN ELECTRIC DRIVESElectric Drives: A DefinitionApplication Range of Electric DrivesEnergy Savings Pay Off RapidlyGlobal Energy Savings Through PEC DrivesMotor/Mechanical Load MatchMotion/Time Profile MatchLoad Dynamics and StabilityMultiquadrant OperationPerformance IndexesProblemsELECTRIC MOTORS FOR DRIVESElectric Drives: A Typical ConfigurationElectric Motors for DrivesDC Brush MotorsConventional AC MotorsPower Electronic Converter Dependent MotorsEnergy Conversion in Electric Motors/GeneratorsPOWER ELECTRONIC CONVERTERS (PECs) FOR DRIVESPower Electronic Switches (PESs)The

  6. Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

    DEFF Research Database (Denmark)

    Petersen, Marian Christin; Kristensen, Ellids; Berg, Søren;


    year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used...... the Epworth sleepiness scale (ESS). RESULTS: Response rate was 76%. We found no significant changes in satisfaction with relation to partner or life as a whole, but satisfaction with sexual life (LiSat-11) and both general and functional aspects of sexuality (BSFI) were significantly improved after 1 year......OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1...

  7. Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Steinke, E; Palm Johansen, P; Fridlund, B


    AIMS: Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. METHODS: A systematic......-analysis. RESULTS: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 sexual...... to erectile dysfunction. CONCLUSIONS: The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function....

  8. Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma (United States)

    Taillé, Camille; Rouvel-Tallec, Anny; Stoica, Maria; Danel, Claire; Dehoux, Monique; Marin-Esteban, Viviana; Pretolani, Marina; Aubier, Michel; d’Ortho, Marie-Pia


    Background Obstructive sleep apnoea (OSA) is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA. Materials and Methods An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM) thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies. Results In total, 27/55 patients (49%) had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2±1.6 event/h [5–35]), the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8±0.4 vs. 7.8±0.4 μm, p<0.05). RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05). OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment. Conclusion Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling. PMID:26934051

  9. Comparison of Standard and Novel Signal Analysis Approaches to Obstructive Sleep Apnoea Classification

    Directory of Open Access Journals (Sweden)

    Aoife eRoebuck


    Full Text Available Obstructive sleep apnoea (OSA is a disorder characterised by repeated pauses in breathing during sleep, which leads to deoxygenation and voiced chokes at the end of each episode. OSA is associated by daytime sleepiness and an increased risk of serious conditions such as cardiovascular disease, diabetes and stroke. Between 2-7% of the adult population globally has OSA, but it is estimated that up to 90% of those are undiagnosed and untreated. Diagnosis of OSA requires expensive and cumbersome screening. Audio offers a potential non-contact alternative, particularly with the ubiquity of excellent signal processing on every phone.Previous studies have focused on the classification of snoring and apnoeic chokes. However, such approaches require accurate identification of events. This leads to limited accuracy and small study populations. In this work we propose an alternative approach which uses multiscale entropy (MSE coefficients presented to a classifier to identify disorder in vocal patterns indicative of sleep apnoea. A database of 858 patients was used, the largest reported in this domain. Apnoeic choke, snore, and noise events encoded with speech analysis features were input into a linear classifier. Coefficients of MSE derived from the first 4 hours of each recording were used to train and test a random forest to classify patients as apnoeic or not.Standard speech analysis approaches for event classification achieved an out of sample accuracy (Ac of 76.9% with a sensitivity (Se of 29.2% and a specificity (Sp of 88.7% but high variance. For OSA severity classification, MSE provided an out of sample Ac of 79.9%, Se of 66.0% and Sp = 88.8%. Including demographic information improved the MSE-based classification performance to Ac = 80.5%, Se = 69.2%, Sp = 87.9%. These results indicate that audio recordings could be used in screening for OSA, but are generally under-sensitive.

  10. Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. (United States)

    Grunstein, R R


    CPAP should be considered the first line of treatment in patients with moderate to severe obstructive sleep apnoea. In our centre in Sydney this generally means patients with more than 20 apnoea/hypopnoeas per hour with repeated dips in oxyhaemoglobin saturation and usually some symptomatology. Despite this first line role of nasal CPAP, recent objective studies question whether earlier enthusiastic reports on adherence to CPAP are correct. The role of technical innovations in new CPAP machines in improving usage remains to be tested. The "drop out" rate from physician selection for a CPAP trial to highly compliant user is certainly more than 50% of patients. What happens to these patients? Data from some studies suggest that surgical treatments are used, at least in the USA, but in all probability many of these patients remain untreated. The challenge in the next decade is either to improve CPAP devices to increase usage in this group or to develop other treatment options. The role of intensive inhospital "acclimatisation" to CPAP also has yet to be objectively tested. It is unclear whether "intelligent" CPAP will make huge inroads in increasing the number of patients who accept CPAP trials, prescriptions, or compliance. It will have minimal impact on patients with mask problems or claustrophobia or those who feel that CPAP is inconvenient. There is a high likelihood that it will reduce technologist workload during CPAP titration studies. "Intelligent" CPAP may help to reduce total overnight mouth leakage and therefore reduce nasal side effects. The current expense of developing such devices will mean that they are unlikely to supersede much cheaper standard "one pressure" CPAP machines in the next few years.

  11. Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma.

    Directory of Open Access Journals (Sweden)

    Camille Taillé

    Full Text Available Obstructive sleep apnoea (OSA is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA.An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies.In total, 27/55 patients (49% had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2 ± 1.6 event/h [5-35], the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8 ± 0.4 vs. 7.8 ± 0.4 μm, p<0.05. RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05. OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment.Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling.

  12. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design

    DEFF Research Database (Denmark)

    Petri, N.; Svanholt, P.; Solow, B.;


    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non-adva...... is essential for the effect. MNA has no placebo effect. MAA may be a good alternative to CPAP in subsets of OSA patients Udgivelsesdato: 2008/6...... beneficial effect on the vitality domain of SF-36. Four MAA patients (14.8%) and two MNA patients (8%) discontinued interventions because of adverse effects. Our conclusion is that MAA has significant beneficial effects on OSA, including cure in some cases of severe OSA. Protrusion of the mandible...

  13. The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea

    Directory of Open Access Journals (Sweden)

    Horner Richard L


    Full Text Available Abstract Obstructive sleep apnoea is a common and serious breathing problem that is caused by effects of sleep on pharyngeal muscle tone in individuals with narrow upper airways. There has been increasing focus on delineating the brain mechanisms that modulate pharyngeal muscle activity in the awake and asleep states in order to understand the pathogenesis of obstructive apnoeas and to develop novel neurochemical treatments. Although initial clinical studies have met with only limited success, it is proposed that more rational and realistic approaches may be devised for neurochemical modulation of pharyngeal muscle tone as the relevant neurotransmitters and receptors that are involved in sleep-dependent modulation are identified following basic experiments.

  14. Pile Driving (United States)


    Machine-oriented structural engineering firm TERA, Inc. is engaged in a project to evaluate the reliability of offshore pile driving prediction methods to eventually predict the best pile driving technique for each new offshore oil platform. Phase I Pile driving records of 48 offshore platforms including such information as blow counts, soil composition and pertinent construction details were digitized. In Phase II, pile driving records were statistically compared with current methods of prediction. Result was development of modular software, the CRIPS80 Software Design Analyzer System, that companies can use to evaluate other prediction procedures or other data bases.

  15. Distinct severity stages of obstructive sleep apnoea are correlated with unique dyslipidaemia: large-scale observational study


    Guan, Jian; YI, HONGLIANG; Zou, Jianyin; Meng, Lili; Tang, Xulan; Zhu, Huaming; Yu, Dongzhen; Zhou, Huiqun; Su, Kaiming; Yang, Mingpo; Chen, Haoyan; Shi, Yongyong; Wang, Yue; WANG Jian; YIN, SHANKAI


    Background Dyslipidaemia is an intermediary exacerbation factor for various diseases but the impact of obstructive sleep apnoea (OSA) on dyslipidaemia remains unclear. Methods A total of 3582 subjects with suspected OSA consecutively admitted to our hospital sleep centre were screened and 2983 (2422 with OSA) were included in the Shanghai Sleep Health Study. OSA severity was quantified using the apnoea–hypopnea index (AHI), the oxygen desaturation index and the arousal index. Biochemical indi...

  16. Non-traumatic trans-diaphragmatic intercostal hernia and cor pulmonale in a patient with poorly controlled obstructive sleep apnoea. (United States)

    Mehdi, Syed Basharath; Madi, Salem; Sudworth, Jordan


    Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.

  17. Paternal uniparental disomy 11p15.5 in the pancreatic nodule of an infant with Costello syndrome: Shared mechanism for hyperinsulinemic hypoglycemia in neonates with Costello and Beckwith-Wiedemann syndrome and somatic loss of heterozygosity in Costello syndrome driving clonal expansion. (United States)

    Gripp, Karen W; Robbins, Katherine M; Sheffield, Brandon S; Lee, Anna F; Patel, Millan S; Yip, Stephen; Doyle, Daniel; Stabley, Deborah; Sol-Church, Katia


    Costello syndrome (CS) entails a cancer predisposition and is caused by activating HRAS mutations, typically arising de novo in the paternal germline. Hypoglycemia is common in CS neonates. A previously reported individual with the rare HRAS p.Gln22Lys had hyperinsulinemic hypoglycemia. Autopsy showed a discrete pancreatic nodule. The morphologic and immunohistochemistry findings, including loss of p57(Kip2) protein, were identical to a focal lesion of congenital hyperinsulinism, however, no KCNJ11 or ABCC8 mutation was identified and germline derived DNA showed no alternation of the maternal or paternal 11p15 alleles. Here we report paternal uniparental disomy (pUPD) within the lesion, similar to the pUPD11p15.5 in Beckwith-Wiedemann syndrome (BWS). The similar extent of the pUPD suggests a similar mechanism driving hyperinsulinemia in both conditions. After coincidental somatic LOH and pUPD, the growth promoting effects of the paternally derived HRAS mutation, in combination with the increased function of the adjacent paternally expressed IGF2, may together result in clonal expansion. Although this somatic LOH within pancreatic tissue resulted in hyperinsulinism, similar LOH in mesenchymal cells may drive embryonal rhabdomyosarcoma (ERMS). Interestingly, biallelic IGF2 expression has been linked to rhabdomyosarcoma tumorigenesis and pUPD11 occurred in all 8 ERMS samples from CS individuals. Somatic KRAS and HRAS mutations occur with comparable frequency in isolated malignancies. Yet, the malignancy risk in CS is notably higher than in Noonan syndrome with a KRAS mutation. It is conceivable that HRAS co-localization with IGF2 and the combined effect of pUPD 11p15.5 on both genes contributes to the oncogenic potential.

  18. Metabolic syndrome, diet and exercise. (United States)

    De Sousa, Sunita M C; Norman, Robert J


    Polycystic ovary syndrome (PCOS) is associated with a range of metabolic complications including insulin resistance (IR), obesity, dyslipidaemia, hypertension, obstructive sleep apnoea (OSA) and non-alcoholic fatty liver disease. These compound risks result in a high prevalence of metabolic syndrome and possibly increased cardiovascular (CV) disease. As the cardiometabolic risk of PCOS is shared amongst the different diagnostic systems, all women with PCOS should undergo metabolic surveillance though the precise approach differs between guidelines. Lifestyle interventions consisting of increased physical activity and caloric restriction have been shown to improve both metabolic and reproductive outcomes. Pharmacotherapy and bariatric surgery may be considered in resistant metabolic disease. Issues requiring further research include the natural history of PCOS-associated metabolic disease, absolute CV risk and comparative efficacy of lifestyle interventions.

  19. Effects of a Pragmatic Lifestyle Intervention for Reducing Body Mass in Obese Adults with Obstructive Sleep Apnoea: A Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    James Moss


    Full Text Available This study investigated the effects of a pragmatic lifestyle intervention in obese adults with continuous positive airway pressure-treated obstructive sleep apnoea hypopnoea syndrome (OSAHS. Sixty patients were randomised 1 : 1 to either a 12-week lifestyle intervention or an advice-only control group. The intervention involved supervised exercise sessions, dietary advice, and the promotion of lifestyle behaviour change using cognitive-behavioural techniques. Outcomes were assessed at baseline (week 0, intervention end-point (week 13, and follow-up (week 26. The primary outcome was 13-week change in body mass. Secondary outcomes included anthropometry, blood-borne biomarkers, exercise capacity, and health-related quality of life. At end-point, the intervention group exhibited small reductions in body mass (−1.8 [−3.0, −0.5] kg; P=0.007 and body fat percentage (−1 [−2, 0]%; P=0.044 and moderate improvements in C-reactive protein (−1.3 [−2.4, −0.2] mg·L−1; P=0.028 and exercise capacity (95 [50, 139] m; P<0.001. At follow-up, changes in body mass (−2.0 [−3.5, −0.5] kg; P=0.010, body fat percentage (−1 [−2, 0]%; P=0.033, and C-reactive protein (−1.3 [−2.5, −0.1] mg·L−1; P=0.037 were maintained and exercise capacity was further improved (132 [90, 175] m; P<0.001. This trial is registered with NCT01546792.


    Institute of Scientific and Technical Information of China (English)


    China is promoting environmentally friendly cars to save energy and protect the environment While people enjoy the pleasure and convenience of driving, they are also creating and breathing more and more toxic

  1. Distracted Driving (United States)

    ... What's this? Submit What's this? Submit Button Distracted Driving Recommend on Facebook Tweet Share Compartir Each day in the United States, over 8 people are killed and 1,161 injured in crashes ...

  2. Stiff baby syndrome er en sjælden årsag til neonatal hypertonicitet

    DEFF Research Database (Denmark)

    Rønne, Maria Sode; Nielsen, Preben Berg; Mogensen, Christian Backer


    Stiff baby syndrome (hyperekplexia) is a rare genetic disorder. The condition can easily be misdiagnosed as epilepsy or severe sepsis because of hypertonicity and seizure-like episodes and has an increased risk of severe apnoea and sudden infant death. Tapping of the nasal bridge inducing a startle...... response is the clinical hallmark. We report cases of two sisters born with stiff baby syndrome with hypertonicity, exaggerated startle reaction and cyanosis. The syndrome has a good prognosis if treated with clonazepam and both cases were developmental normal after one year....

  3. Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea. (United States)

    Hybášková, Jaroslava; Jor, Ondřej; Novák, Vilém; Zeleník, Karol; Matoušek, Petr; Komínek, Pavel


    The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n = 17, 33.3%), followed by palatal and oropharyngeal collapse (n = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

  4. Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

    Directory of Open Access Journals (Sweden)

    Jaroslava Hybášková


    Full Text Available The present study evaluated whether drug-induced sleep endoscopy (DISE helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA. A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%. The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%, followed by palatal and oropharyngeal collapse (n=12, 23.5%. Pathology of the larynx (epiglottis was observed in 16 patients (31.4%. The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3% patients. After DISE, the surgical plan was changed in 31 patients (60.8%. The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

  5. Modafinil/armodafinil in obstructive sleep apnoea: a systematic review and meta-analysis. (United States)

    Chapman, Julia L; Vakulin, Andrew; Hedner, Jan; Yee, Brendon J; Marshall, Nathaniel S


    Modafinil is used internationally to treat residual sleepiness despite continuous positive airway pressure in obstructive sleep apnoea (res-OSA). In 2011, the European Medicines Agency removed the indication based on an unfavourable risk-benefit profile in two trials for efficacy and all accumulated safety data. We performed a meta-analysis of all randomised controlled trials of modafinil (or armodafinil) in res-OSA to quantify efficacy and safety.We systematically searched and assessed studies from major databases, conferences and trials registries to find randomised, placebo-controlled trials of modafinil/armodafinil for ≥2 weeks in adult res-OSA treating sleepiness.We analysed 10 of the 232 articles identified that met inclusion criteria (1466 patients). Modafinil/armodafinil improved the Epworth Sleepiness Scale score (2.2 points, 95% CI 1.5-2.9) and the Maintenance of Wakefulness Test over placebo (3 min, 95% CI 2.1-3.8 min). Modafinil/armodafinil tripled adverse events and doubled adverse events leading to withdrawal but did not increase serious adverse events (hospitalisations or death).Modafinil and armodafinil improve subjective and objective daytime sleepiness in res-OSA. We believe our analysis is a fairer analysis of the risk-benefit profile of this indication. Clinicians may want to use this data to balance the risks and benefits on a case-by-case basis with their patients.

  6. Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea (United States)

    Jor, Ondřej; Novák, Vilém; Matoušek, Petr


    The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n = 17, 33.3%), followed by palatal and oropharyngeal collapse (n = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA. PMID:28070516

  7. A manic episode after CPAP in a patient with obstructive sleep apnoea

    Directory of Open Access Journals (Sweden)

    Margarida Lobo


    Full Text Available Obstructive slee apnoea (OSA is a common sleep disorder. It has been recognized a link between OSA and depression , which is most of the times resistant to treatment. Other aspects of OSA are metabolic: insulin resistance, hypertension and obesity. A common treatment for OSA is Continuous Positive Airway Pressure (CPAP. This treatment may reverse the cognitive and affective dysfunction but in some cases with residual impairment. The author reports a case of a 48 years old man with family history of bipolar disorder but no past history of psychiatric disorders. A diagnosis of OSA led to the use of CPAP. Ten days later he started hypomanic symptoms and 15 days later he was strongly manic. He was hospitalized and treated with olanzapine, lorazepam and divalproate. CPAP treatment was interrupted. After recovery the patient became depressed and, since then, although he doesn't meet the criteria for major depression, depressive symptoms persisted even with olanzapine and lamotrigibne. Meanwhile he was diagnosed with diabettes mellitus 2 and olanzapine was discontinued and he was put on ziprasidone. The author discusses the contribution of the OSA and treatment with CPAC to the appearance and maintenance of the affective disorder in a patient with family susceptibility. The discussion also includes the metabolic aspects of OSA that can be worsened with the medication to control the affective disorder.

  8. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. (United States)

    Isono, Shiroh


    Epidemiological evidence suggests there are significant links between obesity and obstructive sleep apnoea (OSA), with a particular emphasis on the importance of fat distribution in the development of OSA. In patients with OSA, the structure of the pharyngeal airway collapses. A collapsible tube within a rigid box collapses either due to decreased intraluminal pressure or increased external tissue pressure (i.e. reduction in transmural pressure), or due to reduction in the longitudinal tension of the tube. Accordingly, obesity should structurally increase the collapsibility of the pharyngeal airway due to excessive fat deposition at two distinct locations. In the pharyngeal airway region, excessive soft tissue for a given maxillomandibular enclosure size (upper airway anatomical imbalance) can increase tissue pressure surrounding the pharyngeal airway, thereby narrowing the airway. Even mild obesity may cause anatomical imbalance in individuals with a small maxilla and mandible. Lung volume reduction due to excessive central fat deposition may decrease longitudinal tracheal traction forces and pharyngeal wall tension, changing the 'tube law' in the pharyngeal airway (lung volume dependence of the upper airway). The lung volume dependence of pharyngeal airway patency appears to contribute more significantly to the development of OSA in morbidly obese, apnoeic patients. Neurostructural interactions required for stable breathing may be influenced by obesity-related hormones and cytokines. Accumulating evidence strongly supports these speculations, but further intensive research is needed.

  9. The clinical diagnosis of the narcoleptic syndrome. (United States)

    Parkes, J D; Chen, S Y; Clift, S J; Dahlitz, M J; Dunn, G


    Sleep-wake habits and control of postural muscle tone were investigated by self-report questionnaire in 183 subjects considered to have the narcoleptic syndrome, 62 subjects with hypersomnia and 10 with obstructive sleep apnoea. Results were compared with those in a group of 188 control subjects with normal sleep wake habits. Excessive daytime sleepiness, determined by the Epworth Sleepiness Scale (ESS), was five times greater in the narcoleptic syndrome than in control subjects (score range 0-24, mean scores +/-SD 19.6+/-3.0; and 4.5+/-3.3 respectively; Ppostural tone in response to sudden emotional stimuli, including laughter, was 10 times greater in narcoleptic syndrome than in control subjects (postural atonia total score range 0-600; mean + SD 334+/-122 and 28+/-45, respectively; Ppostural atonia scores were similar to those of control subjects.

  10. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device

    DEFF Research Database (Denmark)

    Knappe, S W; Bakke, M; Svanholt, P


    Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to inv......Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim...

  11. [Polycystic ovary syndrome]. (United States)

    Vrbíková, Jana


    For diagnosing of polycystic ovary syndrome (PCOS) it is currently recommended to follow the ESHRE criteria. For diagnosis according to them two of the following three symptoms are sufficient: 1. morphology of polycystic ovaria, 2. clinical manifestations of hyperandrogenism or laboratory proof of hyperandrogenemia, and 3. oligo-anovulation. PCOS is a complex disorder in whose pathogenesis genetic and environmental effects interact. It is not a gynecological disorder alone, the syndrome is accompanied by insulin resistance which leads to increased incidence of type 2 diabetes mellitus and impaired glucose tolerance (4 times and twice, independently of BMI). Also gestational DM occurs more frequently. Dyslipidemia, arterial hypertension, elevated CRP and homocysteine levels, endothelial dysfunction and greater intima-media thickness are also more frequent. It is not quite clear, however, whether women with PCOS suffer cardiovascular events more frequently as well. More often than is accidental PCOS is associated with depression, anxiety and eating disorders, further with nonalcoholic steatohepatitis and with the sleep apnoea syndrome - especially in obese women. Therapeutic measures include non-pharmacological methods - lifestyle adjustments focused on weight reduction in obese individuals, cosmetic measures for dermatologic manifestation of hyperandrogenism, in particular laser and pharmacotherapy (combined hormonal contraceptives and antiandrogens). Menstrual irregularities can be treated with contraceptives or cyclical administration of gestagens, also metformin can be used.

  12. Death Drive


    Stühler, Rebekka Hellstrøm


    The aim of this project is to investigate why the Freudian term Death Drive is not acknowledged in modern psychological therapy. On basis of psychoanalytical theory and through a literary analysis, the project will present a discussion of the significance and presence of the term within these practises.

  13. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care (United States)

    The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for th...

  14. Relationships between polysomnographic variables, parameters of glucose metabolism, and serum androgens in obese adolescents with polycystic ovarian syndrome. (United States)

    de Sousa, Gideon; Schlüter, Bernhard; Menke, Thomas; Trowitzsch, Eckardt; Andler, Werner; Reinehr, Thomas


    The aim of this study was to compare polysomnographic variables of obese adolescents with polycystic ovarian syndrome (PCOS) to those of healthy controls and to analyse whether polysomnographic variables correlate to parameters of body weight/body composition, to serum androgens and to parameters of glucose metabolism. Thirty-one obese adolescents with PCOS (15.0 years ± 1.0, body mass index 32.7 kg per m(2) ± 6.2) and 19 healthy obese adolescents without PCOS (15.2 years ± 1.1, body mass index 32.4 kg per m(2) ± 4.0) underwent polysomnography to compare apnoea index, hypopnoea index, apnoea-hypopnoea index, the absolute number of obstructive apnoeas, percentage sleep Stages 1, 2, 3 and 4 of non-rapid eye movement (NREM) sleep, percentage of REM sleep, TIB, total sleep time (TST), sleep-onset latency, total wake time (TWT), wakefulness after sleep onset (WASO) and sleep efficiency. Furthermore, we correlated polysomnographic variables to parameters of body weight/body composition, to serum androgens and to parameters of glucose metabolism. We found no differences between the two groups concerning the respiratory indices, percentage sleep Stages 2, 3 and 4 of NREM sleep, TIB and sleep-onset latency. The girls with PCOS differed significantly from the controls regarding TST, WASO, TWT, sleep efficiency, percentage Stage 1 of NREM sleep and percentage of REM sleep. We found a weak significant correlation between insulin resistance and apnoea index and between insulin resistance and apnoea-hypopnoea index. Concerning the respiratory variables, adolescents with PCOS do not seem to differ from healthy controls; however, there seem to be differences concerning sleep architecture.

  15. Cervical vertebral column morphology in patients with obstructive sleep apnoea assessed using lateral cephalograms and cone beam CT. A comparative study

    DEFF Research Database (Denmark)

    Sonnesen, L; Jensen, K E; Petersson, A R;


    OBJECTIVES: Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone b...

  16. Sleep apnoea and the hypothalamic-pituitary-adrenal axis in men and women: effects of continuous positive airway pressure. (United States)

    Kritikou, Ilia; Basta, Maria; Vgontzas, Alexandros N; Pejovic, Slobodanka; Fernandez-Mendoza, Julio; Liao, Duanping; Bixler, Edward O; Gaines, Jordan; Chrousos, George P


    Previous findings on the association of obstructive sleep apnoea (OSA) and the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, partly due to the confounding effect of obesity and infrequent sampling. Our goal was to examine whether in a relatively nonobese population, OSA is associated with elevated cortisol levels and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (sham-CPAP) use.72 subjects (35 middle-aged males and post-menopausal females with OSA, and 37 male and female controls) were studied in the sleep laboratory for four nights. 24-h blood sampling was performed every hour on the fourth day and night in the sleep laboratory at baseline, after sham-CPAP and after CPAP treatment.In both apnoeic men and women, OSA was associated with significantly higher 24-h cortisol levels compared with controls, whereas CPAP lowered cortisol levels significantly, close to those of controls.These results suggest that OSA in nonobese men and slightly obese women is associated with HPA axis activation, similar albeit stronger compared with obese individuals with sleep apnoea. Short-term CPAP use decreased cortisol levels significantly compared with baseline, indicating that CPAP may have a protective effect against comorbidities frequently associated with chronic activation of the HPA axis, e.g. hypertension.

  17. Joubert syndrome: large clinical variability and a unique neuroimaging aspect

    Energy Technology Data Exchange (ETDEWEB)

    Leao, Emilia Katiane Embirucu; Lima, Marcilia Martyn; Kok, Fernando; Parizotto, Juliana [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Clinical Hospital. Dept. of Child Neurology; Maia Junior, Otacilio de Oliveira [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Clinical Hospital. Dept. of Child Ophthalmology


    Joubert syndrome (JS) is an autosomal recessive inherited disorder characterized by hypotonia, cerebellar vermis hypoplasia, ocular abnormalities (e.g. pigmentary retinopathy, oculomotor apraxia and nystagmus), renal cysts and hepatic fibrosis. Respiratory abnormalities, as apnoea and hyperpnoea, may be present, as well as mental retardation. At least seven JS loci have been determined and five genes identified. Herein, we report five children, belonging to independent families, with JS: they shared the same typical MRI abnormality, known as molar tooth sign, but had an otherwise quite variable phenotype, regarding mostly their cognitive performance, visual abilities and extra-neurological compromise. (author)

  18. Effects of maternal obstructive sleep apnoea on fetal growth: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Alison M Fung

    Full Text Available OBJECTIVE: The objective of this study is to determine whether obstructive sleep apnea (OSA is associated with reduced fetal growth, and whether nocturnal oxygen desaturation precipitates acute fetal heart rate changes. STUDY DESIGN: We performed a prospective observational study, screening 371 women in the second trimester for OSA symptoms. 41 subsequently underwent overnight sleep studies to diagnose OSA. Third trimester fetal growth was assessed using ultrasound. Fetal heart rate monitoring accompanied the sleep study. Cord blood was taken at delivery, to measure key regulators of fetal growth. RESULTS: Of 371 women screened, 108 (29% were high risk for OSA. 26 high risk and 15 low risk women completed the longitudinal study; 14 had confirmed OSA (cases, and 27 were controls. The median (interquartile range respiratory disturbance index (number of apnoeas, hypopnoeas or respiratory related arousals/hour of sleep was 7.9 (6.1-13.8 for cases and 2.2 (1.3-3.5 for controls (p<0.001. Impaired fetal growth was observed in 43% (6/14 of cases, vs 11% (3/27 of controls (RR 2.67; 1.25-5.7; p = 0.04. Using logistic regression, only OSA (OR 6; 1.2-29.7, p = 0.03 and body mass index (OR 2.52; 1.09-5.80, p = 0.03 were significantly associated with impaired fetal growth. After adjusting for body mass index on multivariate analysis, the association between OSA and impaired fetal growth was not appreciably altered (OR 5.3; 0.93-30.34, p = 0.06, although just failed to achieve statistical significance. Prolonged fetal heart rate decelerations accompanied nocturnal oxygen desaturation in one fetus, subsequently found to be severely growth restricted. Fetal growth regulators showed changes in the expected direction- with IGF-1 lower, and IGFBP-1 and IGFBP-2 higher- in the cord blood of infants of cases vs controls, although were not significantly different. CONCLUSION: OSA may be associated with reduced fetal growth in late pregnancy. Further

  19. Effect of Maximal Apnoea Easy-Going and Struggle Phases on Subarachnoid Width and Pial Artery Pulsation in Elite Breath-Hold Divers.

    Directory of Open Access Journals (Sweden)

    Pawel J Winklewski

    Full Text Available The aim of the study was to assess changes in subarachnoid space width (sas-TQ, the marker of intracranial pressure (ICP, pial artery pulsation (cc-TQ and cardiac contribution to blood pressure (BP, cerebral blood flow velocity (CBFV and cc-TQ oscillations throughout the maximal breath hold in elite apnoea divers. Non-invasive assessment of sas-TQ and cc-TQ became possible due to recently developed method based on infrared radiation, called near-infrared transillumination/backscattering sounding (NIR-T/BSS.The experimental group consisted of seven breath-hold divers (six men. During testing, each participant performed a single maximal end-inspiratory breath hold. Apnoea consisted of the easy-going and struggle phases (characterised by involuntary breathing movements (IBMs. Heart rate (HR was determined using a standard ECG. BP was assessed using the photoplethysmography method. SaO2 was monitored continuously with pulse oximetry. A pneumatic chest belt was used to register thoracic and abdominal movements. Cerebral blood flow velocity (CBFV was estimated by a 2-MHz transcranial Doppler ultrasonic probe. sas-TQ and cc-TQ were measured using NIR-T/BSS. Wavelet transform analysis was performed to assess cardiac contribution to BP, CBFV and cc-TQ oscillations.Mean BP and CBFV increased compared to baseline at the end of the easy phase and were further augmented by IBMs. cc-TQ increased compared to baseline at the end of the easy phase and remained stable during the IBMs. HR did not change significantly throughout the apnoea, although a trend toward a decrease during the easy phase and recovery during the IBMs was visible. Amplitudes of BP, CBFV and cc-TQ were augmented. sas-TQ and SaO2 decreased at the easy phase of apnoea and further decreased during the IBMs.Apnoea increases intracranial pressure and pial artery pulsation. Pial artery pulsation seems to be stabilised by the IBMs. Cardiac contribution to BP, CBFV and cc-TQ oscillations does not

  20. Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon;


    Summary BACKGROUND/OBJECTIVES: The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea...... patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test......, t-test, and multiple regression analysis. RESULTS: Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P

  1. Effect of preoperative continuous positive airway pressure duration on outcomes after maxillofacial surgery for obstructive sleep apnoea. (United States)

    Islam, Shofiq; Taylor, Christopher; Ormiston, Ian W


    Continuous positive airway pressure (CPAP) remains the first-line treatment for obstructive sleep apnoea (OSA), and is known to result in various physiological changes. The objective of this study was to evaluate the association between duration of preoperative CPAP therapy and outcome after maxillomandibular advancement (MMA) for OSA. We retrospectively analysed consecutive patients treated at our institution, and divided them into 2 groups based on duration of treatment with CPAP: short-term (up to 12 months) and long-term use (12 months or more). We controlled for baseline demographic and clinical characteristics. We compared postoperative scores for the apnoea/hypopnoea index (AHI) and the Epworth sleepiness scale (ESS), and lowest recorded oxygen saturation between groups. In 43 patients data were available on the preoperative use of CPAP, and in 37 of them preoperative and postoperative polysomnographic data were also available for inclusion. Most had bimaxillary advancement with genioplasty. Differences between the groups in mean reduction in the AHI and lowest oxygen saturation were not significant, and operative success rates were comparable. After operation, the reduction in ESS scores was significantly greater in the long-term group than in the short-term group (mean (SD) 8(3) compared with 2 (2), respectively, p<0.001). Our results suggest that the duration of use of CPAP preoperatively does not significantly influence objective outcome measures. The reduction in AHI scores after MMA was equivalent in both groups. The long-term group seemed to fare better than the short-term group on subjective outcome measures.

  2. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea: A systematic review and meta-analysis. (United States)

    Schwarz, Esther I; Puhan, Milo A; Schlatzer, Christian; Stradling, John R; Kohler, Malcolm


    Obstructive sleep apnoea (OSA) is a prevalent sleep-related breathing disorder associated with adverse cardiovascular outcome. Endothelial dysfunction is one of the proposed mechanistic links between OSA and the increased cardiovascular risk. Treatment with continuous positive airway pressure (CPAP) may reverse this detrimental pathophysiological consequence of OSA. Most studies on the effect of CPAP on endothelial function in OSA are limited by their low sample size. The objective of this systematic review was to assess the effect CPAP therapy on endothelial function in patients with OSA. We conducted a systematic review and meta-analysis searching literature databases up to August 2013 for randomized controlled trials (RCTs) on the effect of CPAP on endothelial function in OSA, assessed by flow-mediated dilatation (FMD) and other validated techniques. The primary outcome for the meta-analysis (DerSimonian/Laird random-effects method) was the treatment effect on FMD. Eight RCTs comparing the effects of therapeutic CPAP versus subtherapeutic CPAP (or no intervention) on endothelial function involving 245 OSA patients were included in the systematic review. The studies are consistent in effect direction, showing an improvement of endothelial function by CPAP. Four RCTs involving 150 patients could be used for the meta-analysis. Compared to the control group, CPAP therapy (range 2-24 weeks) significantly increased absolute % FMD by 3.87% (95% confidence interval: 1.93-5.80, P CPAP therapy improves endothelial function significantly and to a clinically important extent.

  3. The effectiveness of oral appliances in elderly patients with obstructive sleep apnoea treated with lorazepam--a pilot study. (United States)

    Tihacek-Sojic, L; Andjelkovic, M; Milic-Lemic, A; Milosevic, B


    Obstructive sleep apnoea (OSA) is one of the most common sleep disorders in elderly and represents a special problem for elderly patients. Elderly patients use a large number of drugs that might have an influence on the upper airway structure, anxiolytics or benzodiazepines being the most common. The aim of this study was to examine the effectiveness of mild or moderate OSA treatment with mandibular advance oral appliance in older lorazepam users compared with the age-matched lorazepam-free patients. A total of 40 functionally independent patients with the age of 65-74 were enrolled in the study. All included patients were found to suffer from at least two of the existing OSA symptoms (snoring, sleep fragmentation, daytime sleepiness) and were diagnosed with mild or moderate OSA after nocturnal polysomnography. Patients were divided into two groups. The experimental group consisted of 20 patients who used lorazepam in their daily therapy, and a control group consisted of 20 patients who did not take lorazepam. A mandibular advance appliance was made individually for each patient. Patients involved in the study were not overweight and were suggested to practise sleeping on the side and reduce alcohol consumption during the study. The study has shown that mandibular advance oral appliances were responsible for complete control of the OSA in over 37% of cases (15 patients). Patients have also reported substantial improvement in the symptoms; 80% of them reported that they had snored less, slept better (94%) and have not experienced daytime sleepiness (100%).


    Directory of Open Access Journals (Sweden)

    Piotr FOLĘGA


    Full Text Available The variety of types and sizes currently in production harmonic drive is a problem in their rational choice. Properly selected harmonic drive must meet certain requirements during operation, and achieve the anticipated service life. The paper discusses the problems associated with the selection of the harmonic drive. It also presents the algorithm correct choice of harmonic drive. The main objective of this study was to develop a computer program that allows the correct choice of harmonic drive by developed algorithm.

  5. Distractions in Everyday Driving (United States)

    ... and more states banning handheld phone usage and texting while driving, and new technologies being developed to lock keypads ... made about texting. And you’re right, because texting while driving combines all three types of these distractions. When ...

  6. Driving After a Stroke (United States)

    ... Inspirational Stories Stroke Heroes Among Us Driving After Stroke Updated:Jul 23,2015 Can I drive after ... more tips for daily living . Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, ...

  7. Dementia and driving (United States)

    ... this page: // Dementia and driving To use the sharing features on ... please enable JavaScript. If your loved one has dementia , deciding when they can no longer drive may ...

  8. Non-invasive ventilation for sleep-disordered breathing in Smith-Magenis syndrome. (United States)

    Connor, Victoria; Zhao, Sizheng; Angus, Robert


    Smith-Magenis syndrome (SMS) is a rare genetic neurodevelopmental disorder characterised by behavioural disturbances, intellectual disability and early onset obesity. The physical features of this syndrome are well characterised; however, behavioural features, such as sleep disturbance, are less well understood and difficult to manage. Sleep issues in SMS are likely due to a combination of disturbed melatonin cycle, facial anatomy and obesity-related ventilatory problems. Sleep disorders can be very distressing to patients and their families, as exemplified by our patient's experience, and can worsen behavioural issues as well as general health. This case demonstrates the successful use of non-invasive ventilation in treating underlying obesity hypoventilation syndrome and obstructive sleep apnoea. As a consequence of addressing abnormalities in sleep patterns, some behavioural problems improved.

  9. Gear bearing drive (United States)

    Weinberg, Brian (Inventor); Mavroidis, Constantinos (Inventor); Vranish, John M. (Inventor)


    A gear bearing drive provides a compact mechanism that operates as an actuator providing torque and as a joint providing support. The drive includes a gear arrangement integrating an external rotor DC motor within a sun gear. Locking surfaces maintain the components of the drive in alignment and provide support for axial loads and moments. The gear bearing drive has a variety of applications, including as a joint in robotic arms and prosthetic limbs.

  10. Interaction of chemoreceptor and baroreceptor reflexes by hypoxia and hypercapnia - a mechanism for promoting hypertension in obstructive sleep apnoea. (United States)

    Cooper, V L; Pearson, S B; Bowker, C M; Elliott, M W; Hainsworth, R


    Asphyxia, which occurs during obstructive sleep apnoeic events, alters the baroreceptor reflex and this may lead to hypertension. We have recently reported that breathing an asphyxic gas resets the baroreceptor-vascular resistance reflex towards higher pressures. The present study was designed to determine whether this effect was caused by the reduced oxygen tension, which affects mainly peripheral chemoreceptors, or by the increased carbon dioxide, which acts mainly on central chemoreceptors. We studied 11 healthy volunteer subjects aged between 20 and 55 years old (6 male). The stimulus to the carotid baroreceptors was changed using graded pressures of -40 to +60 mmHg applied to a neck chamber. Responses of vascular resistance were assessed in the forearm from changes in blood pressure (Finapres) divided by brachial blood flow velocity (Doppler) and cardiac responses from the changes in RR interval and heart rate. Stimulus-response curves were defined during (i) air breathing, (ii) hypoxia (12% O(2) in N(2)), and (iii) hypercapnia (5% CO(2) in 95% O(2)). Responses during air breathing were assessed both prior to and after either hypoxia or hypercapnia. We applied a sigmoid function or third order polynomial to the curves and determined the maximal differential (equivalent to peak sensitivity) and the corresponding carotid sinus pressure (equivalent to 'set point'). Hypoxia resulted in an increase in heart rate but no significant change in mean blood pressure or vascular resistance. However, there was an increase in vascular resistance in the post-stimulus period. Hypoxia had no significant effect on baroreflex sensitivity or 'set point' for the control of RR interval, heart rate or mean arterial pressure. Peak sensitivity of the vascular resistance response to baroreceptor stimulation was significantly reduced from -2.5 +/- 0.4 units to -1.4 +/- 0.1 units (P sleep apnoea.

  11. High performance AC drives

    CERN Document Server

    Ahmad, Mukhtar


    This book presents a comprehensive view of high performance ac drives. It may be considered as both a text book for graduate students and as an up-to-date monograph. It may also be used by R & D professionals involved in the improvement of performance of drives in the industries. The book will also be beneficial to the researchers pursuing work on multiphase drives as well as sensorless and direct torque control of electric drives since up-to date references in these topics are provided. It will also provide few examples of modeling, analysis and control of electric drives using MATLAB/SIMULIN

  12. Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men

    Directory of Open Access Journals (Sweden)

    Yingting Cao


    Full Text Available Background: macronutrient intake has been found to affect sleep parameters including obstructive sleep apnoea (OSA in experimental studies, but there is uncertainty at the population level in adults. Methods: cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort (n = 784, age 35–80 years. Dietary intake was measured by a validated food frequency questionnaire. Self-reported poor sleep quality and daytime sleepiness were measured by questionnaires. Overnight in-home polysomnography (PSG was conducted among participants with without previously diagnosed OSA. Results: after adjusting for demographic, lifestyle factors, and chronic diseases, the highest quartile of fat intake was positively associated with excessive daytime sleepiness (relative risk ratio (RRR = 1.78, 95% CI 1.10, 2.89 and apnoea-hypopnoea index (AHI ≥20, (RRR = 2.98, 95% CI 1.20–7.38. Body mass index mediated the association between fat intake and AHI (30%, but not daytime sleepiness. There were no associations between other intake of macronutrient and sleep outcomes. Conclusion: high fat is associated with daytime sleepiness and AHI. Sleep outcomes are generally not assessed in studies investigating the effects of varying macronutrient diets on weight loss. The current result highlights the potential public health significance of doing so.

  13. Use of an individual mandibular advancement device for an?obstructive sleep apnoea patient with facial paralysis: a short-term follow-up case report. (United States)

    Pişkin, B; Sipahi, C; Köse, M; Karakoç, Ö; Şevketbeyoğlu, H; Ataç, G K


    This case report aimed to describe the fabrication procedure and treatment efficacy of an individual, one-piece, non-adjustable mandibular advancement device (MAD) for a moderate obstructive sleep apnoea patient with facial paralysis (FP). Mandibular advancement device was fabricated with autopolymerising acrylic resin. The intermaxillary relations were recorded such as to fix the mandible at a protruded position with increased vertical dimension. Initial evaluation of the MAD was made with axial magnetic resonance imaging and polysomnography on the first day of usage. Following evaluations were made on the third and sixth month. After a follow-up period of 6 months, Apnoea/Hypopnea Index (AHI) significantly decreased from 26·7 to 3·0. However, the average oxygen saturation did not improve as expected initially. The MAD therapy decreased the AHI scores of a patient with FP. At the end of a follow-up period of 6 months, the patient did not report any serious complaint except temporary tooth pains.

  14. Shaken baby syndrome; Shaken-baby-Syndrom

    Energy Technology Data Exchange (ETDEWEB)

    Reith, W.; Ahlhelm, F.; Papanagiotou, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Rohrer, T. [Universitaetsklinikum des Saarlandes, Klinik fuer Allgemeine Paediatrie und Neonatologie, Homburg/Saar (Germany)


    Shaken baby syndrome (SBS) describes the coincidence of subdural hematoma, retinal bleeding and, disadvantageous for the prognosis, diffuse brain damage caused by powerful shaking of the infant. The clinical symptoms include irritability, difficulty with drinking, somnolence, apathy, cerebral cramp attacks, apnoea, temperature regulation disorders and vomiting due to cranial pressure. Milder symptoms of SBS are often not diagnosed and the number of unregistered cases is probably much greater. The diagnosis of SBS is made through the typical symptom constellation, but the lack of retinal bleeding does not exclude the diagnosis. Normally the infants are held by the thorax or upper arms and shaken in a sagittal direction during which the head falls backwards and forwards and is stopped abruptly at each extreme position. The injurious mechanism is considered to be caused by rotational forces which force tissue layers in the brain against each other and also lead to rupture of bridging veins between the skull and the brain. The prognosis is poor and approximately 25% of infants die of SBS within days or weeks. Approximately 75% of survivors suffer from long term damage with physical handicaps, limitations in hearing, visual disturbances up to blindness and mental disorders or combinations of these conditions. Prevention is therefore the most important aspect. (orig.) [German] Das Shaken-baby-Syndrom (SBS) oder Schuetteltrauma des Saeuglings beschreibt die Koinzidenz subduraler Haematome, retinaler Blutungen und prognostisch unguenstiger, diffuser Hirnschaeden durch heftiges Schuetteln eines Saeuglings. Die klinischen Symptome umfassen Irritabilitaet, Trinkschwierigkeiten, Somnolenz, Apathie, zerebrale Krampfanfaelle, Apnoe, Temperaturregulationsstoerungen und Erbrechen durch Hirndruck. Leichtere Symptome des SBS werden haeufig nicht diagnostiziert, die Dunkelziffer ist wahrscheinlich viel hoeher. Die Diagnose des SBS wird durch die typische Symptomkonstellation gestellt

  15. [Assessment of driving in patients with vertigo and dizziness]. (United States)

    von Brevern, M; von Stuckrad-Barre, S; Fetter, M


    The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.

  16. Lectures on magnetohydrodynamical drives (United States)

    Loigom, Villem

    The paper deals with nonconventional types of electrical machines and drives - magnetohydrodynamical (MHD) machines and drives. In cardinal it is based on the research conducted with participation of the author in Tallinn Technical University at the Institute of Electrical Drives and Power Electronics, where the use of magnetohydrodynamical motors and drives in the metallurgical and casting industries have been studied for a long time. Major research interests include the qualities and applications of the induction MHD-drives for set in the motion (pumping, turning, dosing, mixing, etc.) non-ferrous molten metals like Al, Mg, Sn, Pb, Na, K, and their alloys. The first part of the paper describes induction MHD motors and their electrohydraulical qualities. In the second part energy conversion problems are described. Also, on the basis of the analogy between electromechanical and electrohydraulical phenomenas, static and dynamic qualities of MHD drives with induction MHD machines are discussed.

  17. The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study (United States)

    Al Ali, Ala; Richmond, Stephen; Popat, Hashmat; Playle, Rebecca; Pickles, Timothy; Zhurov, Alexei I; Marshall, David; Rosin, Paul L; Henderson, John; Bonuck, Karen


    Objective To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children. Design Observational longitudinal cohort study Setting Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England. Participants Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents’ report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy. Main outcome measures Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences. Results Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI −0.52 to −0.05); a decrease in mandibular prominence of 0.9° (95% CI −1.30 to −0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI −0.10 to −0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence. Conclusions The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of

  18. Universal Drive Train Facility (United States)

    Federal Laboratory Consortium — This vehicle drive train research facility is capable of evaluating helicopter and ground vehicle power transmission technologies in a system level environment. The...

  19. Dumping Syndrome (United States)

    ... System & How it Works Digestive Diseases A-Z Dumping Syndrome What is dumping syndrome? Dumping syndrome occurs when food, especially sugar, ... the colon and rectum—and anus. What causes dumping syndrome? Dumping syndrome is caused by problems with ...

  20. Electric Vehicle - Economical driving

    DEFF Research Database (Denmark)

    Jensen, VCE, Steen V.; Schøn, Henriette


    How do you reduce the energy-wast when driving and loading EV's - or rather: How do I get more km/l out of an EV......How do you reduce the energy-wast when driving and loading EV's - or rather: How do I get more km/l out of an EV...

  1. Recognizing driving in haste

    NARCIS (Netherlands)

    Rendón-Vélez, E.


    One can often hear people discussing the reasons why a road accident has happened: “She had to pick up her kids in the school before four o’clock and she was driving in haste and careless”, “He was stressed, he wanted to reach the beginning of the football match, tried to drive faster and didn't app

  2. Drive Around the World

    Institute of Scientific and Technical Information of China (English)

    Yang Wei


    @@ "It's so cool that I can drive on my own,and my own car,"Cao Gang,WOrking for a private company in Changsha,capital city of Hunan Province,mid-south China,said in excitement when he newly bought Ben Ben,a Chinese local auto brand of Chang'an,with his freshly-passed driving license.

  3. Piezoelectric drive circuit (United States)

    Treu, Jr., Charles A.


    A piezoelectric motor drive circuit is provided which utilizes the piezoelectric elements as oscillators and a Meacham half-bridge approach to develop feedback from the motor ground circuit to produce a signal to drive amplifiers to power the motor. The circuit automatically compensates for shifts in harmonic frequency of the piezoelectric elements due to pressure and temperature changes.

  4. Electric vehicles: Driving range (United States)

    Kempton, Willett


    For uptake of electric vehicles to increase, consumers' driving-range needs must be fulfilled. Analysis of the driving patterns of personal vehicles in the US now shows that today's electric vehicles can meet all travel needs on almost 90% of days from a single overnight charge.

  5. Fundamentals of electrical drives

    CERN Document Server

    Veltman, André; De Doncker, Rik W


    Provides a comprehensive introduction to various aspects of electrical drive systems. This volume provides a presentation of dynamic generic models that cover all major electrical machine types and modulation/control components of a drive as well as dynamic and steady state analysis of transformers and electrical machines.

  6. Simple Driving Techniques

    DEFF Research Database (Denmark)

    Rosendahl, Mads


    Driving was introduced as a program transformation technique by Valentin Turchin in some papers around 1980. It was intended for the programming language REFAL and used in metasystem transitions based on super compilation. In this paper we present one version of driving for a more conventional li...

  7. Sympathetic nervous activation in obesity and the metabolic syndrome--causes, consequences and therapeutic implications. (United States)

    Lambert, Gavin W; Straznicky, Nora E; Lambert, Elisabeth A; Dixon, John B; Schlaich, Markus P


    The world wide prevalence of obesity and the metabolic syndrome is escalating. Contrary to earlier experimental evidence, human obesity is characterised by sympathetic nervous activation, with the outflows to both the kidney and skeletal muscle being activated. While the mechanisms responsible for initiating the sympathetic activation remain to be unequivocally elucidated, hyperinsulinemia, obstructive sleep apnoea, increased circulating adipokines, stress and beta adrenergic receptor polymorphisms are implicated. The pattern of sympathetic activation may be the pathophysiological mechanism underpinning much obesity-related illnesses with the consequences including, amongst others, the development of hypertension, insulin resistance, diastolic dysfunction and renal impairment. While diet and exercise are the first line therapy for the treatment of obesity and the metabolic syndrome, pharmacological interventions targeting the sympathetic nervous system, either directly or indirectly are also likely to be of benefit. Importantly, the benefit may not necessarily be weight related but may be associated with a reduction in end organ damage.

  8. Polar Direct Drive (United States)

    Skupsky, S.


    Direct drive offers the potential of higher target gain on the National Ignition Facility (NIF) than x-ray drive: The initial direct-drive target design had a 1-D gain of 45 and consisted primarily of a pure cryogenic DT shell. Using the expected levels of target and laser nonuniformities for the NIF, two-dimensional (2-D) hydrodynamic simulations predicted target gains around 30.(P.W. McKenty et al.), Phys. Plasmas 8, 2315 (2001). More-recent designs have shown that higher target gains could be obtained by replacing a portion of the DT shell with ``wetted'' CH foam and by using adiabat shaping: (1) Higher-Z material (C) in the foam increases laser absorption by about 40% (from 60% absorption to 85%).(S. Skupsky et al.), in Inertial Fusion Sciences and Applications 2001, edited by K. Tanaka et al. (Elsevier, Paris, 2002), p. 240. (2) Adiabat shaping allows the main portion of the fuel to be placed on a lower adiabat without compromising target stability.(V.N. Goncharov et al.), Phys. Plasmas 10, 1906 (2003). These direct-drive concepts can be tested on the NIF, long before that facility is converted to a direct-drive (spherically symmetric) irradiation configuration. Using the NIF x-ray-drive beam configuration, some of the near-polar beams could be pointed to better illuminate the target's equator. These more-oblique, equatorial beams will have lower absorption and reduced drive efficiency than the polar beams. One strategy to compensate for the difference in polar and equatorial drive is to reduce the irradiation at the poles and employ different pulse shapes to accommodate the time-dependent variations in drive and absorption. This concept of polar direct drive (PDD) has been studied using the 2-D hydrocode DRACO to determine the requirements for achieving ignition and moderate target gain for the NIF. Experiments on the OMEGA laser will examine the effects of oblique irradiation on target drive. Results of simulations for different direct-drive target designs

  9. Serotonin syndrome (United States)

    Hyperserotonemia; Serotonergic syndrome; Serotonin toxicity; SSRI - serotonin syndrome; MAO - serotonin syndrome ... two medicines that affect the body's level of serotonin are taken together at the same time. The ...

  10. Assessment: A Driving Force. (United States)

    Rakow, Steven J.


    Asserts that educational assessment drives the curriculum. Thus, assessment is very important in contemplating reform in science education. Assessment should be an integral part of the instructional process, utilizing diagnostic testing, monitoring, and summative evaluations. (PR)

  11. Driving in a womb

    NARCIS (Netherlands)


    Drive thousands of kilometres on just a litre of fuel? During the annual Shell eco-marathon at the end of May, schoolchildren and students – including a team from TU Delft – demonstrated that it can indeed be done.

  12. Instant Google Drive starter

    CERN Document Server

    Procopio, Mike


    This book is a Starter which teaches you how to use Google Drive practically. This book is perfect for people of all skill levels who want to enjoy the benefits of using Google Drive to safely store their files online and in the cloud. It's also great for anyone looking to learn more about cloud computing in general. Readers are expected to have an Internet connection and basic knowledge of using the internet.

  13. Self-driving carsickness. (United States)

    Diels, Cyriel; Bos, Jelte E


    This paper discusses the predicted increase in the occurrence and severity of motion sickness in self-driving cars. Self-driving cars have the potential to lead to significant benefits. From the driver's perspective, the direct benefits of this technology are considered increased comfort and productivity. However, we here show that the envisaged scenarios all lead to an increased risk of motion sickness. As such, the benefits this technology is assumed to bring may not be capitalised on, in particular by those already susceptible to motion sickness. This can negatively affect user acceptance and uptake and, in turn, limit the potential socioeconomic benefits that this emerging technology may provide. Following a discussion on the causes of motion sickness in the context of self-driving cars, we present guidelines to steer the design and development of automated vehicle technologies. The aim is to limit or avoid the impact of motion sickness and ultimately promote the uptake of self-driving cars. Attention is also given to less well known consequences of motion sickness, in particular negative aftereffects such as postural instability, and detrimental effects on task performance and how this may impact the use and design of self-driving cars. We conclude that basic perceptual mechanisms need to be considered in the design process whereby self-driving cars cannot simply be thought of as living rooms, offices, or entertainment venues on wheels.

  14. Dementia and driving. (United States)

    O'Neill, D; Neubauer, K; Boyle, M; Gerrard, J; Surmon, D; Wilcock, G K


    Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on self-certification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of self-certification of health by the elderly for driver-licensing purposes needs to be reassessed.

  15. Driving anger in Malaysia. (United States)

    Sullman, Mark J M; Stephens, Amanda N; Yong, Michelle


    The present study examined the types of situations that cause Malaysian drivers to become angry. The 33-item version of the driver anger scale (Deffenbacher et al., 1994) was used to investigate driver anger amongst a sample of 339 drivers. Confirmatory factor analysis showed that the fit of the original six-factor model (discourtesy, traffic obstructions, hostile gestures, slow driving, illegal driving and police presence), after removing one item and allowing three error pairs to covary, was satisfactory. Female drivers reported more anger, than males, caused by traffic obstruction and hostile gestures. Age was also negatively related to five (discourtesy, traffic obstructions, hostile gestures, slow driving and police presence) of the six factors and also to the total DAS score. Furthermore, although they were not directly related to crash involvement, several of the six forms of driving anger were significantly related to the crash-related conditions of: near misses, loss of concentration, having lost control of a vehicle and being ticketed. Overall the pattern of findings made in the present research were broadly similar to those from Western countries, indicating that the DAS is a valid measure of driving anger even among non-European based cultures.

  16. U.S. DRIVE

    Energy Technology Data Exchange (ETDEWEB)



    U.S. DRIVE, which stands for United States Driving Research and Innovation for Vehicle efficiency and Energy sustainability, is an expanded government-industry partnership among the U.S. Department of Energy; USCAR, representing Chrysler Group LLC, Ford Motor Company and General Motors; Tesla Motors; five energy companies – BP America, Chevron Corporation, ConocoPhillips, ExxonMobil Corporation, and Shell Oil Products US; two utilities – Southern California Edison and Michigan-based DTE Energy; and the Electric Power Research Institute (EPRI). The U.S. DRIVE mission is to accelerate the development of pre-competitive and innovative technologies to enable a full range of affordable and clean advanced light-duty vehicles, as well as related energy infrastructure.

  17. Gears and gear drives

    CERN Document Server

    Jelaska, Damir T


    Understanding how gears are formed and how they interact or 'mesh' with each other is essential when designing equipment that uses gears or gear trains. The way in which gear teeth are formed and how they mesh is determined by their geometry and kinematics, which is the topic of this book.  Gears and Gear Drives provides the reader with comprehensive coverage of gears and gear drives. Spur, helical, bevel, worm and planetary gears are all covered, with consideration given to their classification, geometry, kinematics, accuracy control, load capacity and manufacturing. Cylindric

  18. Pulsation driving and convection (United States)

    Antoci, Victoria


    Convection in stellar envelopes affects not only the stellar structure, but has a strong impact on different astrophysical processes, such as dynamo-generated magnetic fields, stellar activity and transport of angular momentum. Solar and stellar observations from ground and space have shown that the turbulent convective motion can also drive global oscillations in many type of stars, allowing to study stellar interiors at different evolutionary stages. In this talk I will concentrate on the influence of convection on the driving of stochastic and coherent pulsations across the Hertzsprung-Russell diagram and give an overview of recent studies.

  19. Toyota hybrid synergy drive

    Energy Technology Data Exchange (ETDEWEB)

    Gautschi, H.


    This presentation made at the Swiss 2008 research conference on traffic by Hannes Gautschi, director of service and training at the Toyota company in Switzerland, takes a look at Toyota's hybrid drive vehicles. The construction of the vehicles and their combined combustion engines and electric generators and drives is presented and the combined operation of these components is described. Braking and energy recovery are discussed. Figures on the performance, fuel consumption and CO{sub 2} output of the hybrid vehicles are compared with those of conventional vehicles.

  20. Dangers of Texting While Driving (United States)

    ... . Print Out Texting While Driving Guide (pdf) File a Complaint with the FCC ... Office: Consumer and Governmental Affairs Tags: Consumers - Distracted Driving - Health and Safety - Texting Federal Communications Commission 445 12th Street SW, Washington, ...

  1. The Drive to Influence (United States)

    Rodriguez, Diego


    At the heart of the educational vocation is a drive to influence, to meaningfully affect the learning and development of others. For adult educators working in higher education, daily activities--from teaching classes to supervising student research to attending faculty meetings to sitting on advisory boards--are full of opportunities to…

  2. Driving with a Goat

    Institute of Scientific and Technical Information of China (English)



    <正>A highway patrol officer was sitting in his car beside the road one day when he noticed a man driving with a goat in the back seat of his car.Turning on the lights,he pulled out,sped up, and pulled the man over.

  3. Fresh Drive Against Corruption

    Institute of Scientific and Technical Information of China (English)


    China’s government is making efforts to prevent corruption by taking harsh measures against the illegal selection and appointment of cadres on the 10th anniversary of China’s anti-corruption drive,President Hu Jintao called fogreater efforts to carry it out.

  4. Drugs and driving

    NARCIS (Netherlands)

    Walsh, J. Michael; De Gier, Johan J.; Christopherson, Asbjørg S.; Verstraete, Alain G.


    The authors present a global overview on the issue of drugs and driving covering four major areas: (1) Epidemiology and Prevalence-which reviews epidemiological research, summarizes available information, discusses the methodological shortcomings of extant studies, and makes recommendations for futu

  5. Chaos in drive systems

    Directory of Open Access Journals (Sweden)

    Kratochvíl C.


    Full Text Available The purpose of this article is to provide an elementary introduction to the subject of chaos in the electromechanical drive systems. In this article, we explore chaotic solutions of maps and continuous time systems. These solutions are also bounded like equilibrium, periodic and quasiperiodic solutions.

  6. CSI: Hard Drive (United States)

    Sturgeon, Julie


    Acting on information from students who reported seeing a classmate looking at inappropriate material on a school computer, school officials used forensics software to plunge the depths of the PC's hard drive, searching for evidence of improper activity. Images were found in a deleted Internet Explorer cache as well as deleted file space.…

  7. The effect of short-term withdrawal from continuous positive airway pressure therapy on sympathetic activity and markers of vascular inflammation in subjects with obstructive sleep apnoea. (United States)

    Phillips, Craig L; Yang, Qiao; Williams, Andrew; Roth, Michael; Yee, Brendon J; Hedner, Jan A; Berend, Norbert; Grunstein, Ronald R


    Obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease and sympathetic activation. However, it is unclear whether this association is independent of obesity and to what extent treatment with nasal continuous positive airway pressure (CPAP) alleviates the vascular inflammation that underpins cardiovascular disease. We therefore evaluated whether short-term withdrawal from CPAP therapy in subjects with moderate-severe OSA would result in increased levels of sympathetic activity and circulating inflammatory cytokines independent of weight. Vascular inflammatory markers (hsCRP, hsIL-6 and hsTNF-alpha) were assessed in 20 subjects after one and seven nights of withdrawal from CPAP together with the hypoxia-responsive angiogenic marker VEGF and urinary catecholamines. Compared with baseline on CPAP, withdrawal from therapy resulted in an immediate return of OSA with an increase in RDI to 26.7 +/- 5.2 and 39.0 +/- 5.9 events per hour after one and seven nights without CPAP, respectively (both P 0.1). In conclusion, 1 week of CPAP withdrawal was associated with a return of OSA and a marked increase in sympathetic activity without a concomitant elevation of vascular inflammatory markers.

  8. The effects of exercise modality and intensity on energy expenditure and cardiorespiratory response in adults with obesity and treated obstructive sleep apnoea. (United States)

    Evans, Rachael A; Dolmage, Thomas E; Robles, Priscila G; Brooks, Dina; Goldstein, Roger S


    To inform recommendations for the exercise component of a healthy lifestyle intervention for adults with obesity and treated obstructive sleep apnoea (OSA), we investigated the total energy expenditure (EE) and cardiorespiratory response to weight-supported (cycling) and unsupported (walking) exercise. Individuals with treated OSA and a body mass index (BMI) > 30 kg/m(2)performed an incremental cardiopulmonary exercise test on a cycle ergometer and a treadmill to determine the peak oxygen uptake[Formula: see text] Participants subsequently completed two endurance tests on each modality, matched at 80% and 60% of the highest[Formula: see text]determined by the incremental tests, to intolerance. The cardiorespiratory response was measured and total EE was estimated from the[Formula: see text] Sixteen participants completed all six tests: mean [SD] age 57 [13] years and median [IQ range] BMI 33.3 [30.8-35.3] kg/m(2) Total EE during treadmill walking was greater than cycling at both high (158 [101] vs. 29 [15] kcal;pobesity and treated OSA.

  9. Driving and engine cycles

    CERN Document Server

    Giakoumis, Evangelos G


    This book presents in detail the most important driving and engine cycles used for the certification and testing of new vehicles and engines around the world. It covers chassis and engine-dynamometer cycles for passenger cars, light-duty vans, heavy-duty engines, non-road engines and motorcycles, offering detailed historical information and critical review. The book also provides detailed examples from SI and diesel engines and vehicles operating during various cycles, with a focus on how the engine behaves during transients and how this is reflected in emitted pollutants, CO2 and after-treatment systems operation. It describes the measurement methods for the testing of new vehicles and essential information on the procedure for creating a driving cycle. Lastly, it presents detailed technical specifications on the most important chassis-dynamometer cycles around the world, together with a direct comparison of those cycles.

  10. Driving on the Descartes (United States)


    Astronaut John W. Young, Apollo 16 mission commander, drives the 'Rover', Lunar Roving Vehicle (LRV) to its final parking place near the end of the third extravehicular activity (EVA-3) at the Descartes landing site. Astronaut Charles M. Duke Jr., Lunar Module pilot, took this photograph looking southward. The flank of Stone Mountain can be seen on the horizon at left. The shadow of the Lunar Module 'Orion' is visible in the foreground.

  11. Marfan Syndrome (United States)

    Marfan syndrome is a disorder that affects connective tissue. Connective tissues are proteins that support skin, bones, ... fibrillin. A problem with the fibrillin gene causes Marfan syndrome. Marfan syndrome can be mild to severe, ...

  12. Metabolic Syndrome (United States)

    ... hypertension, hypertriglyceridemia, insulin resistance syndrome, low HDL cholesterol, Metabolic Syndrome, overweight, syndrome x, type 2 diabetes Family Health, Kids and Teens, Men, Women January 2005 Copyright © American Academy of Family PhysiciansThis ...

  13. Williams syndrome (United States)

    Williams-Beuren syndrome ... Williams syndrome is caused by not having a copy of several genes. Parents may not have any family history of the condition. However, people with Williams syndrome have a 50% chance of passing the ...

  14. Offset Compound Gear Drive (United States)

    Stevens, Mark A.; Handschuh, Robert F.; Lewicki, David G.


    The Offset Compound Gear Drive is an in-line, discrete, two-speed device utilizing a special offset compound gear that has both an internal tooth configuration on the input end and external tooth configuration on the output end, thus allowing it to mesh in series, simultaneously, with both a smaller external tooth input gear and a larger internal tooth output gear. This unique geometry and offset axis permits the compound gear to mesh with the smaller diameter input gear and the larger diameter output gear, both of which are on the same central, or primary, centerline. This configuration results in a compact in-line reduction gear set consisting of fewer gears and bearings than a conventional planetary gear train. Switching between the two output ratios is accomplished through a main control clutch and sprag. Power flow to the above is transmitted through concentric power paths. Low-speed operation is accomplished in two meshes. For the purpose of illustrating the low-speed output operation, the following example pitch diameters are given. A 5.0 pitch diameter (PD) input gear to 7.50 PD (internal tooth) intermediate gear (0.667 reduction mesh), and a 7.50 PD (external tooth) intermediate gear to a 10.00 PD output gear (0.750 reduction mesh). Note that it is not required that the intermediate gears on the offset axis be of the same diameter. For this example, the resultant low-speed ratio is 2:1 (output speed = 0.500; product of stage one 0.667 reduction and stage two 0.750 stage reduction). The design is not restricted to the example pitch diameters, or output ratio. From the output gear, power is transmitted through a hollow drive shaft, which, in turn, drives a sprag during which time the main clutch is disengaged.

  15. Electrical machines & drives

    CERN Document Server

    Hammond, P


    Containing approximately 200 problems (100 worked), the text covers a wide range of topics concerning electrical machines, placing particular emphasis upon electrical-machine drive applications. The theory is concisely reviewed and focuses on features common to all machine types. The problems are arranged in order of increasing levels of complexity and discussions of the solutions are included where appropriate to illustrate the engineering implications. This second edition includes an important new chapter on mathematical and computer simulation of machine systems and revised discussions o

  16. Gaze-controlled Driving

    DEFF Research Database (Denmark)

    Tall, Martin; Alapetite, Alexandre; San Agustin, Javier


    We investigate if the gaze (point of regard) can control a remote vehicle driving on a racing track. Five different input devices (on-screen buttons, mouse-pointing low-cost webcam eye tracker and two commercial eye tracking systems) provide heading and speed control on the scene view transmitted...... from the moving robot. Gaze control was found to be similar to mouse control. This suggests that robots and wheelchairs may be controlled “hands-free” through gaze. Low precision gaze tracking and image transmission delays had noticeable effect on performance....

  17. Electrical machines and drives

    CERN Document Server

    Hindmarsh, John


    Recent years have brought substantial developments in electrical drive technology, with the appearance of highly rated, very-high-speed power-electronic switches, combined with microcomputer control systems.This popular textbook has been thoroughly revised and updated in the light of these changes. It retains its successful formula of teaching through worked examples, which are put in context with concise explanations of theory, revision of equations and discussion of the engineering implications. Numerous problems are also provided, with answers supplied.The third edition in

  18. Electric drive design methodology

    CERN Document Server

    Jufer, Marcel


    An electric drive that is designed or adapted to a specific application must take into account all the elements of the chain of constituent elements in its use and deployment. In addition to the motor, the transmission, power electronics, control, sensors, and electrical protection systems must be taken into account. The motor and the transmission can be optimized and designed to obtain the best energy efficiency assessment, in particular for dynamic nodes. An inventory and a characterization of these various components is proposed as part of this book's examination and explanation


    Institute of Scientific and Technical Information of China (English)


    在2004年奥林匹克赛事中,中国的李婷,孙甜甜取得了中国网球第一个金牌一女子双打冠军。忘记不了当时李婷挥动着她的BABOLAT(百保力)网拍Pure Drive Zylon 360°激动地拥抱着孙甜甜吵闹着,幸福地哭着的情景。

  20. Kindler syndrome

    Directory of Open Access Journals (Sweden)

    Kaviarasan P


    Full Text Available Kindler syndrome is a rare autosomal recessive disorder associated with skin fragility. It is characterized by blistering in infancy, photosensitivity and progressive poikiloderma. The syndrome involves the skin and mucous membrane with radiological changes. The genetic defect has been identified on the short arm of chromosome 20. This report describes an 18-year-old patient with classical features like blistering and photosensitivity in childhood and the subsequent development of poikiloderma. The differential diagnosis of Kindler syndrome includes diseases like Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. Our patient had classical cutaneous features of Kindler syndrome with phimosis as a complication.

  1. Magnetostrictive direct drive motors (United States)

    Naik, Dipak; Dehoff, P. H.


    A new rare earth alloy, Terfenol-D, combines low frequency operation and extremely high energy density with high magnetostriction. Its material properties make it suitable as a drive element for actuators requiring high output torque. The high strains, the high forces and the high controllability of Terfenol alloys provide a powerful and challenging basis for new ways to generate motion in actuators. Two prototypes of motors using Terfenol-D rods were developed at NASA Goddard. The basic principles of operation are provided of the motor along with other relevant details. A conceptual design of a torque limiting safety clutch/brake under development is illustrated. Also, preliminary design drawings of a linear actuator using Terfenol-D is shown.


    Directory of Open Access Journals (Sweden)

    Sanaz Motamedi


    Full Text Available In an increasingly mobile era, the wide availability of technology for texting and the prevalence of hands-free form have introduced a new safety concern for drivers. To assess this concern, a questionnaire was first deployed online to gain an understanding of drivers’ text driving experiences as well as their demographic information. The results from 232 people revealed that the majority of drivers are aware of the associated risks with texting while driving. However, more than one-fourth of them still frequently send or read text messages while driving. In addition to the questionnaire, through the use of a virtual-reality driving simulator, this study examined drivers’ driving performance while they were engaged in some forms of text driving under different challenging traffic conditions. Through a blocked factorial experiment, drivers would either read a text message or respond to it with two levels of text complexity while using either hand-held or hands-free texting method. Their driving performance was assessed based on the number of driving violations observed in each scenario. Conclusions regarding the impacts of different forms of texting, text complexity, and response mode on drivers driving performance were drawn.

  3. Dimensions of driving anger and their relationships with aberrant driving. (United States)

    Zhang, Tingru; Chan, Alan H S; Zhang, Wei


    The purpose of this study was to investigate the relationship between driving anger and aberrant driving behaviours. An internet-based questionnaire survey was administered to a sample of Chinese drivers, with driving anger measured by a 14-item short Driving Anger Scale (DAS) and the aberrant driving behaviours measured by a 23-item Driver Behaviour Questionnaire (DBQ). The results of Confirmatory Factor Analysis demonstrated that the three-factor model (hostile gesture, arrival-blocking and safety-blocking) of the DAS fitted the driving anger data well. The Exploratory Factor Analysis on DBQ data differentiated four types of aberrant driving, viz. emotional violation, error, deliberate violation and maintaining progress violation. For the anger-aberration relation, it was found that only "arrival-blocking" anger was a significant positive predictor for all four types of aberrant driving behaviours. The "safety-blocking" anger revealed a negative impact on deliberate violations, a finding different from previously established positive anger-aberration relation. These results suggest that drivers with different patterns of driving anger would show different behavioural tendencies and as a result intervention strategies may be differentially effective for drivers of different profiles.

  4. Do emotions drive psychosis?

    Directory of Open Access Journals (Sweden)

    João G. Ribeiro


    Full Text Available Introduction: How important is the emotional life of persons who manifest psychotic symptoms? Aims: The aim of this paper is to review evidence on a causal role for emotions in psychotic processes. Methods: Selective review of literature on affective symptoms in psychoses, on emotions in the production of psychotic symptoms and on dopaminergic models of psychosis. Results: Affective symptoms are relevant across psychoses. Persons with schizophrenia have high levels of emotional reactivity and the intensification of negative affects not only is associated with but also precedes the intensification of psychotic symptoms, which is evidence that negative emotions drive the course of psychotic symptoms. Negative self‑representations are central in psychotic processes and can be the link between negative emotions and psychosis. Evidence favours the notion that persecutory delusions are consistent with negative affects and self‑representations, while grandiose delusions are consistent with a defensive amplification of positive affects and self‑representations. Shame has been proposed as the core emotional experience of psychosis, one in which the self becomes vulnerable to the external world, which is consistent with persecutory experiences. Assaults on the self, under the form of hostility in the family environment and society, are strong predictors of relapse and development of schizophrenia. Assaults on the self which induce social defeat are also strong stimulants of mesolimbic dopaminergic pathways, whose hyperactivity is associated with acute psychotic episodes and the experience of “aberrant salience”, put forward as a dopaminergic model of psychosis. Conclusions: The “defeat of the self” emerges as a central link that binds the experience of negative emotions to the expression of psychotic symptoms and its psychological and neurobiological correlates. The hypothesis gains support that the emotions related to that defeat control

  5. CLIC Drive Beam Phase Stabilisation

    CERN Document Server

    Gerbershagen, Alexander; Schulte, Daniel

    The thesis presents phase stability studies for the Compact Linear Collider (CLIC) and focuses in particular on CLIC Drive Beam longitudinal phase stabilisation. This topic constitutes one of the main feasibility challenges for CLIC construction and is an essential component of the current CLIC stabilisation campaign. The studies are divided into two large interrelated sections: the simulation studies for the CLIC Drive Beam stability, and measurements, data analysis and simulations of the CLIC Test Facility (CTF3) Drive Beam phase errors. A dedicated software tool has been developed for a step-by-step analysis of the error propagation through the CLIC Drive Beam. It uses realistic RF potential and beam loading amplitude functions for the Drive and Main Beam accelerating structures, complete models of the recombination scheme and compressor chicane as well as of further CLIC Drive Beam modules. The tool has been tested extensively and its functionality has been verified. The phase error propagation at CLIC h...

  6. The Drive-Wise Project: Driving Simulator Training increases real driving performance in healthy older drivers

    Directory of Open Access Journals (Sweden)

    Gianclaudio eCasutt


    Full Text Available Background: Age-related cognitive decline is often associated with unsafe driving behavior. We hypothesized that 10 active training sessions in a driving simulator increase cognitive and on-road driving performance. In addition, driving simulator training should outperform cognitive training.Methods: Ninety-one healthy active drivers (62 – 87 years were randomly assigned to either (1 a driving simulator training group, (2 an attention training group (vigilance and selective attention, or (3 a control group. The main outcome variables were on-road driving and cognitive performance. Seventy-seven participants (85% completed the training and were included in the analyses. Training gains were analyzed using a multiple regression analysis with planned comparisons.Results: The driving simulator training group showed an improvement in on-road driving performance compared to the attention training group. In addition, both training groups increased cognitive performance compared to the control group. Conclusion: Driving simulator training offers the potential to enhance driving skills in older drivers. Compared to the attention training, the simulator training seems to be a more powerful program for increasing older drivers’ safety on the road.

  7. Driving anger in Ukraine: Appraisals, not trait driving anger, predict anger intensity while driving. (United States)

    Stephens, A N; Hill, T; Sullman, M J M


    Trait driving anger is often, but not always, found to predict both the intensity of anger while driving and subsequent crash-related behaviours. However, a number of studies have not found support for a direct relationship between one's tendency to become angry and anger reported while driving, suggesting that other factors may mediate this relationship. The present self-report study investigated whether, in anger provoking driving situations, the appraisals made by drivers influence the relationship between trait and state anger. A sample of 339 drivers from Ukraine completed the 33-item version of the Driver Anger Scale (DAS; Deffenbacher et al., 1994) and eight questions about their most recent experience of driving anger. A structural equation model found that the intensity of anger experienced was predicted by the negative evaluations of the situation, which was in turn predicted by trait driving anger. However, trait driving anger itself did not predict anger intensity; supporting the hypothesis that evaluations of the driving situation mediate the relationship between trait and state anger. Further, the unique structure of the DAS required to fit the data from the Ukrainian sample, may indicate that the anger inducing situations in Ukraine are different to those of a more developed country. Future research is needed to investigate driving anger in Ukraine in a broader sample and also to confirm the role of the appraisal process in the development of driving anger in both developed and undeveloped countries.

  8. Drive-By Pharming (United States)

    Stamm, Sid; Ramzan, Zulfikar; Jakobsson, Markus

    This paper describes an attack concept termed Drive-by Pharming where an attacker sets up a web page that, when simply viewed by the victim (on a JavaScript-enabled browser), attempts to change the DNS server settings on the victim's home broadband router. As a result, future DNS queries are resolved by a DNS server of the attacker's choice. The attacker can direct the victim's Internet traffic and point the victim to the attacker's own web sites regardless of what domain the victim thinks he is actually going to, potentially leading to the compromise of the victim's credentials. The same attack methodology can be used to make other changes to the router, like replacing its firmware. Routers could then host malicious web pages or engage in click fraud. Since the attack is mounted through viewing a web page, it does not require the attacker to have any physical proximity to the victim nor does it require the explicit download of traditional malicious software. The attack works under the reasonable assumption that the victim has not changed the default management password on their broadband router.

  9. Real-world driving behaviour

    NARCIS (Netherlands)

    Rijkeboer, R.C.; Hendriksen, P.; Gense, N.L.J.


    With increasing complexity of engine management system there is a tendency for traditional driving cyles to become further and further removed from reality. So for a sensible evaluation of emissions and fuel consumption of road vehicles in the field there is an urgent need for 'real-world' driving p

  10. Low Sex Drive in Women (United States)

    Diseases and Conditions Low sex drive in women By Mayo Clinic Staff A woman's sexual desire naturally fluctuates over the years. Highs and lows commonly ... and anti-seizure medications also can cause low sex drive in women. If you have a persistent ...

  11. Driving Resistance from Railroad Trains

    DEFF Research Database (Denmark)

    Lindgreen, Erik Bjørn Grønning; Sorenson, Spencer C


    This report methods and parameters for calculating the driving resistance of railroad trains. Calculations and comparisons are presented for aerodynamic, rolling and total resistance for a variety of freight trains under different loading conditions, operating speed and configuration. Simplified...... methods are presented for the estimation of the driving resistance for passenger trains. This report is a supplement to the ARTEMIS rail emissions model....

  12. Edwards' syndrome. (United States)

    Crawford, Doreen; Dearmun, Annette


    Edwards' syndrome is a serious genetic condition that affects fetal cellular functions, tissue development and organogenesis. Most infants with the syndrome are female, but there is no race predominance.

  13. Metabolic Syndrome (United States)

    Metabolic syndrome is a group of conditions that put you at risk for heart disease and diabetes. These ... doctors agree on the definition or cause of metabolic syndrome. The cause might be insulin resistance. Insulin is ...

  14. Angelman Syndrome (United States)

    ... this syndrome often display hyperactivity, small head size, sleep disorders, and movement and balance disorders that can cause ... this syndrome often display hyperactivity, small head size, sleep disorders, and movement and balance disorders that can cause ...

  15. Lynch Syndrome (United States)

    ... colon cancer may include surgery, chemotherapy and radiation therapy. Cancer screening for people with Lynch syndrome If you ... et al. Milestones of Lynch syndrome: 1895-2015. Nature Reviews Cancer. ...

  16. Cushing's Syndrome (United States)

    Cushing's syndrome is a hormonal disorder. The cause is long-term exposure to too much cortisol, a hormone ... cause your body to make too much cortisol. Cushing's syndrome is rare. Some symptoms are Upper body obesity ...

  17. Paraneoplastic Syndromes (United States)

    ... dementia, seizures, sensory loss in the limbs, and vertigo or dizziness. Paraneoplastic syndromes include Lambert-Eaton myasthenic ... dementia, seizures, sensory loss in the limbs, and vertigo or dizziness. Paraneoplastic syndromes include Lambert-Eaton myasthenic ...

  18. Turner Syndrome (United States)

    Turner syndrome is a genetic disorder that affects a girl's development. The cause is a missing or incomplete ... t work properly. Other physical features typical of Turner syndrome are Short, "webbed" neck with folds of skin ...

  19. Dravet Syndrome (United States)

    ... Craniosynostosis Information Page Creutzfeldt-Jakob Disease Information Page Cushing's Syndrome Information Page Dandy-Walker Syndrome Information Page Deep Brain Stimulation for Parkinson's Disease Information Page Dementia Information ...

  20. Apert Syndrome. (United States)

    Datta, Saikat; Saha, Sandip; Kar, Arnab; Mondal, Souvonik; Basu, Syamantak


    Apert syndrome is one of the craniosynostosis syndromes which, due to its association with other skeletal anomalies, is also known as acrocephalosyndactyly. It is a rare congenital anomaly which stands out from other craniosynostosis due to its characteristic skeletal presentations.

  1. Velocardiofacial Syndrome (United States)

    Gothelf, Doron; Frisch, Amos; Michaelovsky, Elena; Weizman, Abraham; Shprintzen, Robert J.


    Velocardiofacial syndrome (VCFS), also known as DiGeorge, conotruncal anomaly face, and Cayler syndromes, is caused by a microdeletion in the long arm of Chromosome 22. We review the history of the syndrome from the first clinical reports almost half a century ago to the current intriguing molecular findings associating genes from the…

  2. Fraser syndrome

    Directory of Open Access Journals (Sweden)

    Kalpana Kumari M


    Full Text Available Fraser syndrome or cryptophthalmos is a rare autosomal recessive disorder characterized by major features such as cryptophthalmos, syndactyly and abnormal genitalia. The diagnosis of this syndrome can be made on clinical examination and perinatal autopsy. We present the autopsy findings of a rare case of Fraser syndrome in a male infant.

  3. Rowell syndrome

    Directory of Open Access Journals (Sweden)

    Ramesh Y Bhat


    Full Text Available Rowell syndrome is a rare disease consisting of erythema multiforme-like lesions associated with lupus erythematosus. The syndrome occurs mostly in middle-aged women. The authors describe the syndrome in a 15-year-old boy who responded well to systemic steroids and hydroxychloroquine.

  4. Risk factors for Obstructive Sleep Apnoea are prevalent in people with psychosis and correlate with impaired social functioning and poor physical health

    Directory of Open Access Journals (Sweden)

    Dennis Liu


    Full Text Available Background: Obstructive sleep apnoea (OSA in the general community is associated with obesity, smoking, alcohol and sedative medication use; and contributes to depressed mood, daytime sedation, and sudden cardiovascular deaths. Poor cardiovascular health, impaired social functioning, negative and cognitive symptoms are also among the common clinical features of psychotic disorders. People with psychosis have higher rates of sleep disturbance, however, OSA has not been extensively investigated in this population. Aims: This study aimed to determine the prevalence of OSA and general sleep disruption symptoms in a representative Australian sample of people with psychosis. We investigated the prevalence of potential risk factors for OSA including obesity, psychotropic medications, and substance abuse in this population. Finally, we evaluated associations between symptoms of OSA, symptoms of general sleep disruption, and various clinical features in people with psychosis. Methods: Participants took part in the Second National Australian Survey of Psychosis, a population-based survey of Australians with a psychotic disorder aged 18-64 years. Symptoms associated with OSA (snoring and breathing pauses during sleep in the past year were assessed using questions from the University of Maryland Medical Centre Questionnaire, and symptoms associated with general sleep disruption in the past week using the Assessment of Quality of Life Questionnaire (AQoL. Data collected included psychiatric diagnosis and symptoms, education, employment, medications, smoking status, physical activity, drug and alcohol use, and cognitive function. Physical health measures included body mass index, waist circumference, blood pressure, fasting blood glucose and lipids.Results: Snoring was reported by 41.9%; 7% stating they frequently stopped breathing (pauses during sleep. Univariate logistic regressions show OSA symptoms (pauses and snoring were associated with older age

  5. Refeeding syndrome. (United States)

    Fernández López, M T; López Otero, M J; Alvarez Vázquez, P; Arias Delgado, J; Varela Correa, J J


    Refeeding syndrome is a complex syndrome that occurs as a result of reintroducing nutrition (oral, enteral or parenteral) to patients who are starved or malnourished. Patients can develop fluid-balance abnormalities, electrolyte disorders (hypophosphataemia, hypokalaemia and hypomagnesaemia), abnormal glucose metabolism and certain vitamin deficiencies. Refeeding syndrome encompasses abnormalities affecting multiple organ systems, including neurological, pulmonary, cardiac, neuromuscular and haematological functions. Pathogenic mechanisms involved in the refeeding syndrome and clinical manifestations have been reviewed. We provide suggestions for the prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk, reintroduce nutrition cautiously and correct electrolyte and vitamin deficiencies properly.

  6. [Metabolic syndrome]. (United States)

    Mitsuishi, Masanori; Miyashita, Kazutoshi; Itoh, Hiroshi


    Metabolic syndrome, which is consisted of hypertension, dyslipidemia and impaired glucose tolerance, is one of the most significant lifestyle-related disorders that lead to cardiovascular diseases. Among many upstream factors that are related to metabolic syndrome, obesity, especially visceral obesity, plays an essential role in its pathogenesis. In recent studies, possible mechanisms which connect obesity to metabolic syndrome have been elucidated, such as inflammation, abnormal secretion of adipokines and mitochondrial dysfunction. In this review, we focus on the relationship between obesity and metabolic syndrome; and illustrate how visceral obesity contributes to, and how the treatments for obesity act on metabolic syndrome.

  7. Automated driving safer and more efficient future driving

    CERN Document Server

    Horn, Martin


    The main topics of this book include advanced control, cognitive data processing, high performance computing, functional safety, and comprehensive validation. These topics are seen as technological bricks to drive forward automated driving. The current state of the art of automated vehicle research, development and innovation is given. The book also addresses industry-driven roadmaps for major new technology advances as well as collaborative European initiatives supporting the evolvement of automated driving. Various examples highlight the state of development of automated driving as well as the way forward. The book will be of interest to academics and researchers within engineering, graduate students, automotive engineers at OEMs and suppliers, ICT and software engineers, managers, and other decision-makers.



    Sanaz Motamedi; Jyh-Hone Wang


    In an increasingly mobile era, the wide availability of technology for texting and the prevalence of hands-free form have introduced a new safety concern for drivers. To assess this concern, a questionnaire was first deployed online to gain an understanding of drivers’ text driving experiences as well as their demographic information. The results from 232 people revealed that the majority of drivers are aware of the associated risks with texting while driving. However, more than one-fourth of...

  9. The Driving Pipeline: A Driving Control Scheme for Mobile Robots (United States)


    ATrvnCrlShemefortMobilesRobots K)BODTIC MTT Tehnca Report The Driving Pipeline: A Driving Control Scheme for Mobile Robots Yoshimasa Goto, Steven A...October, 1986. [4] Georges Giralt, Raja Chatila, and Marc Vaisset. An Integrated Navigation and Motion Control System for Autonomous Multsensory Mobile ... Robots . In The First International Symposium on Robotics Research, pages 191-214. j5] Y.Goto, etc.. C1M Sidewalk Navigation System. In Proc. of Fall

  10. [Autoinflammatory syndrome]. (United States)

    Ida, Hiroaki; Eguchi, Katsumi


    The autoinflammatory syndromes include a group of inherited diseases that are characterized by 1) seemingly unprovoked episodes of systemic inflammations, 2) absence of high titer of autoantibody or auto-reactive T cell, and 3) inborn error of innate immunity. In this article, we will focus on the clinical features, the pathogenesis related the genetic defects, and the therapeutic strategies in the representative disorders including familial Mediterranean fever (FMF), TNF receptor associated periodic syndrome (TRAPS), cryopyrin-associated periodic syndrome (CAPS), hyper-IgD with periodic fever syndrome (HIDS), syndrome of pyogenic arthritis with pyoderma gangrenosum and acne (PAPA), and Blau syndrome. Recent advances in genetics and molecular biology have proceeded our understanding of the pathogenesis of autoinflammatory syndromes.

  11. Platypnea-Orthodeoxia Syndrome: What Is the Driving Force? (United States)

    Edwards, Adam L; Cornatzer, Eric; Shelton, R Waid


    A 69-year-old patient presented with episodic, acute hypoxia and an increasing oxygen requirement. His hemoglobin oxygenation reached its nadir in the 80% to 85% range as measured by pulse oximetry while he was sitting upright. Oxygenation would improve in this patient to percentages in the upper 90s when he was in the supine position. He was found to have a large secundum atrial septal defect with bidirectional intracardiac shunting, left hemidiaphragmatic dysfunction, a dilated ascending aorta and a prominent Eustachian valve. The patient was stabilized with oxygen therapy, and the cardiology service provided definitive treatment via percutaneous shunt closure with a septal occluder.

  12. Alzheimer's: When to Stop Driving (United States)

    Healthy Lifestyle Caregivers If your loved one has Alzheimer's, he or she may not be safe on ... for safe driving tends to decline with age, Alzheimer's disease accelerates this process dramatically. If you're ...

  13. Motor Integrated Variable Speed Drives

    DEFF Research Database (Denmark)

    Singh, Yash Veer

    rectifier at the front end is presented in this thesis and requirements of a buffer stage in the form of ESI is explained in detail. An equivalent circuit and linear model are developed to give the transfer function and control of the ESI based three-phase rectifier. In this thesis a power converter......A new trend in the variable speed drives (VSDs) is to develop fully integrated systems, which lead to low-cost products with shorter design cycles. Motor Integrated design of VSDs will reduce cable length to connect drive with machine windings and installation time for end user. The electric drives...... when it comes to the development of any kind of power converter topology for power electronic applications. Concerning the use of a power converter in motor integrated VSDs, the first two mentioned aspects receive an even greater im-portance. Power converter design for integrated drives poses a host...

  14. Is Drunk Driving a Felony?

    Institute of Scientific and Technical Information of China (English)


    Drunk driving, a major killer in China for decades, may soon incur harsher penalties for offenders. Several high-profile alcoholrelated traffic accidents in recent months have triggered a nationwide debate on

  15. Quantum effects in warp drives

    Directory of Open Access Journals (Sweden)

    Finazzi Stefano


    Full Text Available Warp drives are interesting configurations that, at least theoretically, provide a way to travel at superluminal speed. Unfortunately, several issues seem to forbid their realization. First, a huge amount of exotic matter is required to build them. Second, the presence of quantum fields propagating in superluminal warp-drive geometries makes them semiclassically unstable. Indeed, a Hawking-like high-temperature flux of particles is generated inside the warp-drive bubble, which causes an exponential growth of the energy density measured at the front wall of the bubble by freely falling observers. Moreover, superluminal warp drives remain unstable even if the Lorentz symmetry is broken by the introduction of regulating higher order terms in the Lagrangian of the quantum field. If the dispersion relation of the quantum field is subluminal, a black-hole laser phenomenon yields an exponential amplification of the emitted flux. If it is superluminal, infrared effects cause a linear growth of this flux.

  16. Lunar Core Drive Tubes Summary (United States)

    National Aeronautics and Space Administration — Contains a brief summary and high resolution imagery from various lunar rock and core drive tubes collected from the Apollo and Luna missions to the moon.

  17. Mulholland Drive: An Intertextual Reading

    Directory of Open Access Journals (Sweden)

    Ebrahim Barzegar


    Full Text Available This article examines David Lynch’s Mulholland Drive from Kristeva’s concept of intertextuality. To achieve this aim, this study provides a close reading of the selected film so as to trace and illustrate the polyphonic network of references, citations, quotations and intertexts of Mulholland Drive to the significant already-made films such as Sunset Boulevard, The Wizard of Oz, and Persona.


    Institute of Scientific and Technical Information of China (English)

    LI Xianghua; ZHANG Jianwu


    A newly found phenomenon of carved driving wheels of a rea-wheel-drive tractor used in an airport is discussed. The circum of every driving wheel is damaged at three regions, which distribute regularly and uniformly. Everyday, the tractor tows a trailer which are times heavier than the tractor, and moves on the same road in the airport. The phenomenon is explained by the torsional self-excited vibration system of the powertrain. The simplified torsional vibration system is discribed by a 2-order ordinary differential equation, which has a limit circle. Experiments and numerical simulations show the followings: Because of the heavy trailer, the slip ratio of the tractor's driving wheels is very large. Therefore, there is severe torsional self-excited vibration in the tractor's drivetrain, and the self-excited vibration results in severe and regular fluctuations of the rear wheel's velocity. The severe fluctuations in velocity fastens the damage of the driving wheels. At the same time, the time interval in which an arbitrary point in the circum of the driving wheel contacts with the road twice is two times more than the period of the torsional self-excited vibration, and this times explained the existence of three damaged regions. At last, it points out that the phenomenon can be avoided when the torsional damping is large enough.

  19. Efficient Driving of Piezoelectric Transducers Using a Biaxial Driving Technique.

    Directory of Open Access Journals (Sweden)

    Samuel Pichardo

    Full Text Available Efficient driving of piezoelectric materials is desirable when operating transducers for biomedical applications such as high intensity focused ultrasound (HIFU or ultrasound imaging. More efficient operation reduces the electric power required to produce the desired bioeffect or contrast. Our preliminary work [Cole et al. Journal of Physics: Condensed Matter. 2014;26(13:135901.] suggested that driving transducers by applying orthogonal electric fields can significantly reduce the coercivity that opposes ferroelectric switching. We present here the experimental validation of this biaxial driving technique using piezoelectric ceramics typically used in HIFU. A set of narrow-band transducers was fabricated with two sets of electrodes placed in an orthogonal configuration (following the propagation and the lateral mode. The geometry of the ceramic was chosen to have a resonance frequency similar for the propagation and the lateral mode. The average (± s.d. resonance frequency of the samples was 465.1 (± 1.5 kHz. Experiments were conducted in which each pair of electrodes was driven independently and measurements of effective acoustic power were obtained using the radiation force method. The efficiency (acoustic/electric power of the biaxial driving method was compared to the results obtained when driving the ceramic using electrodes placed only in the pole direction. Our results indicate that the biaxial method increases efficiency from 50% to 125% relative to the using a single electric field.

  20. Wellens' syndrome

    Directory of Open Access Journals (Sweden)

    Franco Lai


    Full Text Available We report a case of quite rare cause of thoracic pain suspected by emergency physician as Wellens’ syndrome. Wellens’ syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending artery (LAD. This syndrome is about 10-15% of all unstable angina in emergency department (ED. The cardiologic consult was obtained in ED and it was not conclusive for a Wellens’ syndrome, so that the diagnostistic planning was wrong. The authors point out the importance of this syndrome in ED and the necessity of an urgent angiographic study as every acute coronary syndrome presented in ED. We remark the importance in ED to recognize these changes associated with critical LAD obstruction and the high risk for anterior wall myocardial infarction.

  1. [Autoinflammatory syndromes]. (United States)

    Lamprecht, P; Gross, W L


    In its strict sense, the term "autoinflammatory syndromes" comprises the hereditary periodic fever syndromes (HPF), which are caused by mutations of pattern-recognition receptors (PRR) and perturbations of the cytokine balance. These include the crypyrinopathies, familial Mediterranean fever, TNF-receptor associated periodic fever syndrome (TRAPS), hyper-IgD and periodic syndrome (HIDS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, NALP12-HPF, and the Blau syndrome. The diseases are characterized by spontaneous activation of cells of the innate immunity in the absence of ligands. Autoantibodies are usually not found. HPF clinically present with recurrent fever episodes and inflammation, especially of serosal and synovial interfaces and the skin. Intriguingly, PRR-mediated autoinflammtory mechanisms also play a role in a number of chronic inflammatory and autoimmune diseases.

  2. High-power converters and AC drives

    CERN Document Server

    Wu, Bin


    This new edition reflects the recent technological advancements in the MV drive industry, such as advanced multilevel converters and drive configurations. It includes three new chapters, Control of Synchronous Motor Drives, Transformerless MV Drives, and Matrix Converter Fed Drives. In addition, there are extensively revised chapters on Multilevel Voltage Source Inverters and Voltage Source Inverter-Fed Drives. This book includes a systematic analysis on a variety of high-power multilevel converters, illustrates important concepts with simulations and experiments, introduces various megawatt drives produced by world leading drive manufacturers, and addresses practical problems and their mitigations methods.

  3. Metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Gogia Atul


    Full Text Available The Metabolic syndrome is a widely prevalent and multi-factorial disorder. The syndrome has been given several names, including- the metabolic syndrome, the insulin resistance syndrome, the plurimetabolic syndrome, and the deadly quartet. With the formulation of NCEP/ATP III guidelines, some uniformity and standardization has occurred in the definition of metabolic syndrome and has been very useful for epidemiological purposes. The mechanisms underlying the metabolic syndrome are not fully known; however resistance to insulin stimulated glucose uptake seems to modify biochemical responses in a way that predisposes to metabolic risk factors. The clinical relevance of the metabolic syndrome is related to its role in the development of cardiovascular disease. Management of the metabolic syndrome involves patient-education and intervention at various levels. Weight reduction is one of the main stays of treatment. In this article we comprehensively discuss this syndrome- the epidemiology, pathogenesis, clinical relevance and management. The need to do a comprehensive review of this particular syndrome has arisen in view of the ever increasing incidence of this entitiy. Soon, metabolic syndrome will overtake cigarette smoking as the number one risk factor for heart disease among the US population. Hardly any issue of any primary care medical journal can be opened without encountering an article on type 2 diabetes, dyslipidemia or hypertension. It is rare to see type 2 diabetes, dyslipidemia, obesity or hypertension in isolation. Insulin resistance and resulting hyperinsulinemia have been implicated in the development of glucose intolerance (and progression to type 2 diabetes, hypertriglyceridemia, hypertension, polycystic ovary yndrome, hypercoagulability and vascular inflammation, as well as the eventual development of atherosclerotic cardiovascular disease manifested as myocardial infarction, stroke and myriad end organ diseases. Conversely

  4. Revesz syndrome

    Directory of Open Access Journals (Sweden)

    Dayane Cristine Issaho


    Full Text Available Revesz syndrome is a rare variant of dyskeratosis congenita and is characterized by bilateral exudative retinopathy, alterations in the anterior ocular segment, intrauterine growth retardation, fine sparse hair, reticulate skin pigmentation, bone marrow failure, cerebral calcification, cerebellar hypoplasia and psychomotor retardation. Few patients with this syndrome have been reported, and significant clinical variations exist among patients. This report describes the first Brazilian case of Revesz syndrome and its ocular and clinical features.

  5. Urofacial syndrome

    Directory of Open Access Journals (Sweden)

    Kamal F Akl


    Full Text Available The urofacial syndrome is characterized by functional obstructive uropathy asso-ciated with an inverted smile. The importance of the subject is that it sheds light, not only on the muscles of facial expression, but also on the inheritance of voiding disorders and lower urinary tract malformations. We report a 10-year-old-male patient who had the urofacial syndrome. Early diagnosis of the urofacial syndrome is important to avoid upper urinary tract damage and renal failure.

  6. Gorlin syndrome

    Directory of Open Access Journals (Sweden)

    Basanti Devi


    Full Text Available Gorlin Syndrome, a rare genodermatosis, otherwise known as Nevoid basal cell carcinoma syndrome (NBCCS is a multisystem disease affecting skin, nervous system, eyes, endocrine glands, and bones. It is characterized by multiple basal cell carcinomas, palmoplantar pits, jaw cysts, and bony deformities like kyphoscoliosis and frontal bossing. We would like to report a case of Gorlin syndrome with classical features, as this is a rare genodermatosis.

  7. Gorlin syndrome. (United States)

    Devi, Basanti; Behera, Binodini; Patro, Sibasish; Pattnaik, Subhransu S; Puhan, Manas R


    Gorlin Syndrome, a rare genodermatosis, otherwise known as Nevoid basal cell carcinoma syndrome (NBCCS) is a multisystem disease affecting skin, nervous system, eyes, endocrine glands, and bones. It is characterized by multiple basal cell carcinomas, palmoplantar pits, jaw cysts, and bony deformities like kyphoscoliosis and frontal bossing. We would like to report a case of Gorlin syndrome with classical features, as this is a rare genodermatosis.

  8. Down Syndrome: Eye Problems (United States)

    ... En Español Read in Chinese What causes Down syndrome? Down syndrome is caused by a duplication of all ... in persons with Down syndrome. How common is Down syndrome? The frequency of Down syndrome is approximately 1 ...

  9. Facts about Down Syndrome (United States)

    ... Down syndrome. View charts » What is Down Syndrome? Down syndrome is a condition in which a person ... in height as children and adults Types of Down Syndrome There are three types of Down syndrome. People ...

  10. Exploring Forensic Implications of the Fusion Drive

    Directory of Open Access Journals (Sweden)

    Shruti Gupta


    Full Text Available This paper explores the forensic implications of Apple's Fusion Drive. The Fusion Drive is an example of auto-tiered storage. It uses a combination of a flash drive and a magnetic drive. Data is moved between the drives automatically to maximize system performance. This is different from traditional caches because data is moved and not simply copied. The research included understanding the drive structure, populating the drive, and then accessing data in a controlled setting to observe data migration strategies. It was observed that all the data is first written to the flash drive with 4 GB of free space always maintained. If data on the magnetic drive is frequently accessed, it is promoted to the flash drive while demoting other information. Data is moved at a block-level and not a file-level. The Fusion Drive didn't alter the timestamps of files with data migration.

  11. Vitreomacular Traction Syndrome

    Directory of Open Access Journals (Sweden)

    Juliana Bottós


    Full Text Available The advent of new technologies such as high definition optical coherence tomography (OCT has not only provided unprecedented imaging capabilities, but also raised the need to define concepts not yet settled and often confusing such as the vitreomacular traction (VMT syndrome. While technological advances drive us into the future by clarifying the pathophysiology of many diseases and enabling novel therapeutic options, it is at the same time necessary to review basic disease concepts in addition to definitions and classifications. VMT syndrome is implicated in the pathophysiology of a number of macular disorders, translating into a variety of anatomical and functional consequences underscoring the complexity of the condition. These macular changes are closely related to the VMT configuration and have led to proposing classification of this syndrome based on OCT findings. The size and severity of the remaining vitreomacular attachment may define the specific maculopathy. Focal VMT usually leads to macular hole formation, tractional cystoid macular edema and foveal retinal detachment, while broad VMT is associated with epiretinal membranes, diffuse retinal thickening and impaired foveal depression recovery. Despite similar postoperative visual acuity (VA in focal and broad VMT subgroups, visual improvement is greater with focal VMT because preoperative VA is frequently lower. Surgical procedures are effective to relieve VMT and improve VA in most eyes; outcomes vary with VMT morphology and the duration of symptoms.

  12. High Amplitude Secondary Mass Drive

    Energy Technology Data Exchange (ETDEWEB)



    In this paper we describe a high amplitude electrostatic drive for surface micromachined mechanical oscillators that may be suitable for vibratory gyroscopes. It is an advanced design of a previously reported dual mass oscillator (Dyck, et. al., 1999). The structure is a 2 degree-of-freedom, parallel-plate driven motion amplifier, termed the secondary mass drive oscillator (SMD oscillator). During each cycle the device contacts the drive plates, generating large electrostatic forces. Peak-to-peak amplitudes of 54 {micro}m have been obtained by operating the structure in air with an applied voltage of 11 V. We describe the structure, present the analysis and design equations, and show recent results that have been obtained, including frequency response data, power dissipation, and out-of- plane motion.

  13. Drive: Theory and Construct Validation. (United States)

    Siegling, Alex B; Petrides, K V


    This article explicates the theory of drive and describes the development and validation of two measures. A representative set of drive facets was derived from an extensive corpus of human attributes (Study 1). Operationalised using an International Personality Item Pool version (the Drive:IPIP), a three-factor model was extracted from the facets in two samples and confirmed on a third sample (Study 2). The multi-item IPIP measure showed congruence with a short form, based on single-item ratings of the facets, and both demonstrated cross-informant reliability. Evidence also supported the measures' convergent, discriminant, concurrent, and incremental validity (Study 3). Based on very promising findings, the authors hope to initiate a stream of research in what is argued to be a rather neglected niche of individual differences and non-cognitive assessment.

  14. Multi-propeller drive system (United States)

    Belenger, Robert V.


    A multipropeller drive system having a single input shaft for connection to an engine system, a differential gear assembly for dividing the driving force from the input drive shaft between a pair of output shafts, and a pair of laterally spaced propellers driven by the output shafts of the differential gear assembly is disclosed. The differential gear assembly operates in a manner wherein one output shaft, if required, is permitted to revolve at a different rate than the other output shaft. A pair of brake mechanisms acting on the output shafts of the differential gear assembly enable an operator to control the rotational speed of the respective propellers without modifying the engine speed or transmission settings.

  15. Influence of roadside infrastructure on driving behavior: driving simulator study

    NARCIS (Netherlands)

    Horst, A.R.A. van der; Ridder, S. de


    This paper describes the results of a driving simulator study that focused on the influence of roadside infrastructure on speed choice and lateral placement of car drivers. A review of the RISER detailed accident database revealed that lateral positioning and speed of the vehicle were two of the pri

  16. Franceschetti syndrome

    Directory of Open Access Journals (Sweden)

    Vikrant Kasat


    Full Text Available Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable expressivity. It is commonly known as Treacher Collins syndrome (TCS. It is named after E. Treacher Collins who described the essential components of the condition. It affects both genders equally. This article reports a case of TCS in an 18-year-old female.

  17. Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Akcan AB.


    Full Text Available Turner syndrome is an important cause of short stature in girls and primer amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This topic will review the clinical manifestations, diagnosis and management of Turner syndrome.

  18. Proteus syndrome

    Directory of Open Access Journals (Sweden)

    George Renu


    Full Text Available A case of proteus syndrome in a 20 year old male is repoted. Hemihypertrophy, asymmetric megalodactyly, linear epidermal naevus, naevus flammeus, angiokeratoma, lymphangioma circumscriptum, thickening of the palms and soles, scoliosis and varicose veins were present. There are only few reports of these cases in adults. The syndrome has not been reported from India.

  19. Poland syndrome


    Chandra Madhur Sharma; Shrawan Kumar; Meghwani, Manoj K.; Agrawal, Ravi P.


    Poland′s syndrome is a rare congenital condition, characterized by the absence of the sternal or breastbone portion of the pectoralis major muscle, which may be associated with the absence of nearby musculoskeletal structures. We hereby report an 8-year-old boy with typical features of Poland syndrome, the first documented case from Uttar Pradesh, India.

  20. Poland syndrome

    Directory of Open Access Journals (Sweden)

    Chandra Madhur Sharma


    Full Text Available Poland′s syndrome is a rare congenital condition, characterized by the absence of the sternal or breastbone portion of the pectoralis major muscle, which may be associated with the absence of nearby musculoskeletal structures. We hereby report an 8-year-old boy with typical features of Poland syndrome, the first documented case from Uttar Pradesh, India.

  1. Myelodysplastic Syndromes (United States)

    ... your body, the white blood cells that fight infections, and the platelets that help with blood clotting. If you have a myelodysplastic syndrome, the stem cells do not mature into healthy blood cells. ... anemia, or easy bleeding. Myelodysplastic syndromes often do ...

  2. LEOPARD syndrome (United States)

    ... L, Strano S, Carbone A, Calvieri C, Giustini S. LEOPARD syndrome. Dermatol Online J . 2008;14(3):7. PMID: 18627709 . Sarkozy A, Digilio MC, Dallapiccola B. LEOPARD syndrome. Orphanet J Rare Dis . 2008;3:13. PMID: ...

  3. Wallenberg's Syndrome (United States)

    ... way, which makes it difficult to keep their balance when they walk. Treatment Treatment for Wallenberg's syndrome is symptomatic. A feeding ... way, which makes it difficult to keep their balance when they walk. Treatment Treatment for Wallenberg's syndrome is symptomatic. A feeding ...

  4. Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Ravinder K. Gupta, Ritu Gupta, Sunil Dutt Sharma


    Full Text Available Turner Syndrome is one of the important chromosomal disorders characterised by loss (total or part ofsex chromosome. The manifestations being peripheral edema, short stature, extra skin fold, webbing ofneck, renal and cardiovascular anomalies, sexual infantilism, learning disability etc. We present here aone month female baby who had classical features of Turner Syndrome. The karyotape analysis wasconsistent with the diagnosis.

  5. Antiphospholipid syndrome

    DEFF Research Database (Denmark)

    Cervera, Ricard; Piette, Jean-Charles; Font, Josep


    To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a large cohort of patients and to define patterns of disease expression.......To analyze the clinical and immunologic manifestations of antiphospholipid syndrome (APS) in a large cohort of patients and to define patterns of disease expression....

  6. Digital control of electric drives

    CERN Document Server

    Koziol, R; Szklarski, L


    The electromechanical systems employed in different branches of industry are utilized most often as drives of working machines which must be fed with electric energy in a continuous, periodic or even discrete way. Some of these machines operate at constant speed, others require wide and varying energy control. In many designs the synchronous cooperation of several electric drives is required in addition to the desired dynamic properties. For these reasons the control of the cooperation and dynamics of electromechanical systems requires the use of computers.This book adopts an unusual approach

  7. Polar-direct-drive simulations and experiments

    Energy Technology Data Exchange (ETDEWEB)

    Marozas, J.A.; Marshall, F.J.; Craxton, R.S.; Igumenshchev, I.V.; Skupsky, S.; Bonino, M.J.; Collins, T.J.B.; Epstein, R.; Glebov, V.Yu.; Jacobs-Perkins, D.; Knauer, J.P.; McCrory, R.L.; McKenty, P.W.; Meyerhofer, D.D.; Noyes, S.G.; Radha, P.B.; Sangster, T.C.; Seka, W.; Smalyuk, V.A.


    Polar direct drive (PDD) will allow direct-drive ignition experiments on the National Ignition Facility (NIF) as it is configured for x-ray drive. Optimal drive uniformity is obtained via a combination of beam repointing, pulse shapes, spot shapes, and/or target design. This article describes progress in the development of standard and "Saturn" PDD target designs.

  8. Driving and Age-Related Macular Degeneration (United States)

    Owsley, Cynthia; McGwin, Gerald, Jr.


    This article reviews the research literature on driving and age-related macular degeneration, which is motivated by the link between driving and the quality of life of older adults and their increased collision rate. It addresses the risk of crashes, driving performance, driving difficulty, self-regulation, and interventions to enhance, safety,…

  9. Roller/Gear Drives For Robotic Manipulators (United States)

    Anderson, William J.; Shipitalo, William


    Pitch/yaw roller/gear drive and wrist-roll roller/gear drive designed to incorporate several features desirable in robotic-joint actuators. Includes zero backlash, high efficiency, smooth motion (little ripple in torque and in speed ratio), and high degree of back-drivability. Pitch/yaw drive is novel two-axis drive containing combination of gears, rollers, and springs acting together eliminating backlash and cogging. Wrist-roll drive more-conventional single-axis drive offering advantages like those of pitch/yaw drive.

  10. Electronic 4-wheel drive control device (United States)

    Hayato, S.; Takanori, S.; Shigeru, H.; Tatsunori, S.


    The internal rotation torque generated during operation of a 4-wheel drive vehicle is reduced using a control device whose clutch is attached to one part of the rear-wheel drive shaft. One torque sensor senses the drive torque associated with the rear wheel drive shaft. A second sensor senses the drive torque associated with the front wheel drive shaft. Revolution count sensors sense the revolutions of each drive shaft. By means of a microcomputer, the engagement of the clutch is changed to insure that the ratio of the torque sensors remains constant.

  11. The "Shaken Baby" syndrome: pathology and mechanisms. (United States)

    Squier, Waney


    The "Shaken Baby" syndrome (SBS) is the subject of intense controversy; the diagnosis has in the past depended on the triad of subdural haemorrhage (SDH), retinal haemorrhage and encephalopathy. While there is no doubt that infants do suffer abusive injury at the hands of their carers and that impact can cause catastrophic intracranial damage, research has repeatedly undermined the hypothesis that shaking per se can cause this triad. The term non-accidental head injury has therefore been widely adopted. This review will focus on the pathology and mechanisms of the three physiologically associated findings which constitute the "triad" and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions. "Sub" dural bleeding in fact originates within the deep layers of the dura. The potential sources of SDH include: the bridging veins, small vessels within the dura itself, a granulating haemorrhagic membrane and ruptured intracranial aneurysm. Most neuropathologists do not routinely examine eyes, but the significance of this second arm of the triad in the diagnosis of Shaken Baby syndrome is such that it merits consideration in the context of this review. While retinal haemorrhage can be seen clinically, dural and subarachnoid optic nerve sheath haemorrhage is usually seen exclusively by the pathologist and only rarely described by the neuroradiologist. The term encephalopathy is used loosely in the context of SBS. It may encompass anything from vomiting, irritability, feeding difficulties or floppiness to seizures, apnoea and fulminant brain swelling. The spectrum of brain pathology associated with retinal and subdural bleeding from a variety of causes is described. The most important cerebral pathology is swelling and hypoxic-ischaemic injury. Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. Clefts and haemorrhages in the immediate

  12. Death Drive in Tourism Studies

    NARCIS (Netherlands)

    Buda, Dorina


    The psychoanalytical concept of the death drive refers to a constant metapsychological force at the junction between life and death: it is not understood in a biological sense of physical demise of the body, nor in opposition to life. Geographies of tourist performances in places in the proximity of

  13. Heavy consumption and drink driving

    DEFF Research Database (Denmark)

    Fynbo, Lars


    on the interviewee’s risk behaviour, especially in relation to driving. The interviewees are first divided into 1) a group of young “edgeworkers” with pronounced general risk behaviour, 2) a group of middle-aged “post-edgeworkers”, most with criminal records, and 3) a group of middle-aged and older heavy consumers...

  14. Torque-Splitting Gear Drive (United States)

    Kish, J.


    Geared drive train transmits torque from input shaft in equal parts along two paths in parallel, then combines torques in single output shaft. Scheme reduces load on teeth of meshing gears while furnishing redundancy to protect against failures. Such splitting and recombination of torques common in design of turbine engines.

  15. Police enforcement and driving speed.

    NARCIS (Netherlands)


    Speed limits are violated frequently in the Netherlands. As speed is an important factor in road crashes, the surveillance of driving speeds is one of the spearheads in the policy plans of the Dutch police. Different methods of speed enforcement have proved to be effective in reducing speed and cras

  16. What Drives Politicians’ Online Popularity?

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Kleis; Vaccari, Cristian


    The number of website visits, Facebook friends, or Twitter followers that politicians attract varies greatly, but little is known about what drives politicians' online popularity. In this article, we use data from a systematic tracking of congressional candidates' popularity on four web platforms...... help us understand the dynamics of internet politics, and have wider implications for candidate competition and party politics....

  17. Water drives peptide conformational transitions

    CERN Document Server

    Nerukh, Dmitry


    Transitions between metastable conformations of a dipeptide are investigated using classical molecular dynamics simulation with explicit water molecules. The distribution of the surrounding water at different moments before the transitions and the dynamical correlations of water with the peptide's configurational motions indicate that water is the main driving force of the conformational changes.

  18. CLIC Drive Beam Accelerating Structures

    CERN Document Server

    Wegner, Rolf


    Travelling structures for accelerating the high-current (4.2 A) CLIC Drive Beam to an energy of 2.37 GeV are presented. The structures are optimised for efficiency (full beam loading operation) and a desired filling time. Higher order modes are studied and are reduced by detuning along the structure and by damping with silicon carbide loads.

  19. Digital control of electrical drives

    CERN Document Server

    Vukosavic, Slobodan N


    Offers insight into electric drives and their usage in motion control environment. This book provides links among electrical machine and control theory, practical hardware aspects, programming issues, and application-specific problems. It covers the key elements of motion control systems, and discrete-time speed and position controllers.

  20. Foreign driving licences in Switzerland

    CERN Multimedia

    DG Unit


    1. Persons residing in Switzerland 1.1 Holders of a B, C, D, E or P-type "carte de légitimation" For holders of a B, C, D, E or P-type "carte de légitimation" issued by the Swiss Federal Department for Foreign Affairs (DFAE), current non-Swiss national driving licences are valid in Switzerland. If they so wish, holders of such driving licences may apply to the relevant road licensing authority in the canton where they live (Service des Automobiles et de la Navigation; for Geneva call + 41 22 388 30 30, website; for Vaud call + 41 21 316 82 10, website to exchange their driving licence for an equivalent Swiss licence (they must pass a test if they are not citizens of countries with which Switzerland has concluded an agreement on this matter, e.g. Member States of the European Union, the United States and Japan). However, such an exchange is not possible if the driving licence was issued in a foreign country during a...


    CERN Multimedia

    Relatiopns with the Host States Service


    1. PERSONS RESIDING IN SWITZERLAND 1.1 Holders of a B, C, D or E-type carte de légitimation For holders of B, C, D or E-type cartes de légitimation issued by the Swiss Federal Department for Foreign Affairs (Département fédéral suisse des Affaires étrangères, hereinafter called DFAE), current non-Swiss national driving licences are valid in Switzerland. Should they so wish, holders of such driving licences may apply to the relevant roads authority in the canton where they live (Service des Automobiles et de la Navigation ; for Geneva call 022/343 02 00, website:, for Vaud call 021/316 82 10, website: in order to exchange their driving licence for an equivalent Swiss licence. However, exchanges are not permitted if the driving licence was issued in a foreign country during a stay there of less than six months' duration while the person concerned was officially...

  2. Sensory drive in cichlid speciation

    NARCIS (Netherlands)

    Maan, Martine E.; Hofker, Kees D.; van Alphen, Jacques J. M.; Seehausen, Ole


    The role of selection in speciation is a central yet poorly understood problem in evolutionary biology. The rapid radiations of extremely colorful cichlid fish in African lakes have fueled the hypothesis that sexual selection can drive species divergence without geographical isolation. Here we prese

  3. CHARGE syndrome

    Directory of Open Access Journals (Sweden)

    Prasad Chitra


    Full Text Available Abstract CHARGE syndrome was initially defined as a non-random association of anomalies (Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness. In 1998, an expert group defined the major (the classical 4C's: Choanal atresia, Coloboma, Characteristic ears and Cranial nerve anomalies and minor criteria of CHARGE syndrome. Individuals with all four major characteristics or three major and three minor characteristics are highly likely to have CHARGE syndrome. However, there have been individuals genetically identified with CHARGE syndrome without the classical choanal atresia and coloboma. The reported incidence of CHARGE syndrome ranges from 0.1–1.2/10,000 and depends on professional recognition. Coloboma mainly affects the retina. Major and minor congenital heart defects (the commonest cyanotic heart defect is tetralogy of Fallot occur in 75–80% of patients. Choanal atresia may be membranous or bony; bilateral or unilateral. Mental retardation is variable with intelligence quotients (IQ ranging from normal to profound retardation. Under-development of the external genitalia is a common finding in males but it is less apparent in females. Ear abnormalities include a classical finding of unusually shaped ears and hearing loss (conductive and/or nerve deafness that ranges from mild to severe deafness. Multiple cranial nerve dysfunctions are common. A behavioral phenotype for CHARGE syndrome is emerging. Mutations in the CHD7 gene (member of the chromodomain helicase DNA protein family are detected in over 75% of patients with CHARGE syndrome. Children with CHARGE syndrome require intensive medical management as well as numerous surgical interventions. They also need multidisciplinary follow up. Some of the hidden issues of CHARGE syndrome are often forgotten, one being the feeding adaptation of these children, which needs an early aggressive approach from a feeding team. As the child

  4. Neuroacanthocytosis Syndromes

    Directory of Open Access Journals (Sweden)

    Walker Ruth H


    Full Text Available Abstract Neuroacanthocytosis (NA syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis and progressive degeneration of the basal ganglia. NA syndromes are exceptionally rare with an estimated prevalence of less than 1 to 5 per 1'000'000 inhabitants for each disorder. The core NA syndromes include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome which have a Huntington´s disease-like phenotype consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. In addition, cardiomyopathy may occur in McLeod syndrome. Acanthocytes are also found in a proportion of patients with autosomal dominant Huntington's disease-like 2, autosomal recessive pantothenate kinase-associated neurodegeneration and several inherited disorders of lipoprotein metabolism, namely abetalipoproteinemia (Bassen-Kornzweig syndrome and hypobetalipoproteinemia leading to vitamin E malabsorption. The latter disorders are characterized by a peripheral neuropathy and sensory ataxia due to dorsal column degeneration, but movement disorders and cognitive impairment are not present. NA syndromes are caused by disease-specific genetic mutations. The mechanism by which these mutations cause neurodegeneration is not known. The association of the acanthocytic membrane abnormality with selective degeneration of the basal ganglia, however, suggests a common pathogenetic pathway. Laboratory tests include blood smears to detect acanthocytosis and determination of serum creatine kinase. Cerebral magnetic resonance imaging may demonstrate striatal atrophy. Kell and Kx blood group antigens are reduced or absent in McLeod syndrome. Western blot for chorein demonstrates absence of this protein in red blood cells of chorea-acanthocytosis patients. Specific genetic testing is possible in all NA syndromes


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION: Hydrolethalus Syndrome (HLS is a rare lethal genetic syndrome, recognized as a consequence of a study on Meckle syndrome in Finland .1 HLS is characterized by multiple developmental defects of fetus which include fetal hydrocephalus, agenesis of corpus callosum, absent midline structures of brain, Cleft lip and cleft palate, defective lobulation of lungs, micrognathia and very characteristic abnormality of polydactyly. About 80% of patients have polydactyly, in hands it is postaxial and preaxial in feet with duplicated big toe. A highly characteristic hallux duplex is seen in almost no other situation .2 Club feet is also common.

  6. Hubris syndrome. (United States)

    Owen, David


    Hubris syndrome is associated with power, more likely to manifest itself the longer the person exercises power and the greater the power they exercise. A syndrome not to be applied to anyone with existing mental illness or brain damage. Usually symptoms abate when the person no longer exercises power. It is less likely to develop in people who retain a personal modesty, remain open to criticism, have a degree of cynicism or well developed sense of humour. Four heads of government in the last 100 years are singled out as having developed hubris syndrome: David Lloyd George, Margaret Thatcher, George W Bush and Tony Blair.

  7. CLOVES syndrome. (United States)

    Bloom, Jacob; Upton, Joseph


    A cohort of patients with overgrowth syndromes has been identified with congenital lipomatous overgrowth, dysregulated fat deposits, and mixed vascular malformations. The acronym CLOVES was given on a heuristic basis to stand for congenital lipomatous overgrowth (CLO), vascular malformation (V), epidermal nevi (E), and scoliosis and spinal deformities (S). These patients have upper limb anomalies with variable phenotypes. Although hand anomalies alone cannot make the diagnosis, the foot, truncal, cutaneous and spinal anomalies are particularly diagnostic. CLOVES syndrome has emerged as a distinct clinical entity diagnosed by clinical and radiographic examinations. The overgrowth pattern is now easily distinguished from other overgrowth syndromes.

  8. Alagille Syndrome (United States)

    ... Baby Boomers Get Tested Core Programs HE Webinar Disney 2014 5 Ways to Love Your Liver Liver ... Drive Away Liver Disease Liver Lowdown Aug 2013 Disney Marathon In The Field Healthy Foods Diet Recommendations ...

  9. Reye Syndrome (United States)

    ... Baby Boomers Get Tested Core Programs HE Webinar Disney 2014 5 Ways to Love Your Liver Liver ... Drive Away Liver Disease Liver Lowdown Aug 2013 Disney Marathon In The Field Healthy Foods Diet Recommendations ...

  10. [Autoinflammatory syndromes/fever syndromes]. (United States)

    Schedel, J; Bach, B; Kümmerle-Deschner, J B; Kötter, I


    Hereditary periodic (fever) syndromes, also called autoinflammatory syndromes, are characterized by relapsing fever and additional manifestations such as skin rashes, mucosal manifestations, or joint symptoms. Some of these disorders present with organ involvement and serological signs of inflammation without fever. There is a strong serological inflammatory response with an elevation of serum amyloid A (SAA), resulting in an increased risk of secondary amyloidosis. There are monogenic disorders (familial mediterranean fever (FMF), hyper-IgD-syndrome (HIDS), cryopyrin-associated periodic syndromes (CAPS), "pyogenic arthritis, acne, pyoderma gangrenosum" (PAPA), and "pediatric granulomatous arthritis (PGA) where mutations in genes have been described, which in part by influencing the function of the inflammasome, in part by other means, lead to the induction of the production of IL-1β. In "early-onset of enterocolitis (IBD)", a functional IL-10 receptor is lacking. Therapeutically, above all, the IL-1 receptor antagonist anakinra is used. In case of TRAPS and PGA, TNF-antagonists (etanercept) may also be used; in FMF colchicine is first choice. As additional possible autoinflammatory syndromes, PFAPA syndrome (periodic fever with aphthous stomatitis, pharyngitis and adenitis), Schnitzler syndrome, Still's disease of adult and pediatric onset, Behçet disease, gout, chronic recurrent multifocal osteomyelitis (CRMO) and Crohn's disease also are mentioned.

  11. Noonan syndrome (United States)

    ... chest shape (most often a sunken chest called pectus excavatum) Webbed and short-appearing neck Exams and Tests ... to consider genetic counseling before having children. Images Pectus excavatum References Ali O, Donohoue PA. Noonan syndrome. In: ...

  12. Marfan syndrome (United States)

    ... at least once every year. Alternative Names Aortic aneurysm - ... syndrome. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 702. ...

  13. Usher Syndrome (United States)

    ... optic nerve (arrow) looks very pale, the vessels (stars) are very thin and there is characteristic pigment, ... syndrome gene have a child together, with each birth there is a: 1-in-4 chance of ...

  14. Bart syndrome

    Directory of Open Access Journals (Sweden)

    Gaikwad Anil


    Full Text Available An infant presenting with extensive aplasia cutis on lower extremities later developed blisters on skin and mucous membrane. Clinical features and histopathological examination of skin favoured the diagnosis of Bart syndrome.

  15. Beals Syndrome (United States)

    ... arachnoldactyly (CCA), which refers to the joint contractures (shortening) that are key features of the syndrome. How ... remain contracted for long periods of time, the muscles can become tight and short, restricting movement. When ...

  16. Isaac's Syndrome (United States)

    ... Page NINDS Wernicke-Korsakoff Syndrome Information Page NINDS Whiplash Information Page NINDS Infantile Spasms Information Page NINDS ... Support Library Clinical Research Next Steps Pre-Funding: After Review Terms of Award Pre-Award Start-up ...

  17. Zellweger Syndrome (United States)

    ... Page NINDS Wernicke-Korsakoff Syndrome Information Page NINDS Whiplash Information Page NINDS Infantile Spasms Information Page NINDS ... Support Library Clinical Research Next Steps Pre-Funding: After Review Terms of Award Pre-Award Start-up ...

  18. Neurocutaneous Syndromes (United States)

    ... affect kids include: neurofibromatosis, types 1 and 2 (NF1 and NF2) Sturge-Weber syndrome tuberous sclerosis (TS) ... forms of this disorder are neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and Schwannomatosis. NF1 is ...

  19. [Mobius syndrome]. (United States)

    Vladuţiu, Cristina; Duma, Ionela


    Mobius syndrom, an anomaly in cranial nerve developement, presents with a remarkable clinical polymorphism. The rare occurence of this pathology and the questions raised by the diagnosis and treatment determined us to make this presentation.

  20. Autoinflammatory syndromes. (United States)

    Galeazzi, M; Gasbarrini, G; Ghirardello, A; Grandemange, S; Hoffman, H M; Manna, R; Podswiadek, M; Punzi, L; Sebastiani, G D; Touitou, I; Doria, A


    The autoinflammatory disorders are a new and expanding classification of inflammatory diseases characterized by recurrent episodes of systemic inflammation in the absence of pathogens, autoantibodies or antigen specific T cells. These disorders are caused by primary dysfunction of the innate immune system, without evidence of adaptive immune dysregulation. Innate immune abnormalities include aberrant responses to pathogen associated molecular patterns (PAMPs) like lipopolysaccharide and peptidoglycan, prominent neutrophilia in blood and tissues, and dysregulation of inflammatory cytokines (IL-1beta, TNF-alpha) or their receptors. The autoinflammatory diseases comprise both hereditary (Familial Mediterranean Fever, FMF; Mevalonate Kinase Deficiency, MKD; TNF Receptor Associated Periodic Syndrome, TRAPS; Cryopyrin Associated Periodic Syndrome, CAPS; Blau syndrome; Pyogenic sterile Arthritis, Pyoderma gangrenosum and Acne syndrome, PAPA; Chronic Recurrent Multifocal Osteomyelitis, CRMO) and multifactorial (Crohn's and Behçet's diseases) disorders. Mutations responsible for FMF, TRAPS, CAPS, PAPA are in proteins involved in modulation of inflammation and apoptosis.

  1. [Refeeding syndrome]. (United States)

    Ševela, Stanislav; Novák, František; Kazda, Antonín; Brodská, Helena


    Despite being known more than 60 years, refeeding syndrome (RS) still bears many uncertainties. For example, its definition is not clear and definite, and the attitude to it varies from the complete neglect to over-prevention.The term "refeeding syndrome" refers to electrolyte and metabolic changes occurring in malnourished patients after the readministration of nutrition. These changes concern especially to phosphates and ions. Potassium, magnesium, naturism and fluids balance are involved. The changes lead to cell energetic metabolism and electric potential disturbances, with related clinical symptoms.Fully developed refeeding syndrome is quite rare; nevertheless it can be fatal for the patient. However, even its development can lead to many complications increasing the patient's morbidity and the length of stay in the hospital. Yet the refeeding syndrome is more or less predictable and if kept in mind also preventable.The aim of this article is to get the reader to know more about this metabolic phenomenon and possible attitudes towards it.

  2. Barth Syndrome

    DEFF Research Database (Denmark)

    Saric, Ana; Andreau, Karine; Armand, Anne-Sophie


    Mutations in the gene encoding the enzyme tafazzin, TAZ, cause Barth syndrome (BTHS). Individuals with this X-linked multisystem disorder present cardiomyopathy (CM) (often dilated), skeletal muscle weakness, neutropenia, growth retardation, and 3-methylglutaconic aciduria. Biopsies of the heart,...

  3. Cockayne syndrome

    DEFF Research Database (Denmark)

    Karikkineth, Ajoy C; Scheibye-Knudsen, Morten; Fivenson, Elayne;


    Cockayne syndrome (CS) is a disorder characterized by a variety of clinical features including cachectic dwarfism, severe neurological manifestations including microcephaly and cognitive deficits, pigmentary retinopathy, cataracts, sensorineural deafness, and ambulatory and feeding difficulties...

  4. Gardner Syndrome (United States)

    ... or central nervous system tumor less than 1% Stomach cancer 0.5% Bile duct cancer small, but increased Adrenal gland cancer small, but increased What are the screening options for Gardner syndrome? The screening options for ...

  5. Metabolic syndrome (United States)

    ... obesity ). This body type may be described as "apple-shaped." Insulin resistance. Insulin is a hormone produced ... Syndrome Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

  6. Down Syndrome (United States)

    ... Diagnostic tests that can identify Down syndrome include: Amniocentesis. A sample of the amniotic fluid surrounding the ... somewhat higher risk of miscarriage than second trimester amniocentesis. Cordocentesis. In this test, also known as percutaneous ...

  7. Turner Syndrome (United States)

    ... in the inner layer of the aorta (aortic dissection). A defect in the valve between the heart ... Turner syndrome are at increased risk of aortic dissection during pregnancy, they should be evaluated by a ...

  8. Eagle's Syndrome


    Pinheiro, Thaís Gonçalves; Soares,Vítor Yamashiro Rocha; Ferreira,Denise Bastos Lage; Raymundo,Igor Teixeira; Nascimento, Luiz Augusto; Oliveira, Carlos Augusto Costa Pires de


    Summary Introduction: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is diffic...

  9. SAPHO syndrome. (United States)

    Carneiro, Sueli; Sampaio-Barros, Percival D


    SAPHO syndrome is a disorder characterized by Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis. As the osteoarticular and skin manifestations often do not occur simultaneously and there are no validated diagnostic criteria, the diagnosis can be difficult. Clinical and imaging investigation is necessary to establish the many differential diagnoses of SAPHO syndrome. The etiopathogenesis involves infectious (probably Propionibacterium acnes), immunologic, and genetic factors. Treatment is based on information gathered from case reports and small series, and is related to specific skin or articular symptoms.

  10. The warp drive and antigravity

    CERN Document Server

    Ellis, H G


    The warp drive envisioned by Alcubierre that can move a spaceship faster than light can, with modification, levitate it as if it were lighter than light, even allow it to go below a black hole's horizon and return unscathed. Wormhole-like versions of the author's `drainhole' (1973) might provide the drive, in the form of a by-pass of the spaceship composed of a multitude of tiny topological tunnels. The by-pass would divert the gravitational `ether' into a sink covering part of the spaceship's hull, connected by the tunnels to a source covering the remainder of the hull, to produce an ether flow like that of a river that disappears underground only to spring forth at a point downstream. This diversion would effectively shield the spaceship from external gravity.

  11. Inside Solid State Drives (SSDs)

    CERN Document Server

    Micheloni, Rino; Eshghi, Kam


    Solid State Drives (SSDs) are gaining momentum in enterprise and client applications, replacing Hard Disk Drives (HDDs) by offering higher performance and lower power. In the enterprise, developers of data center server and storage systems have seen CPU performance growing exponentially for the past two decades, while HDD performance has improved linearly for the same period. Additionally, multi-core CPU designs and virtualization have increased randomness of storage I/Os. These trends have shifted performance bottlenecks to enterprise storage systems. Business critical applications such as online transaction processing, financial data processing and database mining are increasingly limited by storage performance. In client applications, small mobile platforms are leaving little room for batteries while demanding long life out of them. Therefore, reducing both idle and active power consumption has become critical. Additionally, client storage systems are in need of significant performance improvement as well ...

  12. Carpenter syndrome. (United States)

    Hidestrand, Pip; Vasconez, Henry; Cottrill, Carol


    Carpenter syndrome is a rare autosomal recessive disorder that belongs to a group of rare craniosynostosis syndromes (Bull Soc Med Paris 1906;23:1310). Carpenter syndrome is the rarest, with only occasional patients seen. There are 3 common features in all of these syndromes: craniosynostosis (skull base abnormalities, with early fusion in different sutures), midface hypoplasia, and musculoskeletal abnormalities. Clinical features of Carpenter syndrome include peculiar facies, asymmetry of the skull, polydactyly, brachymesophalangy, mild soft tissue syndactyly, obesity, hypogenitalism, congenital heart disease, and mental retardation (J Pediatr 1966;69:1; Am J Roentgenol 1969;106). The brachycephaly is caused by early fusion in the coronal, sagittal, and lambdoidal sutures (Proc R Soc Med Sect Study Dis Child 1909). Most of the affected patients have a surgical procedure between 3 to 9 months of age to open the cranial vault to make space for the brain to grow (Plast Reconstr Surg 1978;62:335). We present a patient with Carpenter syndrome who is unusual in that she is an adult who has never had surgical intervention.

  13. Opportunities and Cooperation Drive Prosperity

    Institute of Scientific and Technical Information of China (English)


    The old industrial base is lying in Northeast China. Although boasting many advantages such as talents, resources, transportation, environment, the region still have many disadvantages that needs opening up and reform. Revitalizing the Northeast region is an important task for China to built well-off society in an all-round way in the new century. It is also a big strategy made after developing costal region and western region by Chinese leaders according to current situation, which is a driving force

  14. Foreign driving licences in France

    CERN Multimedia

    HR Department


    The following information is subject to possible amendments decided by the competent French authorities. Those wishing to undertake the necessary steps with the prefectural services of the Departments of the Ain and Haute-Savoie may obtain information by calling the following numbers: + 33 4 74 32 30 65 for the Ain and + 33 4 50 33 60 00 for Haute-Savoie. 1. PERSONS RESIDING IN FRANCE 1.1 Driving licences issued by a State belonging to the EU or the EEA a) Recognition on French territory All currently valid driving licences issued by States belonging to the European Union (EU) or to the European Economic Area (EEA) are generally valid for driving on French territory. However, if the licence was originally obtained in exchange for a licence issued by a State not belonging to the EU or to the EEA and with which France has not concluded a reciprocity agreement, it will be recognised for a maximum of one year following the date of establishment of normal residence in France ...


    CERN Multimedia

    DSU Unit


    The following information is provided subject to possible amendments decided by the competent French authorities. Those wishing to undertake the necessary steps with the prefectural services of the Departments of Ain and Haute-Savoie may obtain information by calling the following numbers: + 33 474 32 30 65 for Ain and + 33 450 33 60 00 for Haute-Savoie. 1. PEOPLE RESIDING IN FRANCE 1.1 Driving licences issued by a state belonging to the EU or the EEA a) Recognition on French territory All currently valid driving licences issued by States belonging to the European Union (EU) or to the European Economic Area (EEA) are generally valid for driving on French territory. However, if the licence was originally obtained in exchange for a licence issued by a State not belonging to the EU or to the EEA with which France has not concluded a reciprocity agreement, it is recognised only up to one year following the date of establishment of normal residence in France (date of the first special residence permit issu...


    CERN Multimedia

    Service des relations avec les Pays Hôtes


    1. PERSONS RESIDING IN FRANCE1.1 National driving licences from countries belonging to the EEAa) ValidityCurrent national driving licences issued by a country belonging to the European Economic Area (here inafter called EEA) are, in principle, valid in France. N.B. : The countries belonging to the EEA are Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom.b)\tRegistrationTo ensure that all the conditions of validity in France have been met, holders of driving licences issued by a country belonging to the EEA, who reside in France (i.e. hold a residence permit issued by a Préfecture, or a carte spéciale issued by the French Ministry of Foreign Affairs, which is equivalent to a residence permit), can have their licences registered with the Préfecture of the department where they live (for Ain, call 04 74 32 30 00, for Haute Savoie call 04 50 33 ...

  17. Foreign driving licences in Switzerland

    CERN Multimedia


    1. Persons residing in Switzerland 1.1 Holders of a B, C, D, E or P-type "carte de légitimation" For holders of a B, C, D, E or P-type "carte de légitimation" issued by the Swiss Federal Department for Foreign Affairs (DFAE), current non-Swiss national driving licences are valid in Switzerland. (see the official news about the new "Carte de légitimation P") If they so wish, holders of such driving licences may apply to the relevant road licensing authority in the canton where they live (Service des Automobiles et de la Navigation; for Geneva call + 41 22 388 30 30, website; for Vaud call + 41 21 316 82 10, website to exchange their driving licence for an equivalent Swiss licence (they must pass a test if they are not citizens of countries with which Switzerland has concluded an agreement on this matter, e.g. Member States of the European Union, the United States and Japan). However, such an exchange is not possible...

  18. Juvenile Polyposis Syndrome (United States)

    ... Types of Cancer > Juvenile Polyposis Syndrome Request Permissions Juvenile Polyposis Syndrome Approved by the Cancer.Net Editorial Board , 12/2015 What is juvenile polyposis syndrome? Juvenile polyposis syndrome (JPS) is a ...

  19. Cardiac Syndrome X (United States)

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  20. What is Metabolic Syndrome? (United States)

    ... from the NHLBI on Twitter. What Is Metabolic Syndrome? Metabolic syndrome is the name for a group of ... that may play a role in causing metabolic syndrome. Outlook Metabolic syndrome is becoming more common due to a ...

  1. Down Syndrome (For Kids) (United States)

    ... continue Do a Lot of People Have Down Syndrome? Down syndrome is not contagious , so you can't ... have it. What's Life Like for Kids With Down Syndrome? Many kids with Down syndrome go to regular ...

  2. Metabolic Syndrome (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Metabolic Syndrome KidsHealth > For Parents > Metabolic Syndrome A A A ... this is a condition called metabolic syndrome . About Metabolic Syndrome Not to be confused with metabolic disease (which ...

  3. Metabolic Syndrome (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Metabolic Syndrome KidsHealth > For Parents > Metabolic Syndrome Print A A ... this is a condition called metabolic syndrome . About Metabolic Syndrome Not to be confused with metabolic disease (which ...

  4. Implicit attitudes towards risky and safe driving

    DEFF Research Database (Denmark)

    Martinussen, Laila Marianne; Sømhovd, Mikael Julius; Møller, Mette;

    ; further, self-reports of the intention to drive safely (or not) are socially sensitive. Therefore, we examined automatic preferences towards safe and risky driving with a Go/No-go Association Task (GNAT). The results suggest that (1) implicit attitudes towards driving behavior can be measured reliably...... with the GNAT; (2) implicit attitudes towards safe driving versus towards risky driving may be separable constructs. We propose that research on driving behavior may benefit from routinely including measures of implicit cognition. A practical advantage is a lesser susceptibility to social desirability biases......, compared to self-report methods. Pending replication in future research, the apparent dissociation between implicit attitudes towards safe versus risky driving that we observed may contribute to a greater theoretical understanding of the causes of unsafe and risky driving behavior....

  5. Electron cyclotron heating and current drive

    NARCIS (Netherlands)

    Westerhof, E.


    Plasma heating and non-inductive current drive by waves in the electron cyclotron range of frequencies are reviewed. Both theoretical aspects concerning wave properties, heating and current drive mechanisms, as well as the major experimental results are summarized.

  6. UDRIVE : the European naturalistic driving study.

    NARCIS (Netherlands)

    Eenink, R.G. Barnard, Y. Baumann, M. Augros, X. & Utesch, F.


    UDRIVE is the first large-scale European Naturalistic Driving Study on cars, trucks and powered two wheelers. The acronym stands for “European naturalistic Driving and Riding for Infrastructure & Vehicle safety and Environment”. Naturalistic driving can be defined as a study undertaken to provide in

  7. Static load testing of a heliostat drive

    Energy Technology Data Exchange (ETDEWEB)

    Grossman, J.W.


    The drive designed and built by the Solar Power Engineering Company (SPECO) for its large area heliostat failed under high wind loads during a winter storm. This report details the testing and analysis done to verify the load capabilities of the rebuilt heliostat drive. Changes in design and improvements in fabrication resulted in a usable drive. 12 figs., 7 tabs.

  8. Driving When You Have Parkinson's Disease (United States)

    Driving When You Have Parkinson’s Disease DRIVEWELL You have been a safe driver for years. For you, driving means freedom and control. As you get older, ... mental health can affect how safely you drive. Parkinson’s disease is a disorder of the central nervous system ...

  9. 77 FR 51610 - Distracted Driving Grant Program (United States)


    ... Driving Grant (hereinafter ``First-Year Texting-Ban Grant''). See ] Section III.C. The basis for an award... Section 405(e), as outlined below: (1) Prohibition on texting while driving. The State statute must-- (a) Prohibit drivers from texting through a personal wireless communications device while driving; (b)...

  10. CAAD: Computer Architecture for Autonomous Driving


    Liu, Shaoshan; Tang, Jie; Zhang, Zhe; Gaudiot, Jean-Luc


    We describe the computing tasks involved in autonomous driving, examine existing autonomous driving computing platform implementations. To enable autonomous driving, the computing stack needs to simultaneously provide high performance, low power consumption, and low thermal dissipation, at low cost. We discuss possible approaches to design computing platforms that will meet these needs.

  11. Pfeiffer syndrome

    Directory of Open Access Journals (Sweden)

    Fryns Jean-Pierre


    Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

  12. Burnout syndrome and analytical hypnosis

    Directory of Open Access Journals (Sweden)

    Carolusson, Susanna


    Full Text Available The author aims to discuss her experience that patients with Burnout syndromes need to recover in a unique individualised relational therapy and that they need a slower pace than national authorities are implementing through contemporary national guidelines for health and care systems. The author reviews published definitions of the syndrome and then presents two cases to illustrate the principle of finding the patients’ own resources, the value of exploring the history of their drive to achieve and also how to utilize resistance as information about defenses and their functions. She uses hypnosis, hypnoanalysis and ego state imagery as a tool for finding the patients’ pace, needs and unique ways for recovery.

  13. Heavy consumption and drink driving

    DEFF Research Database (Denmark)

    Fynbo, Lars


    on the interviewee’s risk behaviour, especially in relation to driving. The interviewees are first divided into 1) a group of young “edgeworkers” with pronounced general risk behaviour, 2) a group of middle-aged “post-edgeworkers”, most with criminal records, and 3) a group of middle-aged and older heavy consumers...... with a more comprehensive approach towards drinking. In this paper focus is on the younger edgeworkers and post-edgeworkers, to which alcohol seems to play lesser role and is often mixed with other drugs as part of a wider scope of seeking excitement from risky behaviour....

  14. Error signals driving locomotor adaptation

    DEFF Research Database (Denmark)

    Choi, Julia T; Jensen, Peter; Nielsen, Jens Bo


    perturbations. Forces were applied to the ankle joint during the early swing phase using an electrohydraulic ankle-foot orthosis. Repetitive 80 Hz electrical stimulation was applied to disrupt cutaneous feedback from the superficial peroneal nerve (foot dorsum) and medial plantar nerve (foot sole) during...... anaesthesia (n = 5) instead of repetitive nerve stimulation. Foot anaesthesia reduced ankle adaptation to external force perturbations during walking. Our results suggest that cutaneous input plays a role in force perception, and may contribute to the 'error' signal involved in driving walking adaptation when...

  15. Electric Drive Study. Volume 1 (United States)



  16. [Serotonin syndrome]. (United States)

    Lheureux, P; Penaloza, A; De Cottenier, V; Ullmann, U; Gris, M


    The serotonin syndrome is a hyperserotoninergic state resulting from an excess of intrasynaptic 5-hydroxytryptamine, induced by multiple psychotropic agents, but also non psychiatric drugs. It is a potentially dangerous and sometimes lethal condition. The clinical manifestations usually include cognitive, neuromuscular and autonomic features and are mediated by the action of serotonin on various subtypes of receptors. The main differential diagnosis is the neuroleptic malignant syndrome. Treatment is mainly supportive. No pharmacological agent has been definitely demonstrated really effective. However, reports of cases treated with the 5-HT2 blockers, including cyproheptadine or chlorpromazine have suggested that these agents could have some efficacy. Serotonin syndrome is a toxic condition which requires heightened clinical awareness among physicians in order to prevent, recognize, and treat the condition promptly.

  17. Lemierre's syndrome

    DEFF Research Database (Denmark)

    Johannesen, Katrine M; Bodtger, Uffe


    necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre....../or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium......This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and...

  18. Microcephaly syndromes. (United States)

    Abuelo, Dianne


    The objective of this article is to review microcephaly from a genetics point of view, especially with regard to the process of identification of syndromes in which small head circumference occurs. Microcephaly can be due to either genetic or environmental causes. It can be the only positive finding or may be part of a syndrome of congenital anomalies. The genetic etiology can be caused by autosomal dominant, autosomal recessive, or X-linked genes or various types of chromosome anomalies. Some of the gene mutations have been identified recently. Syndromic microcephaly is associated with a large number of conditions. Some can be diagnosed, or at least suspected, based on their characteristic facial dysmorphism, and others can be searched for using databases of genetic disorders.

  19. Postconcussional Syndrome

    Directory of Open Access Journals (Sweden)

    Necla Keskin


    Full Text Available Postconcussional syndrome is characterized by somatic, cognitive and psychiatric (emotional, behavioral symptoms that occurs after mild traumatic brain injury. It has been known that these symptoms recover fully within 3-6 months almost in 90% of patients. Although its etiology is still controversial, biological, psychological and social factors may account for the development and continuation of the symptoms. Diagnosis is based on the subjective complaints. To find out an objective method for definite diagnosis, trials searching for both neuroimaging and specific serum biomarkers stil continue. The treatment of the syndrome is mainly of palliative nature. Information, education, reassurance and multifaceted rehabilitation programmes can be beneficial. There are promising trials reporting the effectiveness of cognitive behavioral therapy in the treatment of postconcussional syndrome. [Archives Medical Review Journal 2013; 22(1.000: 96-109

  20. Compartment syndromes (United States)

    Mubarak, S. J.; Pedowitz, R. A.; Hargens, A. R.


    The compartment syndrome is defined as a condition in which high pressure within a closed fascial space (muscle compartment) reduces capillary blood perfusion below the level necessary for tissue viability'. This condition occurs in acute and chronic (exertional) forms, and may be secondary to a variety of causes. The end-result of an extended period of elevated intramuscular pressure may be the development of irreversible tissue injury and Volkmann's contracture. The goal of treatment of the compartment syndrome is the reduction of intracompartmental pressure thus facilitating reperfusion of ischaemic tissue and this goal may be achieved by decompressive fasciotomy. Controversy exists regarding the critical pressure-time thresholds for surgical decompression and the optimal diagnostic methods of measuring intracompartmental pressures. This paper will update and review some current knowledge regarding the pathophysiology, aetiology, diagnosis, and treatment of the acute compartment syndrome.

  1. Refeeding syndrome

    Directory of Open Access Journals (Sweden)

    Tripathy Swagata


    Full Text Available We report a case of a fifty-year-old male who was admitted with a three month history of increasing weakness, prostration, decreasing appetite and inability to swallow. The patient was a chronic alcoholic, unemployed, and of very poor socioeconomic background. The patient was initially investigated for upper GI malignancy, Addisons disease, bulbar palsy and other endocrinopathies. Concurrent management was started for severe electrolyte abnormalities and enteral nutritional supplementation was begun. By the fourth day of feeding patient developed severe hypophosphatemia and other life-threatening features suggesting refeeding syndrome. The patient was managed for the manifestations of refeeding syndrome. A final diagnosis of chronic alcoholic malnutrition with refeeding syndrome was made. Refeeding of previously starving patients may lead to a variety of complications including sudden death.

  2. Fraser syndrome

    DEFF Research Database (Denmark)

    Barisic, Ingeborg; Odak, Ljubica; Loane, Maria


    Fraser syndrome is a rare autosomal recessive disorder characterized by cryptophthalmos, cutaneous syndactyly, laryngeal, and urogenital malformations. We present a population-based epidemiological study using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network...... of birth defect registries. Between January 1990 and December 2008, we identified 26 cases of Fraser syndrome in the monitored population of 12,886,464 births (minimal estimated prevalence of 0.20 per 100,000 or 1:495,633 births). Most cases (18/26; 69%) were registered in the western part of Europe, where...... was particularly high (42%). Most cases of Fraser syndrome (85%) are suspected prenatally, often due to the presence of the association of renal agenesis and cryptophthalmos. In the European population, a high proportion (82%) of pregnancies is terminated, thus reducing the live birth prevalence to a third...

  3. Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Sevil Ikinci


    Full Text Available Metabolic Syndrome is a combination of risk factors including common etiopathogenesis. These risk factors play different roles in occurence of atherosclerotic diseases, type 2 diabetes, and cancers. Although a compromise can not be achieved on differential diagnosis for MS, the existence of any three criterias enable to diagnose MS. These are abdominal obesity, dislipidemia (hypertrigliceridemia, hypercholesterolemia, and reduced high density lipoprotein hypertension, and elevated fasting blood glucose. According to the results of Metabolic Syndrome Research (METSAR, the overall prevalence of MS in Turkey is 34%; in females 40%, and in males it is 28%. As a result of “Western” diet, and increased frequency of obesity, MS is observed in children and in adolescents both in the world and in Turkey. Resulting in chronic diseases, it is thought that the syndrome can be prevented by healthy lifestyle behaviours. [TAF Prev Med Bull 2010; 9(5.000: 535-540

  4. Permanent magnetic toroidal drive with half stator

    Directory of Open Access Journals (Sweden)

    Lizhong Xu


    Full Text Available A permanent magnetic toroidal drive with a half stator is proposed that avoids noise and mechanical vibrations. The effects of the system parameters on the output torque of the drive were investigated. A model machine was designed and produced. The output torque and speed fluctuation of the drive system were measured, and the calculated and measured output torque were compared. The tests demonstrated that the drive system could operate continuously without noise, and the system achieved a given speed ratio. The drive system had high load-carrying ability and a maximum output torque of 0.15 N m when certain parameter values were used.

  5. Eagle's Syndrome

    Directory of Open Access Journals (Sweden)

    Pinheiro, Thaís Gonçalves


    Full Text Available Introduction: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. Objective: To describe a case of Eagle's syndrome. Case Report: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. Final Comments: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical.

  6. [PFAPA syndrome]. (United States)

    André, Suzete Costa Anjos; Vales, Fernando; Cardoso, Eduardo; Santos, Margarida


    PFAPA syndrome is characterized by periodic fever, pharyngitis, cervical adenitis and aphthous stomatitis. The bouts of fever can last for days or even weeks. Between crises, patients remain asymptomatic for variable periods. It appears before the age of five and has limited duration (4-8 years). Its aetiopathogeny is unknown. Corticoids are the treatment of choice. Tonsillectomy has been proposed as a solution but remains controversial. We present the case of a 4-year-old girl with PFAPA syndrome who underwent tonsillectomy in January, 2008, and we review the literature.

  7. Lemierre's syndrome.

    LENUS (Irish Health Repository)

    O'Dwyer, D N


    Lemierre\\'s syndrome is a rare disease that results in an oropharyngeal infection, which precipitates an internal jugular vein thrombosis and metastatic infection. Fusobacterium necrophorum is an anaerobic Gram-negative bacillus and has been identified as the causative agent. We describe the case of a young girl whose presentation and diagnosis were confounded by a history of valvular heart disease. Infection of heart valves can produce many of the signs and symptoms associated with Lemierre\\'s syndrome. We describe the diagnosis, investigation and optimal management of this rare disorder.

  8. Waardenburg syndrome

    Directory of Open Access Journals (Sweden)

    Tagra Sunita


    Full Text Available Waardenburg syndrome is a rare inherited and genetically heterogenous disorder of neural crest cell development. Four distinct subtypes showing marked interfamilial and intrafamilial variability have been described. We report a girl showing constellation of congenital hearing impairment with 110 dB and 105 dB loss in right and left ear respectively, hypoplastic blue iridis, white forelock, dystopia canthorum and broad nasal root. Other affected relatives of the family, with variable features of the syndrome, have been depicted in the pedigree.

  9. Eisenmengers syndrom

    DEFF Research Database (Denmark)

    Jensen, Annette Schophuus; Iversen, Kasper; Vejlstrup, Niels G;


    Congenital heart disease with left-to-right shunt can induce proliferation, vasoconstriction and thrombosis in the pulmonary vascular bed. Eventually, the patient may develop Eisenmenger syndrome defined as pulmonary arterial hypertension caused by high pulmonary vascular resistance with right......-to-left shunt and cyanosis. Patients with Eisenmenger syndrome suffer a high risk of complications in connection with acute medical conditions, extra-cardiac surgery and pregnancy. This article describes the precautions that should be taken to reduce morbidity and mortality in these patients. Udgivelsesdato...

  10. Olmsted syndrome

    Directory of Open Access Journals (Sweden)

    Kumar Pramod


    Full Text Available Olmsted syndrome is a rare disorder characterized by the combination of periorificial, keratotic plaques and bilateral palmoplantar keratoderma. New associated features are being reported. Olmsted syndrome is particularly rare in a female patient, and we report such a case in a six year-old Indian girl, who presented with keratoderma of her soles since birth and on her palms since the age of two years along with perioral and perinasal hyperkeratosis. She had sparse, light brown, thin hair. Although the psychomotor development of the child was normal until 18 months of age, the keratoderma plaques had restricted the child′s mobility after that stage.

  11. [Wilkie's syndrome]. (United States)

    Bognár, Gábor; Ledniczky, György; Palik, Eva; Zubek, László; Sugár, István; Ondrejka, Pál


    Loss of retroperitoneal fatty tissue as a result of a variety of debilitating conditions and noxa is believed to be the etiologic factor of superior mesenteric artery syndrome. A case of a 35 years old female patient with severe malnutrition and weight loss is presented, who developed superior mesenteric artery syndrome. Various theories of etiology, clinical course and treatment options of this uncommon disease are discussed. In our case, conservative management was inefficient, while surgical treatment aiming to bypass the obstruction by an anastomosis between the jejunum and the proximal duodenum (duodenojejunostomy) was successful. An interdisciplinary teamwork provides the most beneficial diagnostic and therapeutic result in this often underestimated disease.

  12. Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Ramachandran Sudarshan


    Full Text Available Turner syndrome is a genetic disorder that affects mostly females. Affected females have characteristic features such as short stature, premature ovarian failure, and several other features. Oral manifestations of this condition are not much discussed in the literature. But reported literature includes teeth, palate, periodontal and salivary changes. So the aim of this review is to illustrate the general manifestations, and especially the oral manifestations of Turner syndrome and evaluate their possible management. [Archives Medical Review Journal 2012; 21(4.000: 246-252

  13. Gorlin Syndrome

    Directory of Open Access Journals (Sweden)

    Siroos Risbaf


    Full Text Available Gorlin syndrome is a dominant autosomal familial disorder. The manifestations begin at an early age and a combination of phenotypic abnormalities such special facial appearance, jaw cysts and skeletal anomalies are seen in this disease. A 22-year-old woman referred to Zahedan Dental School complaining of pain on the left cheek. During the examination, several cutaneous lesions in the neck, pits in palm and sole and multiple jaw cysts were observed. According to the clinical symptoms, lesion biopsy and reports of Gorlin syndrome radiography were presented.

  14. Morbihan syndrome. (United States)

    Veraldi, Stefano; Persico, Maria Chiara; Francia, Claudia


    We report a case of severe Morbihan syndrome (chronic erythematous edema of the upper portion of the face) in a 60-year-old man. The syndrome was characterized clinically by erythematous edema involving the forehead, glabella, and both eyelids, because of which the patient was not able to open completely his eyes. Furthermore, erythema and telangiectasiae were visible on the nose and cheeks. Laboratory and instrumental examinations were within normal ranges or negative. Histopathological examination showed dermal edema, perivascular and periadnexal lympho-histiocytic infiltrate, and sebaceous gland hyperplasia. Oral isotretinoin was ineffective despite the relatively long duration of the therapy (26 weeks).

  15. Morbihan syndrome

    Directory of Open Access Journals (Sweden)

    Stefano Veraldi


    Full Text Available We report a case of severe Morbihan syndrome (chronic erythematous edema of the upper portion of the face in a 60-year-old man. The syndrome was characterized clinically by erythematous edema involving the forehead, glabella, and both eyelids, because of which the patient was not able to open completely his eyes. Furthermore, erythema and telangiectasiae were visible on the nose and cheeks. Laboratory and instrumental examinations were within normal ranges or negative. Histopathological examination showed dermal edema, perivascular and periadnexal lympho-histiocytic infiltrate, and sebaceous gland hyperplasia. Oral isotretinoin was ineffective despite the relatively long duration of the therapy (26 weeks.

  16. Driving Extreme Efficiency to Market (United States)

    Garbesi, Karina


    The rapid development of extremely energy efficient appliances and equipment is essential to curtail catastrophic climate disruption. This will require the on-going development of products that apply all best-practices and that take advantage of the synergies of hybridization and building integration. Beyond that, it requires the development of new disruptive technologies and concepts. To facilitate these goals, in 2011 the Lawrence Berkeley National Laboratory and the U.S. Department of Energy launched the Max Tech and Beyond Design Competition for Ultra-Low-Energy-Use Appliances and Equipment. Now in its third year, the competition supports faculty-lead student design teams at U.S. universities to develop and test new technology prototypes. This talk describes what the competition and the Max Tech Program are doing to drive such rapid technology progress and to facilitate the entry to the market of successful Max Tech prototypes. The talk also initiates a discussion of physicists' unique role in driving that technology progress faster and farther. Emerging Technologies, Building Technologies Office, U.S. Department of Energy.

  17. Computer Security: drive-bye

    CERN Multimedia

    Stefan Lueders, Computer Security Team


    Like a lion waiting to ambush gazelles at a waterhole, malware can catch you by surprise.    As some of you might have noticed, the Computer Security Team had to block the news site “” a while ago, as it was found to be distributing malware. This block comes after similar incidents at other Swiss organizations. Our blocking is protective in order to safeguard your computers, laptops, tablets and smartphones. Unfortunately, this is not the first time we have seen these so-called drive-by/waterhole attacks: once you have visited an affected website, embedded third-party malicious code is downloaded to your computer and subsequently infects it (if running Windows or Android as well as, less likely, Mac operating systems). Hence the name “drive-by”. As “” is a very frequented website among CERN staff members and users, it makes it a perfect source for attacks against CERN (or other Geneva-based organisations): inste...

  18. Exposure to Movie Reckless Driving in Early Adolescence Predicts Reckless, but Not Inattentive Driving.

    Directory of Open Access Journals (Sweden)

    Evelien Kostermans

    Full Text Available We examine the association between exposure to depictions of reckless driving in movies and unsafe driving, modeling inattentive and reckless driving as separate outcomes.Data were obtained by telephone from 1,630 US adolescents aged 10 to 14 years at baseline who were drivers at a survey 6 years later. Exposure to movie reckless driving was measured based on movies seen from a randomly selected list of 50 movie titles that had been content coded for reckless driving among characters. Associations were tested with inattentive and reckless driving behaviors in the subsequent survey-controlling for baseline age, sex, socioeconomic status, parental education, school performance, extracurricular activities, daily television and video/computer game exposure, number of movies watched per week, self-regulation and sensation seeking.Exposure to movie reckless driving was common, with approximately 10% of movie characters having driven recklessly. Confirmatory factor analysis revealed a significant distinction between items tapping reckless and inattentive driving at the 6th wave. Age and exposure to movie reckless driving at baseline were directly associated with wave-6 reckless (but not inattentive driving. Additionally, growth in sensation seeking mediated a prospective relation between the total number of movies watched per week at baseline and reckless driving, independent of exposure to movie reckless driving. Males and high sensation seekers reported lower seatbelt usage and more reckless driving, whereas lower self-regulation predicted inattentive driving.In this study, exposure to movie reckless driving during early adolescence predicted adolescents' reckless driving, suggesting a direct modeling effect. Other aspects of movies were also associated with reckless driving, with that association mediated through growth in sensation seeking. Predictors of reckless driving were different from predictors of inattentive driving, with lower self

  19. Marfan syndrome masked by Down syndrome?

    NARCIS (Netherlands)

    Vis, J.C.; Engelen, K. van; Timmermans, J.; Hamel, B.C.J.; Mulder, B.J.


    Down syndrome is the most common chromosomal abnormality. A simultaneous occurrence with Marfan syndrome is extremely rare. We present a case of a 28-year-old female with Down syndrome and a mutation in the fibrillin-1 gene. The patient showed strikingly few manifestations of Marfan syndrome. Althou

  20. Impact of Facial Conformation on Canine Health: Brachycephalic Obstructive Airway Syndrome.

    Directory of Open Access Journals (Sweden)

    Rowena M A Packer

    Full Text Available The domestic dog may be the most morphologically diverse terrestrial mammalian species known to man; pedigree dogs are artificially selected for extreme aesthetics dictated by formal Breed Standards, and breed-related disorders linked to conformation are ubiquitous and diverse. Brachycephaly--foreshortening of the facial skeleton--is a discrete mutation that has been selected for in many popular dog breeds e.g. the Bulldog, Pug, and French Bulldog. A chronic, debilitating respiratory syndrome, whereby soft tissue blocks the airways, predominantly affects dogs with this conformation, and thus is labelled Brachycephalic Obstructive Airway Syndrome (BOAS. Despite the name of the syndrome, scientific evidence quantitatively linking brachycephaly with BOAS is lacking, but it could aid efforts to select for healthier conformations. Here we show, in (1 an exploratory study of 700 dogs of diverse breeds and conformations, and (2 a confirmatory study of 154 brachycephalic dogs, that BOAS risk increases sharply in a non-linear manner as relative muzzle length shortens. BOAS only occurred in dogs whose muzzles comprised less than half their cranial lengths. Thicker neck girths also increased BOAS risk in both populations: a risk factor for human sleep apnoea and not previously realised in dogs; and obesity was found to further increase BOAS risk. This study provides evidence that breeding for brachycephaly leads to an increased risk of BOAS in dogs, with risk increasing as the morphology becomes more exaggerated. As such, dog breeders and buyers should be aware of this risk when selecting dogs, and breeding organisations should actively discourage exaggeration of this high-risk conformation in breed standards and the show ring.

  1. Dumping Syndrome (United States)

    ... stomach move to your small intestine in an uncontrolled, abnormally fast manner. This is most often related to changes in your stomach associated with surgery. Dumping syndrome can occur after any stomach operation or removal of the esophagus (esophagectomy). Gastric bypass surgery for ...

  2. Sotos Syndrome (United States)

    ... 663-4637) Sotos Syndrome Support Association P.O. Box 4626 Wheaton IL Wheaton, IL 60189 Tel: 888-246-7772 The Arc of the United States 1825 K Street, NW ...

  3. Reifenstein syndrome (United States)

    Androgens are most important during early development in the womb. People with Reifenstein syndrome can have a normal lifespan and be totally healthy, but they may have difficulty conceiving a child. In the most severe cases, boys with outer female genitals ...

  4. Nodding Syndrome

    Centers for Disease Control (CDC) Podcasts


    Dr. Scott Dowell, a CDC director, discusses the rare illness, nodding syndrome, in children in Africa.  Created: 12/19/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/27/2014.

  5. Lemierre's syndrome

    DEFF Research Database (Denmark)

    Johannesen, Katrine; Bødtger, Uffe; Heltberg, Ole


    a variety of infectious complications. Rapid diagnosis and treatment is necessary to avoid severe complications or death. Close collaboration with local microbiologist is pivotal. Treatment consists of longterm treatment with penicillin and metronidazole. This is a case report of Lemierre's syndrome....

  6. [Waardenburg's syndrome]. (United States)

    Gimñenez, F; Carbonell, R; Pérez, F; Lozano, I


    Reporting one case of this condition type-2 with heterochromia iridis and cochlear deafness. The AA. review the syndrome's components and it nomenclature as well. They discuss about the convenience of including this deviation in the chapter of "diseases of the embryonic neural crest". The specific place of the gene responsibly in the chromosome-2 and the possibilities of genetic counselling are considered.

  7. Waardenburg's syndrome. (United States)

    Yesudian, D P; Jayaraman, M; Janaki, V R; Yesudian, P


    Three children in a family of five presented with heterochromia iridis, lateral displacement of inner canthi and varying degrees of sensorineural deafness. All the 3 showed iris atrophy. The father of the children had only heterochromia iridis. A diagnosis of Waardenburg's syndrome Type I was made in the children with the father probably representing a forme fruste of the condition.

  8. Klinefelter Syndrome

    Directory of Open Access Journals (Sweden)

    Hande Peynirci


    Full Text Available Klinefelter syndrome is the most common sex chromosome disorder in males. Variation in clinical presentation and insufficient awareness of this syndrome among clinicians lead to fifty percent of patients remain undetected. Typical clinical features of Klinefelter syndrome are various degrees of hypogonadal symptoms, atrophic testes and gynaecomastia. However, these typical clinical symptoms may not be present in all patients. Even if serum testosterone levels are not markedly low, elevated serum follicle-stimulating hormone is a considerable laboratory finding. Definitive diagnosis is made by karyotype analysis of peripheral blood lymphocytes. It must be kept in mind that this analysis may be normal in rare conditions. Early recognition of patients during puberty and handling them as soon as possible is important. Testosterone replacement therapy results in increased muscle mass, bone mineral density and libido. The patient’s mood and self-esteem improve significantly. In general, patients with Klinefelter syndrome are accepted as infertile, however, assisted reproductive techniques may provide fertilization. Turk Jem 2013; 17: 63-7

  9. Aicardi Syndrome (United States)

    ... such as lower tone around the head and trunk, microcephaly (small head circumference), and spasticity in the limbs. Typical findings in the brain of girls with Aicardi syndrome include heterotopias , which are groups of brain cells that, during development, migrated to the wrong area ...

  10. Gitelman syndrome.

    NARCIS (Netherlands)

    Knoers, N.V.A.M.; Levtchenko, E.N.


    Gitelman syndrome (GS), also referred to as familial hypokalemia-hypomagnesemia, is characterized by hypokalemic metabolic alkalosis in combination with significant hypomagnesemia and low urinary calcium excretion. The prevalence is estimated at approximately 1:40,000 and accordingly, the prevalence

  11. Rett Syndrome. (United States)

    Culbert, Linda A.

    This pamphlet reviews the historical process involved in initially recognizing Rett Syndrome as a specific disorder in girls. Its etiology is unknown, but studies have considered factors as hyperammonemia, a two-step mutation, a fragile X chromosome, metabolic disorder, environmental causation, dopamine deficiency, and an inactive X chromosome.…

  12. Chylomicronemia syndrome (United States)

    ... the blood. The disorder is passed down through families. Causes Chylomicronemia syndrome can occur due to a rare genetic disorder in which a protein (enzyme) called lipoprotein lipase (LpL) is broken or missing. LpL is normally found in fat and muscle. ...

  13. Proteus syndrome

    Directory of Open Access Journals (Sweden)

    Debi Basanti


    Full Text Available Proteus syndrome is a variable and complex disorder characterized by multifocal overgrowths affecting any tissue or structure of the body. We present a girl aged 3 years and 8 months with an epidermal nevus, port-wine stain, macrodactyly with gigantism of the feet, lymphohemagiomas and multiple lipomas.

  14. Metabolic syndrome

    Institute of Scientific and Technical Information of China (English)

    Charles Shaeffer


    @@ The emergence of cardiac disease as the number one world-wide cause of death justifies efforts to identify individuals at higher risk for preventive therapy. The metabolic syndrome, originally described by Reaven, 1 has been associated with higher cardiovascular disease risk. 2 Type Ⅱ diabetes is also a frequent sequela. 3

  15. Troyer Syndrome (United States)

    ... atrophy of the hand muscles, developmental delays, fluctuating emotions, and short stature. Onset is typically in early childhood, and symptoms gradually worsen over time. Troyer syndrome is an autosomal recessive disorder (meaning that both parents must carry and pass on the defective gene ...

  16. Caplan syndrome (United States)

    ... CT scan of the chest Joint x-rays Pulmonary function tests Rheumatoid factor test and other blood tests Treatment There is no specific treatment for Caplan syndrome, other than treating any lung and joint disease. ... MD, MHS, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, ...

  17. Brugada Syndrome (United States)

    ... to look at your heart's electrical activity (electrophysiology study), you'll need to fast for eight to 12 hours before your test. Write down any symptoms you're experiencing, including any that may seem unrelated to Brugada syndrome. Write down key personal information, especially any family ...

  18. [SAPHO syndrome]. (United States)

    Heldmann, F; Kiltz, U; Baraliakos, X; Braun, J


    The SAPHO syndrome, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a rare disease which affects bones, joints and the skin. The main osteoarticular features are hyperostosis and osteitis. Osteoarticular symptoms predominantly occur on the anterior chest wall but the spine and the peripheral skeleton can also be involved. The most important skin affections are palmoplantar pustulosis and severe acne. The etiology of this syndrome remains unclear but infectious, immunological and genetic factors are involved. The diagnostic features of SAPHO syndrome are clinical and radiological. The most important diagnostic procedure is Tc-99 m bone scintigraphy but conventional x-rays as well as computed tomography (CT) and magnetic resonance imaging (MRI) can also contribute to the final diagnosis. Bone histology and positron emission tomography CT (PET-CT) may help to differentiate SAPHO syndrome from malignancies and infectious osteomyelitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of treatment. The results obtained using antibiotics and disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine and methotrexate are inconsistent. Bisphosphonates and anti-tumor necrosis factor (anti-TNF) drugs have shown promising results in small studies but further research is still necessary.

  19. Bloom syndrome. (United States)

    Arora, Harleen; Chacon, Anna H; Choudhary, Sonal; McLeod, Michael P; Meshkov, Lauren; Nouri, Keyvan; Izakovic, Jan


    Bloom Syndrome (BS, MIM #210900) is an autosomal recessive genetic disorder caused by a mutation in the BLM gene, which codes for the DNA repair enzyme RecQL3 helicase. Without proper DNA repair mechanisms, abnormal DNA exchange takes place between sister chromatids and results in genetic instability that may lead to cancer, especially lymphoma and acute myelogenous leukemia, lower and upper gastrointestinal tract neoplasias, cutaneous tumors, and neoplasias in the genitalia and urinary tract. BS patients are usually of Ashkenazi Jewish descent and exhibit narrow facial features, elongated limbs, and several dermatologic complications including photosensitivity, poikiloderma, and telangiectatic erythema. The most concerning manifestation of BS is multiple malignancies, which require frequent screenings and strict vigilance by the physician. Therefore, distinguishing between BS and other dermatologic syndromes of similar presentation such as Rothmund-Thomson Syndrome, Erythropoietic Protoporphyria, and Cockayne Syndrome is paramount to disease management and to prolonging life. BS can be diagnosed through a variety of DNA sequencing methods, and genetic testing is available for high-risk populations. This review consolidates several sources on BS sequelae and aims to suggest the importance of differentiating BS from other dermatologic conditions. This paper also elucidates the recently discovered BRAFT and FANCM protein complexes that link BS and Fanconi anemia.

  20. Circuit for Driving Piezoelectric Transducers (United States)

    Randall, David P.; Chapsky, Jacob


    The figure schematically depicts an oscillator circuit for driving a piezoelectric transducer to excite vibrations in a mechanical structure. The circuit was designed and built to satisfy application-specific requirements to drive a selected one of 16 such transducers at a regulated amplitude and frequency chosen to optimize the amount of work performed by the transducer and to compensate for both (1) temporal variations of the resonance frequency and damping time of each transducer and (2) initially unknown differences among the resonance frequencies and damping times of different transducers. In other words, the circuit is designed to adjust itself to optimize the performance of whichever transducer is selected at any given time. The basic design concept may be adaptable to other applications that involve the use of piezoelectric transducers in ultrasonic cleaners and other apparatuses in which high-frequency mechanical drives are utilized. This circuit includes three resistor-capacitor networks that, together with the selected piezoelectric transducer, constitute a band-pass filter having a peak response at a frequency of about 2 kHz, which is approximately the resonance frequency of the piezoelectric transducers. Gain for generating oscillations is provided by a power hybrid operational amplifier (U1). A junction field-effect transistor (Q1) in combination with a resistor (R4) is used as a voltage-variable resistor to control the magnitude of the oscillation. The voltage-variable resistor is part of a feedback control loop: Part of the output of the oscillator is rectified and filtered for use as a slow negative feedback to the gate of Q1 to keep the output amplitude constant. The response of this control loop is much slower than 2 kHz and, therefore, does not introduce significant distortion of the oscillator output, which is a fairly clean sine wave. The positive AC feedback needed to sustain oscillations is derived from sampling the current through the

  1. Older drivers with cognitive impairment: Perceived changes in driving skills, driving-related discomfort and self-regulation of driving

    DEFF Research Database (Denmark)

    Meng, A.; Siren, A.; Teasdale, Thomas William


    The results of a previous study indicate that in general, older drivers who recognise cognitive problems show realistic self-assessment of changes in their driving skills and that driving-related discomfort may function as an indirect monitoring of driving ability, contributing to their safe...... driving performance. The aim of the present study was to examine whether these findings also apply to cognitively impaired older drivers. Structured face-to-face interviews were conducted with 25 cognitively impaired older drivers. The results showed that the participants were most likely to report...... their driving skills as unchanged. There was an association between level of discomfort and avoidance of driving situations, but not between cognitive status and discomfort or avoidance. The results suggest that cognitively impaired older drivers constitute a unique group; while cognitively impaired older...

  2. Compartment syndromes

    Institute of Scientific and Technical Information of China (English)

    Aly Saber


    Body compartments bound by fascia and limited by bony backgrounds are found in the extremities, buttocks, abdomen and thoracic cavity; conditions that cause intracompartmental swelling and hypertension can lead to ischemia and limb loss.Although compartment syndromes are described in all body regions from head to toe, the etiology, diagnosis, treatment, and prevention are best characterized for three key body regions: the first is extremity, the second is abdominal, and the third is thoracic compartment syndromes.Thoracic compartment syndrome usually occurs as a result of pathological accumulation of air, fluid or blood in the mediastinum and has traditionally been described in trauma.As the intracranial contents are confined within a rigid bony cage, any increase in volume within thiscompartment as a result of brain oedema or an expanding traumatic intracranial haematoma, leads to a reciprocal decrease in the volume of cerebrospinal fluid and intracranial venous blood volume.Limb compartment syndromes may present either in acute or chronic clinical forms.Intra-abdominal pressure can be measured by direct or indirect methods.While the direct methods are quite accurate, theyare impractical and not feasible for routine practice.Indirect measurement is done through inferior vena cava, gastric, rectal and urinary bladder.Indirect measurement through urinary bladder is the simplest and is considered the method of choice for intra-abdominal pressure measurement.The management of patients with intra-abdominal hypertension is based on four important principles: the first is related to the specific procedures aiming at lowering intra-abdominal pressure and the consequences of intra-abdominal hypertension and abdominal compartment syndrome; the second is for general support and medical management of the critically ill patient; while the third is surgical decompression and the fourth is optimization after surgical decompression.

  3. Bottomwater drive in tarmat reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kaabi, A.A.; Menouar, H.; Al-Marhoun, M.A.; Al-Hashim, H.S.


    This paper addresses the class of tarmat reservoirs subject to bottomwater drive. Different shapes of tar layers are simulated physically and numerically to study the behavior of WOR and oil recovery. Four different cases were studied: a square barrier beneath the well, a disk beneath the well, a hollow square or disk beneath the well, and a half plane. The results showed that breakthrough time occurs earlier in the case of hollow tarmat barriers, while it is delayed considerably in the case of tarmat barriers shaped in the form of a disk beneath the well. Paradoxically, in this last case, the WOR increases more rapidly and becomes higher toward the end of the depletion than in any other case. Among all the cases studied, the no-barrier case gives the highest recovery, while the hollow-tarmat-barrier case leads to the lowest recovery.

  4. Technology as a driving force

    Energy Technology Data Exchange (ETDEWEB)

    Torvund, T. [Norsk Hydro A/S (Norway)


    The competitiveness of the Norwegian Continental shelf has been put firmly on the agenda in Norway since the report from a working group set up by the Ministry of Industry and Energy was released in February this year. If there is to be secured a long future for oil and gas activities, a reduction in the time and costs used in the projects of the order of 40-50%, without jeopardizing the high safety and environmental standards achieved in Norway. The paper addresses how technology can be a driving force in achieving these aims. But technology alone cannot do the job. Progress and changes in several other areas are also necessary, and the new scenario also calls for improved relations between all actors in the North Sea, authorities, oil companies, contractors and labour unions. 15 figs.

  5. Short Bowel Syndrome (United States)

    ... System & How it Works Digestive Diseases A-Z Short Bowel Syndrome What is Short Bowel Syndrome Short bowel syndrome is a group of problems ... between the stomach and large intestine. What causes Short Bowel Syndrome? The main cause of short bowel syndrome is ...

  6. Electric vehicle drive train with contactor protection (United States)

    Konrad, Charles E.; Benson, Ralph A.


    A drive train for an electric vehicle includes a traction battery, a power drive circuit, a main contactor for connecting and disconnecting the traction battery and the power drive circuit, a voltage detector across contacts of the main contactor, and a controller for controlling the main contactor to prevent movement of its contacts to the closed position when the voltage across the contacts exceeds a predetermined threshold, to thereby protect the contacts of the contactor. The power drive circuit includes an electric traction motor and a DC-to-AC inverter with a capacitive input filter. The controller also inhibits the power drive circuit from driving the motor and thereby discharging the input capacitor if the contacts are inadvertently opened during motoring. A precharging contactor is controlled to charge the input filter capacitor prior to closing the main contactor to further protect the contacts of the main contactor.

  7. Energy Optimal Control of Induction Motor Drives

    DEFF Research Database (Denmark)

    Abrahamsen, Flemming

    This thesis deals with energy optimal control of small and medium-size variable speed induction motor drives for especially Heating, Ventilation and Air-Condition (HVAC) applications. Optimized efficiency is achieved by adapting the magnetization level in the motor to the load, and the basic...... purpose is demonstrate how this can be done for low-cost PWM-VSI drives without bringing the robustness of the drive below an acceptable level. Four drives are investigated with respect to energy optimal control: 2.2 kW standard and high-efficiency motor drives, 22 kW and 90 kW standard motor drives....... The method has been to make extensive efficiency measurements within the specified operating area with optimized efficiency and with constant air-gap flux, and to establish reliable converter and motor loss models based on those measurements. The loss models have been used to analyze energy optimal control...

  8. Electromagnetic drive system of robotic fish

    Institute of Scientific and Technical Information of China (English)

    ZHU Hong-xiu; SUN Nai-di; YUE Yao-hui; DENG Jing; LI Fei-hang; GU Yue; JIA Rui-qing


    With the aim to apply the electric fish into practice to assist coal mine water disaster life detection and rescue work,based on the analysis on swing propulsion movements of tail fin,this paper integrates the electromagnet technology with tail fin drive system by analyzing how the fish swims with tail fin under the law of progression.The principle,structure,and drive signals of tail fin electromagnetic drive are researched,the enforced situation of fish under electromagnetic driving modes are analyzed,and the experimental plat-form of tail fin electromagnetic drive is established.The best distance between electromagnet and armature,which can realize the swing of tail fin,was researched in the experiment under water.The robotic fish structure parameters of tail fin electromagnetic drive was finalized by theoretical analysis and experimental measurement.

  9. Progeria syndromes and ageing: what is the connection? (United States)

    Burtner, Christopher R; Kennedy, Brian K


    One of the many debated topics in ageing research is whether progeroid syndromes are really accelerated forms of human ageing. The answer requires a better understanding of the normal ageing process and the molecular pathology underlying these rare diseases. Exciting recent findings regarding a severe human progeria, Hutchinson-Gilford progeria syndrome, have implicated molecular changes that are also linked to normal ageing, such as genome instability, telomere attrition, premature senescence and defective stem cell homeostasis in disease development. These observations, coupled with genetic studies of longevity, lead to a hypothesis whereby progeria syndromes accelerate a subset of the pathological changes that together drive the normal ageing process.

  10. Women drive better if not stereotyped. (United States)

    Moè, Angelica; Cadinu, Mara; Maass, Anne


    A commonly held stereotype is that women are poor drivers. This stereotype is recognized and endorsed by women and girls very early on, long before taking their driving licence, nevertheless they are less involved in accidents and drive safer and less fast than men. In line with the stereotype threat theory, the present study tests the hypothesis that making the driving stereotype salient will lead women to underperform in a driving simulation task. In Experiment 1women in the stereotype threat condition were told that the aim of the study was to detect gender differences in driving whereas in a control condition no study aim was provided. In Experiment 2, two conditions were compared: stereotype threat (same instructions as in Experiment 1), and stereotype boost (the alleged goal was to compare driving ability of young vs. old people). As predicted, the results of both experiments showed that women under stereotype threat, as compared to either control or stereotype boost participants, doubled the number of mistakes. Nevertheless, they overall expected/self-reported to drive/have driven poorly. Importantly, their level of expectation was a significant predictor of their actual driving performance only in the stereotype threat condition. Implications of these effects of stereotype threat on women's driving performance and self-assessment are discussed.

  11. Warp Drive - From Imagination to Reality (United States)

    Gardiner, J.

    The realisation of warp drive is far beyond current science and technology; nevertheless, setting out a timetable for the realisation of warp drive is instructive as this will set expectations for the progress of future research. It is proposed that a time scale for the realisation of warp drive can be estimated by historical analogy with the development of manned space travel to the Moon, using conventional project estimation techniques. A timeline for space travel to the Moon begins with Cyrano de Bergerac's Voyage dans la Lune in 1657 and culminates with the Apollo 11 Moon landing in 1969, a little over 300 years later. A similar timeline for warp drive begins with John W. Campbell's novel Islands of Space in 1930. Fictional conjecture on the warp drive has given way to serious scientific speculation following publication of Alcubierre's seminal warp drive paper in 1994. It is concluded that the realisation of warp drive might be achieved around the year 2180. A projected timetable for the realisation of warp drive through phases of conjecture , speculation , science , technology and application suggests that the warp drive proposal should enter the science phase around the year 2030.

  12. Mild cognitive impairment: safe to drive? (United States)

    Olsen, Kirsty; Taylor, John-Paul; Thomas, Alan


    Driving is an important aspect of daily living and for many older people provides autonomy and psycho-social benefits. Cognitive impairment has been found to impact driving skills at the level of dementia, however, uncertainty remains around the impact of a diagnosis of the pre-dementia condition mild cognitive impairment. Current official guidelines are unclear, and assessment of fitness to drive can be problematical. This editorial examines current official guidance available to the clinician and problems with existing assessment as well as the current position of research specifically into MCI and driving, and considers future direction for research in this field.

  13. Risky driving and lifestyles in adolescence. (United States)

    Bina, Manuela; Graziano, Federica; Bonino, Silvia


    Several studies have shown that risky driving is especially prevalent among young drivers and recent research has pointed out that driving in adolescence should be investigated in the more general context of adolescent development. The first aim of this contribution was to analyze involvement in risky driving in a normative sample of 645 Italian adolescents, boys and girls, aged 14-17, through a self-report questionnaire. A second aim was to evaluate the association between risky driving and lifestyle, defined as involvement in other health risk behaviors and leisure activities. The main results showed that many adolescents drove cars and motorcycles without the required driving license and the most frequent offences were speeding and failure to maintain a safe braking distance. Gender and age differences were also investigated. Results concerning the association between risky driving and lifestyle showed that risky driving was not an isolated behavior. Boys who displayed risky driving practices were more likely to adopt a lifestyle characterized by high involvement in antisocial behaviors, tobacco smoking, comfort eating and time spent in non-organized activities with friends. Girls involved in risky driving were more likely to be involved in other risk-taking behaviors, antisocial behaviors and drug use.

  14. Fluency Disorders in Genetic Syndromes (United States)

    Van Borsel, John; Tetnowski, John A.


    The characteristics of various genetic syndromes have included "stuttering" as a primary symptom associated with that syndrome. Specifically, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Tourette syndrome, Neurofibromatosis type I, and Turner syndrome all list "stuttering" as a characteristic of that syndrome. An extensive review of…

  15. Otodental syndrome

    Directory of Open Access Journals (Sweden)

    Bloch-Zupan Agnès


    Full Text Available Abstract The otodental syndrome also named otodental dysplasia, is characterised by a striking dental phenotype known as globodontia, associated with sensorineural high frequency hearing loss and eye coloboma. Globodontia occurs in both primary and permanent dentition, affecting canine and molar teeth (i.e. enlarged bulbous malformed posterior teeth with almost no discernable cusps or grooves. The condition appears to be inherited in an autosomal dominant mode, although sporadic cases have been reported. It is a rare disease, a few families have been described in the literature. In the British family, the locus for oculo-oto-dental syndrome was mapped to 20q13.1 within a 12-cM critical chromosomal region. Dental management is complex, interdisciplinary and will include regular follow up, scheduled teeth extraction and orthodontic treatment. Hearing checks and, if necessary, hearing aids are mandatory, as well as eye examination and ad hoc treatment if necessary.

  16. Dravet syndrome

    Directory of Open Access Journals (Sweden)

    Incorpora Gemma


    Full Text Available Abstract "Dravet syndrome" (DS previously named severe myoclonic epilepsy of infancy (SMEI, or epilepsy with polymorphic seizures, is a rare disorder characterized by an early, severe, generalized, epileptic encephalopathy. DS is characterized by febrile and afebrile seizures beginning in the 1st year of life followed by different types of seizures (either focal or generalized, which are typically resistant to antiepileptic drugs. A developmental delay from the 2nd to 3rd year of life becomes evident, together with motor disturbances and personality disorders. Beside the classic syndrome, there are milder cases which have been called severe myoclonic epilepsy borderline (SMEB. DS is caused by a mutation in the neuronal sodium channel gene, SCN1A , that is also mutated in generalized epilepsy with FS+ (GEFS+.

  17. Parinaud's syndrome. (United States)

    Moffie, D; Ongerboer de Visser, B W; Stefanko, S Z


    Five cases of a tumour in the quadrigeminal area have been described, 4 of which could be verified by autopsy. In 2 cases with a metastasis in the tegmentum of the mesencephalon, a Parinaud syndrome was present. In 2 other cases, however, with extensive destruction of the quadrigeminal plate and of the posterior commissure this syndrome was not present. In the 5th case, with a big vascular tumour of the pineal area, disturbances of eye movements and pupils were also lacking. From these observations we may conclude that (1) destruction of the quadrigeminal plate has no influence upon vertical eye movements. (2) destruction of the posterior commissure, in combination with the quadrigeminal plate, is not always followed by disturbances of vertical eye movements. In man it is still not clear which structures are responsible for the performance of vertical eye movements.

  18. Paraneoplastic syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Weller, R.E.


    Paraneoplastic syndromes (PNS) comprise a diverse group of disorders that are associated with cancer but unrelated to the size, location, metastases, or physiologic activities of the mature tissue of origin. They are remote effects of tumors that may appear as signs, symptoms, or syndromes which can mimic other disease conditions encountered in veterinary medicine. Recognition of PNS is valuable for several reasons: the observed abnormalities may represent tumor cell markers and facilitate early diagnosis of the tumor; they may allow assessment of premalignant states; they may aid in the search metastases; they may help quantify and monitor response to therapy; and, they may provide insight into the study of malignant transformation and oncogene expression. This review will concentrate on the pathophysiology, diagnosis, and treatment of some of the common PNS encountered in veterinary medicine.

  19. Lemierre's syndrome

    DEFF Research Database (Denmark)

    Johannesen, Katrine M; Bodtger, Uffe


    This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and...... necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre......-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4-6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other...

  20. Griscelli syndrome

    Directory of Open Access Journals (Sweden)

    Kumar T


    Full Text Available Partial albinism with immunodeficiency is a rare and fatal immunologic disorder characterized by pigmentary dilution and variable cellular immunodeficiency. It was initially described in 1978. Primary abnormalities included silvery grayish sheen to the hair, large pigment agglomerations in hair shafts and an abundance of mature melanosomes in melanocytes, with reduced pigmentation of adjacent keratinocytes. We describe a child with Griscelli syndrome who presented with hepatitis, pancytopenia and silvery hair. The diagnosis was confirmed by microscopic skin and hair examination.

  1. Hepatorenal syndrome

    Institute of Scientific and Technical Information of China (English)

    Sharon Turban; Paul J Thuluvath; Mohamed G Atta


    Hepatorenal syndrome (HRS) is a "functional" and reversible form of renal failure that occurs in patients with advanced chronic liver disease. The distinctive hallmark feature of HRS is the intense renal vasoconstriction caused by interactions between systemic and portal hemodynamics. This results in activation of vasoconstrictors and suppression of vasodilators in the renal circulation. Epidemiology, pathophysiology, as well as current and emerging therapies of HRS are discussed in this review.

  2. Postconcussional Syndrome


    Necla Keskin; Lut Tamam


    Postconcussional syndrome is characterized by somatic, cognitive and psychiatric (emotional, behavioral) symptoms that occurs after mild traumatic brain injury. It has been known that these symptoms recover fully within 3-6 months almost in 90% of patients. Although its etiology is still controversial, biological, psychological and social factors may account for the development and continuation of the symptoms. Diagnosis is based on the subjective complaints. To find out an objective method f...

  3. Fraser syndrome.

    Directory of Open Access Journals (Sweden)

    Chattopadhyay A


    Full Text Available Fraser Syndrome is a rare disorder with only a few cases having been described in Indian literature. We report here a case of a patient aged 16 yr present with primary amenorrhea which is a very unusual mode of presentation. Multiple associated anomalies were present including those of eyelids, eyebrow, face, fingers and genitalia. Chromosome analysis revealed a normal female karyotype. Pituitary gonadotropins were within normal range.

  4. [Fibromyalgia syndrome]. (United States)

    Naranjo Hernández, A; Rodríguez Lozano, C; Ojeda Bruno, S


    The Fibromialgia Syndrome (FS) is a common clinical entity which may produce symtoms and signs related to multiple fields of Medicine. Typical clinical characteristics of FS include extensive pain, presence of sensitive points during exploration, morning stiffness, asthenia and non-refresing sleep. Frequently, associated rheumatologic diseases are observed, as rheumatoid arthritis, osteoarthrosis and vertebral disorders. In FS, complementary tests are usually normal. The most widely accepted hypothesis suggests that this is a disorder affecting modulation of pain sensitivity.

  5. Gerstmann's syndrome.


    Sukumar, S.; Ferguson, G C


    Although Gerstmann's syndrome has been well documented since it was characterised in the latter half of last century, there has not been much literature on it in the last few years. We present a classical case in a patient who was admitted into hospital for an unrelated problem. We conclude that clinical examination still has a valuable role in neurology, despite the availability of excellent imaging techniques.

  6. Neonatal respiratory distress syndrome (United States)

    Hyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants ... improves slowly after that. Some infants with severe respiratory distress syndrome will die. This most often occurs between days ...

  7. What Causes Down Syndrome? (United States)

    ... Information Clinical Trials Resources and Publications What causes Down syndrome? Skip sharing on social media links Share this: ... Down Syndrome Registry​ . Chromosomal Changes That Can Cause Down Syndrome Research shows that three types of chromosomal changes ...

  8. Genetic obesity syndromes. (United States)

    Goldstone, Anthony P; Beales, Philip L


    There are numerous reports of multi-system genetic disorders with obesity. Many have a characteristic presentation and several, an overlapping phenotype indicating the likelihood of a shared common underlying mechanism or pathway. By understanding the genetic causes and functional perturbations of such syndromes we stand to gain tremendous insight into obesogenic pathways. In this review we focus particularly on Bardet-Biedl syndrome, whose molecular genetics and cell biology has been elucidated recently, and Prader-Willi syndrome, the commonest obesity syndrome due to loss of imprinted genes on 15q11-13. We also discuss highlights of other genetic obesity syndromes including Alstrom syndrome, Cohen syndrome, Albright's hereditary osteodystrophy (pseudohypoparathyroidism), Carpenter syndrome, MOMO syndrome, Rubinstein-Taybi syndrome, cases with deletions of 6q16, 1p36, 2q37 and 9q34, maternal uniparental disomy of chromosome 14, fragile X syndrome and Börjeson-Forssman-Lehman syndrome.

  9. Blind Loop Syndrome (United States)

    ... more commonly result from other conditions such as short bowel syndrome or chronic pancreatitis. Small intestine aspirate and fluid ... people with severe blind loop syndrome resulting in short bowel syndrome. References Townsend CM Jr, et al. Sabiston Textbook ...

  10. Asperger Syndrome (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Asperger Syndrome KidsHealth > For Parents > Asperger Syndrome Print A A ... the medical community still use the term. About Asperger Syndrome The disorder is named after Hans Asperger, a ...

  11. Antiphospholipid syndrome

    Directory of Open Access Journals (Sweden)

    Pavlović Dragan M.


    Full Text Available Antiphospholipid syndrome (APS is an autoimmune disease with recurrent thromboses and pregnancy complications (90% are female patients that can be primary and secondary (with concomitant autoimmune disease. Antiphospholipid antibodies are prothrombotic but also act directly with brain tissue. One clinical and one laboratory criterion is necessary for the diagnosis of APS. Positive serological tests have to be confirmed after at least 12 weeks. Clinical picture consists of thromboses in many organs and spontaneous miscarriages, sometimes thrombocytopaenia and haemolytic anaemia, but neurological cases are the most frequent: headaches, stroke, encephalopathy, seizures, visual disturbances, Sneddon syndrome, dementia, vertigo, chorea, balism, transitory global amnesia, psychosis, transversal myelopathy and Guillain-Barre syndrome. About 50% of strokes below 50 years of age are caused by APS. The first line of therapy in stroke is anticoagulation: intravenous heparin or low-weight heparins. In chronic treatment, oral anticoagulation and antiplatelet therapy are used, warfarin and aspirin, mostly for life. In resistant cases, corticosteroids, intravenous immunoglobulins and plasmapheresis are necessary. Prognosis is good in most patients but some are treatment-resistant with recurrent thrombotic events and eventually death.

  12. Kartagener syndrome

    Directory of Open Access Journals (Sweden)

    Nedaa Skeik


    Full Text Available Nedaa Skeik1–3, Fadi I Jabr41Mayo Clinic, Rochester, MN, USA; 2Dartmouth Medical School, Hannover, NH, USA; 3New York Medical College, New York, NY, USA; 4Horizon Medical Center, Hospital Medicine, Dickson, TN, USAAbstract: Kartagener syndrome is a rare, ciliopathic, autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract and fallopian tube. Patients usually present with chronic recurrent rhinosinusitis, otitis media, pneumonia, and bronchiectasis caused by pseudomonal infection. Situs inversus can be seen in about 50% of cases. Diagnosis can be made by tests to prove impaired cilia function, biopsy, and genetic studies. Treatment is supportive. In severe cases, the prognosis can be fatal if bilateral lung transplantation is delayed. We present a case of a 66-year-old woman with chronic recurrent upper respiratory infections, pseudomonal pneumonia, and chronic bronchiectasis who presented with acute respiratory failure. She was diagnosed with Kartagener syndrome based on her clinical presentation and genetic studies. She expired on ventilator with refractory respiratory and multiorgan failure.Keywords: chronic obstructive pulmonary disease, bronchiectasis, immotile cilia syndrome, situs inversus

  13. Crush syndrome

    Directory of Open Access Journals (Sweden)

    Emily Lovallo


    Full Text Available The first detailed cases of crush syndrome were described in 1941 in London after victims trapped beneath bombed buildings presented with swollen limbs, hypovolemic shock, dark urine, renal failure, and ultimately perished. The majority of the data and studies on this topic still draw from large databases of earthquake victims. However, in Africa, a continent with little seismic activity, the majority of crush syndrome cases are instead victims of severe beatings rather than earthquake casualties, and clinical suspicion by emergency personnel must be high in this patient group presenting with oliguria or pigmenturia. Damaged skeletal muscle fibres and cell membranes lead to an inflammatory cascade resulting in fluid sequestration in the injured extremity, hypotension, hyperkalemia and hypocalcemia and their complications, and renal injury from multiple sources. Elevations in the serum creatinine, creatine kinase (CK, and potassium levels are frequent findings in these patients, and can help guide critical steps in management. Fluid resuscitation should begin prior to extrication of trapped victims or as early as possible, as this basic intervention has been shown to in large part prevent progression of renal injury to requiring haemodialysis. Alkalinization of the urine and use of mannitol for forced diuresis are recommended therapies under specific circumstances and are supported by studies done in animal models, but have not been shown to change clinical outcomes in human crush victims. In the past 70 years the crush syndrome and its management have been studied more thoroughly, however clinical practice guidelines continue to evolve.

  14. Drive Electric Vermont Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Fred [Energetics Incorporated, Columbia, MD (United States); Roberts, Dave [Vermont Energy Investment Corporation (VEIC), Burlington, VT (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States); White, Sera [Idaho National Lab. (INL), Idaho Falls, ID (United States)


    Currently in the United States, the heavy majority of plug-in electric vehicle (PEV) sales have been in highly conducive, selected, metropolitan areas; opposed to more broad distribution across the country. The U.S. Department of Energy’s EV Everywhere Grand Challenge is looking carefully at the barriers and opportunities that exist to enable small and midsize communities to partake in the PEV market and benefit from the economic and environmental advantages of PEVs. In order to gain insight into these challenges and barriers, DOE selected a success story (i.e., Drive Electric Vermont) as the subject of this case study, as the state of Vermont is tied with Detroit, Michigan in having the highest percentage of 2014 (most recent complete data) PEV registrations for cold weather U.S. cities and has seen more than a sixfold increase in charging stations over the last three years. The overall objective of this case study was to use the lessons learned from Drive Electric Vermont to determine what activities are most effective at encouraging acquisitions of PEVs and deployment of charging infrastructure in small to midsize communities, prioritizing and sequencing their implementation, identifying robust means for extrapolation, and applying this understanding to other small to midsize communities across the nation. The Drive Electric Vermont Program was formed in 2012 with a goal of increasing the use of electrified transportation in Vermont through policy development, education and outreach, and infrastructure development. The Drive Electric Vermont Program can be broadly broken into four components: (1) strategic planning/leadership, (2) stakeholder/partnership development, (3) education and outreach, and (4) incentives. The early phases of the program focused heavily on strategic planning, and stakeholder and partnership development, followed by a transition to education and outreach activities, charging infrastructure development, and grant and incentive programs

  15. The Thermodynamics of Drunk Driving (United States)

    Thompson, Robert Q.


    Chemical and instrumental tests for driving under the influence of alcohol (DUI) measure the concentration of ethanol in the breath (BrAC), while state DUI laws are described in terms of blood alcohol concentration (BAC). Consequently, accurate and fair conversion from BrAC to BAC is crucial to the judicial process. Theoretical treatment of the water-air-ethanol equilibrium system and the related blood-breath-ethanol system, based on principles from general chemistry and biology, yields an equation relating the ratio of BAC to BrAC to the absolute temperature of the breath, the fraction of water in the blood, and the enthalpy and entropy of vaporization of ethanol from aqueous solution. The model equation predicts an average value for the ratio of 2350+100, not significantly different from reported experimental values. An exponential temperature dependence is predicted and has been confirmed experimentally as well. Biological, chemical, and instrumental variables are described along with their contributions to the overall uncertainty in the value of BrAC/BAC. While the forensic science community uses, and debates, a fixed ratio of 2100, the theoretical model suggests that a value of 1880 should be used to reduce the fraction of false positives to <1%.

  16. Redundant Arrays of IDE Drives

    CERN Document Server

    Sanders, D A; Eschenburg, V; Lawrence, C N; Riley, C P; Summers, D J; Petravick, D L


    We report tests of redundant arrays of IDE disk drives for use in offline high energy physics data analysis. Parts costs of total systems using commodity EIDE disks are now at the $4000 per Terabyte level. Disk storage prices have now decreased to the point where they equal the cost per Terabyte of Storage Technology tape silos. The disks, however, offer far better granularity; even small institutions can afford to deploy systems. Our tests include reports on software RAID-5 systems running under Linux 2.4 using Promise Ultra 100 TM disk controllers. RAID-5 protects data in case of a single disk failure by providing parity bits. Tape backup is not required. Journaling file systems are used to allow rapid recovery from crashes. Our data analysis strategy is to encapsulate data and CPU processing power. Analysis for a particular part of a data set takes place on the PC where the data resides. The network is only used to put results together. We explore three methods of moving data between sites; internet transf...

  17. Drive Electric Vermont Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Fred [Energetics Incorporated, Columbia, MD (United States); Roberts, Dave [Vermont Energy Investment Corporation (VEIC), Burlington, VT (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States); White, Sera [Idaho National Lab. (INL), Idaho Falls, ID (United States)


    Currently in the United States, the heavy majority of plug-in electric vehicle (PEV) sales have been in highly conducive, selected, metropolitan areas; opposed to more broad distribution across the country. The U.S. Department of Energy’s EV Everywhere Grand Challenge is looking carefully at the barriers and opportunities that exist to enable small and midsize communities to partake in the PEV market and benefit from the economic and environmental advantages of PEVs. In order to gain insight into these challenges and barriers, DOE selected a success story (i.e., Drive Electric Vermont) as the subject of this case study, as the state of Vermont is tied with Detroit, Michigan in having the highest percentage of 2014 (most recent complete data) PEV registrations for cold weather U.S. cities and has seen more than a sixfold increase in charging stations over the last three years. The overall objective of this case study was to use the lessons learned from Drive Electric Vermont to determine what activities are most effective at encouraging acquisitions of PEVs and deployment of charging infrastructure in small to midsize communities, prioritizing and sequencing their implementation, identifying robust means for extrapolation, and applying this understanding to other small to midsize communities across the nation. The Drive Electric Vermont Program was formed in 2012 with a goal of increasing the use of electrified transportation in Vermont through policy development, education and outreach, and infrastructure development. The Drive Electric Vermont Program can be broadly broken into four components: (1) strategic planning/leadership, (2) stakeholder/partnership development, (3) education and outreach, and (4) incentives. The early phases of the program focused heavily on strategic planning, and stakeholder and partnership development, followed by a transition to education and outreach activities, charging infrastructure development, and grant and incentive programs

  18. Drive for muscularity and drive for thinness: the impact of pro-anorexia websites. (United States)

    Juarez, Lilia; Soto, Ernesto; Pritchard, Mary E


    In recent years, websites that stress the message of thinness as the ideal and only choice have surfaced on the internet. The possibility that pro-anorexia websites may reinforce restrictive eating and exercise behaviors is an area of concern. In addition, friends may be influencing one another to view these websites, further contributing to drive for thinness in women and drive for muscularity in men. Three hundred male and female undergraduate psychology students responded to questionnaires assessing: internalization of pro-anorexia website content, internalization of general media content, influence of friends to view pro-anorexia websites, peer influence, drive for muscularity, and drive for thinness. Results showed internalization of pro-anorexia website content was positively correlated with drive for thinness in women, and negatively correlated with drive for muscularity in men. Internalization of pro-anorexia website content was found to be related to both drive for thinness in women and drive for muscularity in men.

  19. Carpal Tunnel Syndrome (United States)

    ... Pharyngitis, Adenitis Syndrome (Juvenile) Polymyalgia Rheumatica Psoriatic Arthritis Raynaud's Phenomenon Reactive Arthritis Rheumatoid Arthritis Scleroderma Sjogren's Syndrome Spinal Stenosis Spondyloarthritis Systemic Lupus Erythematosus (Juvenile) Takayasu's ...

  20. Inherited ichthyosis: Syndromic forms. (United States)

    Yoneda, Kozo


    Among diseases that cause ichthyosis as one of the symptoms, there are some diseases that induce abnormalities in organs other than the skin. Of these, diseases with characteristic signs are regarded as syndromes. Although these syndromes are very rare, Netherton syndrome, Sjögren-Larsson syndrome, Conradi-Hünermann-Happle syndrome, Dorfman-Chanarin syndrome, ichthyosis follicularis, atrichia and photophobia (IFAP) syndrome, and Refsum syndrome have been described in texts as representative ones. It is important to know the molecular genetics and pathomechanisms in order to establish an effective therapy and beneficial genetic counseling including a prenatal diagnosis.

  1. Clinical symptoms of sleep apnea syndrome and automobile accidents

    DEFF Research Database (Denmark)

    Haraldsson, P O; Carenfelt, C; Diderichsen, Finn


    Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by ca...

  2. Current drive induced by intermittent trapping

    Energy Technology Data Exchange (ETDEWEB)

    Nakach, R. [Association Euratom-CEA, CEA/Cadarache, Dept. de Recherches sur la Fusion Controlee (DRFC), 13 - Saint-Paul-lez-Durance (France); Gell, Y. [CET, Israel (Israel)


    We propose a mechanism for driving a current in a dispersive plasma based on intermittent trapping of electrons in a ponderomotive well generated by two- counterpropagating electron cyclotron waves. By choosing properly the parameters of the system, this mechanism is expected to induce a high efficiency current drive. (authors)

  3. Police enforcement of drinking driving laws.

    NARCIS (Netherlands)

    Verschuur, W.L.G. & Gundy, C.M.


    This survey of Dutch police officers was designed to investigate their opinions, expectations and experiences with the enforcement of drinking driving laws. Although many studies have been done on the subject of drinking driving, and police enforcement is a familiar measure against this problem, les

  4. Driving under the influence of alcohol.

    NARCIS (Netherlands)


    Driving under the influence of alcohol is a threat to road safety. In the Netherlands, the legal limit for novice drivers is a blood alcohol concentration (BAC) of 0.2‰ and for all other drivers of 0.5‰. Young males and heavy drinkers form the most significant risk groups for drink-driving. In the N

  5. Comb-drive actuators for large displacements

    NARCIS (Netherlands)

    Legtenberg, Rob; Groeneveld, A.W.; Elwenspoek, M.


    The design, fabrication and experimental results of lateral-comb-drive actuators for large displacements at low driving voltages is presented. A comparison of several suspension designs is given, and the lateral large deflection behaviour of clamped - clamped beams and a folded flexure design is mod


    Directory of Open Access Journals (Sweden)

    Etsuo HORIKAWA


    Discussions: Of the 30 items monitored in the study, significant differences were evident in only a few. Because the evidence did not suggest a particular link to accident experience, it will be necessary to obtain objective data from other cognitive function tests and driving behavior for reassessment. various problems related to elderly driving in Japan were discussed.

  7. Adjustable Speed Drives and Power Quality

    DEFF Research Database (Denmark)

    Davari, Pooya; Yang, Yongheng; Zare, Firuz;


    This paper provides an overview and proposes cost-effective and efficient opportunities in improving power quality in Adjustable Speed Drive (ASD) systems. In particular, an Electronic Inductor (EI) technique has been used in single drives to overcome the existing challenges in conventional...

  8. Instruction or distraction in the driving school?

    DEFF Research Database (Denmark)

    Andersen, Mike Kirk; Caglio, Agnese

    In this paper we report an ongoing study of driving school practice. We recorded several hours of driving lessons in different environments, which we analyze with the Interaction Analysis method. Our initial analysis suggests that looking at how teachers make use of different communicative...

  9. Use of mobile phone while driving.

    NARCIS (Netherlands)


    Using a mobile phone while driving has negative effects on driving behaviour. This is the case for conducting a conversation, dialling a number, and sending text messages as well as for using the extra functions that smartphones offer, like accessing internet or social networking sites. The negative

  10. Driving Hamiltonian in a Quantum Search Problem

    CERN Document Server

    Oshima, K


    We examine the driving Hamiltonian in the analog analogue of Grover's algorithm by Farhi and Gutmann. For a quantum system with a given Hamiltonian $E|w> $ from an initial state $|s>$, the driving Hamiltonian $E^{\\prime}|s> < s|(E^{\\prime} \

  11. Advisory and autonomous cooperative driving systems

    NARCIS (Netherlands)

    Broek, T.H.A. van den; Ploeg, J.; Netten, B.D.


    In this paper, the traffic efficiency of an advisory cooperative driving system, Advisory Acceleration Control is examined and compared to the efficiency of an autonomous cooperative driving system, Cooperative Adaptive Cruise Control. The algorithms and implementation thereof are explained. The res

  12. Exposure to movie reckless driving in early adolescence predicts reckless, but not inattentive driving

    NARCIS (Netherlands)

    Kostermans, E.; Stoolmiller, M.; Leeuw, R.N.H. de; Engels, R.C.M.E.; Sargent, J.D.


    Objective We examine the association between exposure to depictions of reckless driving in movies and unsafe driving, modeling inattentive and reckless driving as separate outcomes. Methods Data were obtained by telephone from 1,630 US adolescents aged 10 to 14 years at baseline who were drivers at

  13. A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers. (United States)

    Liddle, Jacki; Gustafsson, Louise; Mitchell, Geoffrey; Pachana, Nancy A


    Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving- and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support.

  14. Exhaust powered drive shaft torque enhancer

    Energy Technology Data Exchange (ETDEWEB)

    Koch, A.B.


    This patent describes a power producing combination including an internal combustion engine and a mounting frame therefor, and power transmission means including rotating drive shaft means connected to the engine. The improvement described here is a drive shaft torque enhancing device, the device comprising: a multiplicity of blades secured to the drive shaft, equally spaced therearound, each generally lying in a plane containing the axis of the drive shaft; torque enhancer feed duct means for selectively directing a stream of exhaust gases from the engine to impact against the blades to impart torque to the drive shaft; and wherein the power producing combination is used in a vehicle, the vehicle having braking means including a brake pedal; and the power producing combination further comprising torque enhancer disengagement means responsive to motion of the brake pedal.

  15. DriveID: safety innovation through individuation. (United States)

    Sawyer, Ben; Teo, Grace; Mouloua, Mustapha


    The driving task is highly complex and places considerable perceptual, physical and cognitive demands on the driver. As driving is fundamentally an information processing activity, distracted or impaired drivers have diminished safety margins compared with non- distracted drivers (Hancock and Parasuraman, 1992; TRB 1998 a & b). This competition for sensory and decision making capacities can lead to failures that cost lives. Some groups, teens and elderly drivers for example, have patterns of systematically poor perceptual, physical and cognitive performance while driving. Although there are technologies developed to aid these different drivers, these systems are often misused and underutilized. The DriveID project aims to design and develop a passive, automated face identification system capable of robustly identifying the driver of the vehicle, retrieve a stored profile, and intelligently prescribing specific accident prevention systems and driving environment customizations.

  16. Extracting periodic driving signal from chaotic noise

    Institute of Scientific and Technical Information of China (English)

    MU Jing; TAO Chao; DU Gonghuan


    After periodic signals pass through some nonlinear systems, they are usually transformed into noise-like and wide-band chaotic signals. The discrete spectrums of the original periodic signals are often covered by the chaotic spectrums. Recovering the periodic driving signals from the chaotic signals is important not only in theory but also in practical applications. Based on the modeling theory of nonlinear dynamic system, a "polynomial-simple harmonic drive" non-autonomous equation (P-S equation) to approximate the original system is proposed and the approximation error between P-S equation and the original system is obtained. By changing the drive frequency, we obtain the curve of the approximation error vs. drive frequency. Based on the relation between this curve and the spectrums of the original periodic signals, the spectrum of the original driving signal is extracted and the original signal is recovered.

  17. What drives successful verbal communication?

    Directory of Open Access Journals (Sweden)

    Miriam eDe Boer


    Full Text Available There is a vast amount of potential mappings between behaviours and intentions in communication: a behaviour can indicate a multitude of different intentions, and the same intention can be communicated with a variety of behaviours. Humans routinely solve these many-to-many referential problems when producing utterances for an Addressee. This ability might rely on social cognitive skills, for instance, the ability to manipulate unobservable summary variables to disambiguate ambiguous behaviour of other agents (mentalizing and the drive to invest resources into changing and understanding the mental state of other agents (communicative motivation. Alternatively, the ambiguities of verbal communicative interactions might be solved by general-purpose cognitive abilities that process cues that are incidentally associated with the communicative interaction. In this study, we assess these possibilities by testing which cognitive traits account for communicative success during a verbal referential task. Cognitive traits were assessed with psychometric scores quantifying motivation, mentalizing abilities, and general-purpose cognitive abilities, taxing abstract visuo-spatial abilities. Communicative abilities of participants were assessed by using an on-line interactive task that required a speaker to verbally convey a concept to an Addressee. The communicative success of the utterances was quantified by measuring how frequently a number of Evaluators would infer the correct concept. Speakers with high motivational and general-purpose cognitive abilities generated utterances that were more easily interpreted. These findings extend to the domain of verbal communication the notion that motivational and cognitive factors influence the human ability to rapidly converge on shared communicative innovations.

  18. Raynaud's syndrome and carpal tunnel syndrome.


    Waller, D G; Dathan, J R


    We report three cases of Raynaud's syndrome with digital ischaemic ulceration, in association with carpal tunnel syndrome. In all cases, the aetiology of the Raynaud's syndrome was probably unrelated to the nerve compression. However, symptoms were worse on the side of the median nerve lesion in two patients and worse on the side with the most severe nerve dysfunction in the third; symptoms were relieved by carpal tunnel decompression in two patients. We suggest that carpal tunnel syndrome ma...

  19. Morvan Syndrome (United States)

    Maskery, Mark; Chhetri, Suresh K.; Dayanandan, Rejith; Gall, Claire


    A 74-year-old gentleman was admitted to the regional neurosciences center with encephalopathy, myokymia, and dysautonomia. Chest imaging had previously identified an incidental mass in the anterior mediastinum, consistent with a primary thymic tumor. Antivoltage-gated potassium channel (anti-VGKC) antibodies were positive (titer 1273 pmol/L) and he was hypokalemic. Electromyogram and nerve conduction studies were in keeping with peripheral nerve hyperexcitability syndrome, and an electroencephalogram was consistent with encephalopathy. A diagnosis of Morvan syndrome was made, for which he was initially treated with high-dose steroids, followed by a 5-day course of intravenous immunoglobulin (IVIG) therapy. He also underwent thymectomy, followed by a postexcision flare of his symptoms requiring intensive care management. Further steroids, plasmapheresis, and IVIG achieved stabilization of his clinical condition, enabling transfer for inpatient neurorehabilitation. He was commenced on azathioprine and a prolonged oral steroid taper. A subsequent presumed incipient relapse responded well to further IVIG treatment. This case report documents a thymoma-associated presentation of anti-VGKC-positive Morvan syndrome supplemented by patient and carer narrative and video, both of which provide valuable further insights into this rare disorder. There are a limited number of publications surrounding this rare condition available in the English literature. This, combined with the heterogenous presentation, association with underlying malignancy, response to treatment, and prognosis, provides a diagnostic challenge. However, the association with anti-VGKC antibody-associated complexes and 2 recent case series have provided some scope for both accurate diagnosis and management. PMID:26740856

  20. Hepatorenal syndrome

    Institute of Scientific and Technical Information of China (English)

    Jan Lata


    Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.


    Institute of Scientific and Technical Information of China (English)


    Oculo-cerebro-renal syndrome (Lowe's syndrome) is characterized by mental and motor retardation, cataract, glaucoma and renal abnormalities. It is an X-linked recessive metabolic disease. Two brothers suffering from Lowe's syndrome are reported. Their mother with lenticular opacities and peculiar facial appearance is in concordance with the obligate carrier. The ocular changes and heridity are discussed.

  2. Jacobsen syndrome. (United States)

    Mattina, Teresa; Perrotta, Concetta Simona; Grossfeld, Paul


    Jacobsen syndrome is a MCA/MR contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. To date, over 200 cases have been reported. The prevalence has been estimated at 1/100,000 births, with a female/male ratio 2:1. The most common clinical features include pre- and postnatal physical growth retardation, psychomotor retardation, and characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small ears, low set posteriorly rotated ears). Abnormal platelet function, thrombocytopenia or pancytopenia are usually present at birth. Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Ocular, hearing, immunological and hormonal problems may be also present. The deletion size ranges from approximately 7 to 20 Mb, with the proximal breakpoint within or telomeric to subband 11q23.3 and the deletion extending usually to the telomere. The deletion is de novo in 85% of reported cases, and in 15% of cases it results from an unbalanced segregation of a familial balanced translocation or from other chromosome rearrangements. In a minority of cases the breakpoint is at the FRA11B fragile site. Diagnosis is based on clinical findings (intellectual deficit, facial dysmorphic features and thrombocytopenia) and confirmed by cytogenetics analysis. Differential diagnoses include Turner and Noonan syndromes, and acquired thrombocytopenia due to sepsis. Prenatal diagnosis of 11q deletion is possible by amniocentesis or chorionic villus sampling and cytogenetic analysis. Management is multi-disciplinary and requires evaluation by general pediatrician, pediatric cardiologist, neurologist, ophthalmologist. Auditory tests, blood tests, endocrine and immunological assessment and follow-up should be offered to all patients. Cardiac malformations can be very severe

  3. HELLP syndrome

    Directory of Open Access Journals (Sweden)

    Dilek Acar


    Suggested treatment modality consists, stabilization of blood pressure and magnesium sulfate infusion. Then evaluation of fetal status and planning delivery method and time if maternal status remains unstable. If prognosis seems favorable without urgent delivery and fetus can benefit from it, a course of betamethasone can be given to fetuses between 24 and 34 weeks of gestational age. The only and definite treatment of HELLP syndrome is delivering the baby. Suggested benefits of steroid therapy and other experimental treatments are still to be proven effective by large randomized controlled trials. [Archives Medical Review Journal 2014; 23(4.000: 735-760

  4. Chilaiditi syndrome. (United States)

    Walsh, S D; Cruikshank, J G


    The features of the Chilaiditi Syndrome are described, together with the historial background, and a brief review of the literature on the condition is given. The prevalence in our geriatric population was found to be 1% and the 13 cases seen over 22 months are reported briefly. The prevalence increases with age and may be related to the consumption of drugs by the elderly; although in the majority it is asymptomatic, it may, particularly when associated with gastrointestinal symptoms, lead to unnecessary laparotomy. In the geriatric patient, interposition of the bowel should be considered in the differential diagnosis of air under the right hemidiaphragm.

  5. Trichorhinophalangeal syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Tuzovic, S.; Fiebach, B.J.O.; Magnus, L.; Sauerbrei, H.U.


    This article reports on 14 cases of a trichorhinophalangeal syndrome in five successive generations. Besides the well-known characteristics of the TRPS the following symptoms observed in this family are new: Teething was considerably delayed, intelligence was reduced, and there were skin manifestations resembling eczema. Besides, struma colli and colitis ulcerosa were also observed. Subsequent observations have to clarify whether these symptoms are a facultative part of the TRPS pattern. The constant appearance of carriers of these characteristics during five generation points to dominant heredity.

  6. Eagle Syndrome

    Directory of Open Access Journals (Sweden)

    Beytholahi JM


    Full Text Available Eagle's syndrome is characterized by an elongated styloid process and (or calcification of"nstylohyoid ligament besides clinical symptoms. The symptoms are those related to pain when"nswallowing or rotating the neck, headacke, earache, dizziness, intermittent glossitis, sensation of"nforeign body in pharynx and transient syncope. The case which is presented can be considered a very"nrare form of the disease in which complete calcification of the ligament and it's thickening has"noccured. Also there is little relationship between the severity of calcification and severity of symptoms."nA careful and thorough evaluation of each panoramic radiography is emphasized.

  7. Olmsted Syndrome

    Directory of Open Access Journals (Sweden)

    Sirka C


    Full Text Available A 20-year-old Sikh man had palmoplantar keratoderma, flexion deformity of digits, universal alopecia, keratotic plaques at the angles of mouth, gluteal cleft, knees and dorsal aspects of the metacarpophalangeal joints of the hand; features of Olmsted syndrome. He had normal nails, teeth, oral mucosa and normal joint movements. Treatment with acitretin, 25mg/day for three and a half months, followed by 25mg once daily alternating with 50mg once daily for 3 months resulted in significant improvement.

  8. Refeeding syndrome. (United States)

    Fuentebella, Judy; Kerner, John A


    Refeeding syndrome (RFS) is the result of aggressive enteral or parenteral feeding in a malnourished patient, with hypophosphatemia being the hallmark of this phenomenon. Other metabolic abnormalities, such as hypokalemia and hypomagnesemia, may also occur, along with sodium and fluid retention. The metabolic changes that occur in RFS can be severe enough to cause cardiorespiratory failure and death. This article reviews the pathophysiology, the clinical manifestations, and the management of RFS. The key to prevention is identifying patients at risk and being aware of the potential complications involved in rapidly reintroducing feeds to a malnourished patient.

  9. Jacobsen syndrome

    Directory of Open Access Journals (Sweden)

    Grossfeld Paul


    Full Text Available Abstract Jacobsen syndrome is a MCA/MR contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. To date, over 200 cases have been reported. The prevalence has been estimated at 1/100,000 births, with a female/male ratio 2:1. The most common clinical features include pre- and postnatal physical growth retardation, psychomotor retardation, and characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small ears, low set posteriorly rotated ears. Abnormal platelet function, thrombocytopenia or pancytopenia are usually present at birth. Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Ocular, hearing, immunological and hormonal problems may be also present. The deletion size ranges from ~7 to 20 Mb, with the proximal breakpoint within or telomeric to subband 11q23.3 and the deletion extending usually to the telomere. The deletion is de novo in 85% of reported cases, and in 15% of cases it results from an unbalanced segregation of a familial balanced translocation or from other chromosome rearrangements. In a minority of cases the breakpoint is at the FRA11B fragile site. Diagnosis is based on clinical findings (intellectual deficit, facial dysmorphic features and thrombocytopenia and confirmed by cytogenetics analysis. Differential diagnoses include Turner and Noonan syndromes, and acquired thrombocytopenia due to sepsis. Prenatal diagnosis of 11q deletion is possible by amniocentesis or chorionic villus sampling and cytogenetic analysis. Management is multi-disciplinary and requires evaluation by general pediatrician, pediatric cardiologist, neurologist, ophthalmologist. Auditory tests, blood tests, endocrine and immunological assessment and follow-up should be offered to all patients. Cardiac malformations can be

  10. Myofascial syndrome

    Directory of Open Access Journals (Sweden)

    Giancarlo Carli


    Full Text Available Myofascial pain syndrome is common cause one of musculoskeletal pain and it is characterized by trigger points (TP, limited range of motion in joints and local twitch response (LTR during mechanical stimulation of the TP. Trigger point is a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is tender when pressed and can give rise to characteristic referred pain, motor dysfunction and autonomic phenomena. Palpation is reliable diagnostic criterion for locating TP in patients. Treatment is based on anesthetise TP, stretch and spray, local pression and physical activity.

  11. Rating forces grip and driving and accelerations of the car with drive different configuration

    Directory of Open Access Journals (Sweden)

    Kowalski Mariusz


    Full Text Available The paper shows a typical drive systems used in today's vehicles, mainly cars. Approximated scheme of the formation of the driving force of the vehicle and the necessary mathematical relations for the calculation. For example, a typical passenger car BMW 320 was analyzed and calculations obtained a driving force, of adhesion and acceleration. The calculations were performed for the drive system, the classical (i.e. the rear axle of the vehicle for front-wheel drive and four-wheel drive (4×4. Virtually assumed that to the above mentioned vehicle it is possible buildings of each of said system. These are shown graphically in diagrams bearing a distribution of the forces acting on the substrate and the reactions - the data necessary for the calculations. The resulting calculation is graphically shown in the diagrams, in which is illustrated a change value of the resulting adhesive strength, and the acceleration depending on the drive type vehicle.

  12. The identification of Malaysian driving styles using the multidimensional driving style inventory

    Directory of Open Access Journals (Sweden)

    Karjanto Juffrizal


    Full Text Available A study was conducted to investigate the driving styles within the geographical region of Malaysia. The first part of the study determined Malaysian drivers’ driving styles using the Multidimensional Driving Style Inventory approach. Respondents had various backgrounds in terms of age, gender and experience of driving. A statistical factor analysis was done for 338 respondents revealing four driving styles; careful, risky, anxious-dissociative and angry. In addition, a comparison with previous findings from Netherlands and Israel was also done in this study. The next part of the study focused on the associations of these driving styles with two personality traits (sensation seeking and desire for control, sociodemographic factors and experience of driving. The last part of the paper discusses the relevance of the study against the background of future automotive development.

  13. Chapter 18: Variable Frequency Drive Evaluation Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Romberger, J.


    An adjustable-speed drive (ASD) includes all devices that vary the speed of a rotating load, including those that vary the motor speed and linkage devices that allow constant motor speed while varying the load speed. The Variable Frequency Drive Evaluation Protocol presented here addresses evaluation issues for variable-frequency drives (VFDs) installed on commercial and industrial motor-driven centrifugal fans and pumps for which torque varies with speed. Constant torque load applications, such as those for positive displacement pumps, are not covered by this protocol. Other ASD devices, such as magnetic drive, eddy current drives, variable belt sheave drives, or direct current motor variable voltage drives, are also not addressed. The VFD is by far the most common type of ASD hardware. With VFD speed control on a centrifugal fan or pump motor, energy use follows the affinity laws, which state that the motor electricity demand is a cubic relationship to speed under ideal conditions. Therefore, if the motor runs at 75% speed, the motor demand will ideally be reduced to 42% of full load power; however, with other losses it is about 49% of full load power.

  14. Down Syndrome (For Parents) (United States)

    ... en español El síndrome de Down About Down Syndrome Down syndrome (DS), also called Trisomy 21, is a ... rises to about 1 in 100. continue How Down Syndrome Affects Kids Kids with Down syndrome tend to ...

  15. Sheehan's syndrome. (United States)

    Kilicli, Fatih; Dokmetas, Hatice Sebila; Acibucu, Fettah


    Sheehan's syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The first most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account.

  16. Sotos syndrome

    Directory of Open Access Journals (Sweden)

    Cormier-Daire Valérie


    Full Text Available Abstract Sotos syndrome is an overgrowth condition characterized by cardinal features including excessive growth during childhood, macrocephaly, distinctive facial gestalt and various degrees of learning difficulty, and associated with variable minor features. The exact prevalence remains unknown but hundreds of cases have been reported. The diagnosis is usually suspected after birth because of excessive height and occipitofrontal circumference (OFC, advanced bone age, neonatal complications including hypotonia and feeding difficulties, and facial gestalt. Other inconstant clinical abnormalities include scoliosis, cardiac and genitourinary anomalies, seizures and brisk deep tendon reflexes. Variable delays in cognitive and motor development are also observed. The syndrome may also be associated with an increased risk of tumors. Mutations and deletions of the NSD1 gene (located at chromosome 5q35 and coding for a histone methyltransferase implicated in transcriptional regulation are responsible for more than 75% of cases. FISH analysis, MLPA or multiplex quantitative PCR allow the detection of total/partial NSD1 deletions, and direct sequencing allows detection of NSD1 mutations. The large majority of NSD1 abnormalities occur de novo and there are very few familial cases. Although most cases are sporadic, several reports of autosomal dominant inheritance have been described. Germline mosaicism has never been reported and the recurrence risk for normal parents is very low (

  17. KBG syndrome

    Directory of Open Access Journals (Sweden)

    Brancati Francesco


    Full Text Available Abstract KBG syndrome is a rare condition characterised by a typical facial dysmorphism, macrodontia of the upper central incisors, skeletal (mainly costovertebral anomalies and developmental delay. To date, KBG syndrome has been reported in 45 patients. Clinical features observed in more than half of patients that may support the diagnosis are short stature, electroencephalogram (EEG anomalies (with or without seizures and abnormal hair implantation. Cutaneous syndactyly, webbed short neck, cryptorchidism, hearing loss, palatal defects, strabismus and congenital heart defects are less common findings. Autosomal dominant transmission has been observed in some families, and it is predominantly the mother, often showing a milder clinical picture, that transmits the disease. The diagnosis is currently based solely on clinical findings as the aetiology is unknown. The final diagnosis is generally achieved after the eruption of upper permanent central incisors at 7–8 years of age when the management of possible congenital anomalies should have been already planned. A full developmental assessment should be done at diagnosis and, if delays are noted, an infant stimulation program should be initiated. Subsequent management and follow-up should include an EEG, complete orthodontic evaluation, skeletal investigation with particular regard to spine curvatures and limb asymmetry, hearing testing and ophthalmologic assessment.

  18. Klinefelter syndrome. (United States)

    Smyth, C M; Bremner, W J


    Klinefelter syndrome is the most common sex chromosome disorder. Affected males carry an additional X chromosome, which results in male hypogonadism, androgen deficiency, and impaired spermatogenesis. Some patients may exhibit all of the classic signs of this disorder, including gynecomastia, small testes, sparse body hair, tallness, and infertility, whereas others, because of the wide variability in clinical expression, lack many of these features. Treatment consists of testosterone replacement therapy to correct the androgen deficiency and to provide patients with appropriate virilization. This therapy also has positive effects on mood and self-esteem and has been shown to protect against osteoporosis, although it will not reverse infertility. Although the diagnosis of Klinefelter syndrome is now made definitively using chromosomal karyotyping, revealing in most instances a 47,XXY genotype, the diagnosis also can be made using a careful history and results of a physical examination, with the hallmark being small, firm testes. As it affects 1 in 500 male patients and presents with a variety of clinical features, primary care physicians should be familiar with this condition.

  19. Disability,Driving Licence and Driving Technology:the Italian Experience%Disability, Driving Licence and Driving Technology: the Italian Experience

    Institute of Scientific and Technical Information of China (English)

    Antonino Ridolfi


    Through norms,concessions,assessment and training,the article shows the importance of the rehabilitation approach to identify the ways in which to help the disabled person achieve his driving licence and,therefore drive a vehicle.It shows the number of variants that exist for each system allowing the adaptation of various automobile functions to the needs of disabled people and in this way we can understand how even seriously disabled people with very complex situations can drive when the correct adaptations are identified.

  20. Adjustable Speed Drives - Future Challenges and Applications

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Thoegersen, Paul


    The main trends within Adjustable Drives in industrial and appliance applications for the next decade are discussed based on the newest developments seen on the market and a few historical trends. Different drive configurations are presented and the general demands to adjustable speed drives...... are specified. Further on power architectures and motor types are discussed in a short term and long-term view. Possible drivers of the future development are identified, and the concept of an ?Electronic Motor? is discussed. A number of applications are presented where variable speed is attractive....

  1. Development of belt conveyor driving system

    Institute of Scientific and Technical Information of China (English)

    FU Jun-qing(付峻青); WANG Cong(王聪); HUO Wei(霍伟)


    A short review for the existing various driving methods for belt conveyor was given, which include the analysis and comparison about the advantages, disadvantages and suitable application range of these methods. Based on this the variable-frequency-control(VFC) method for belt conveyor drive was fully discussed with focus on its application in medium-high voltage range. The principle of Neutral Point Clamped (NPC) Three-Level Inverter using high-voltage IGBTs together with the control strategy of rotor field-oriented vector control for induction motor drive were illustrated.

  2. Unexpected cellular players in Rett syndrome pathology. (United States)

    Cronk, James C; Derecki, Noel C; Litvak, Vladimir; Kipnis, Jonathan


    Rett syndrome is a devastating neurodevelopmental disorder, primarily caused by mutations of methyl CpG-binding protein 2 (MeCP2). Although the genetic cause of disease was identified over a decade ago, a significant gap still remains in both our clinical and scientific understanding of its pathogenesis. Neurons are known to be primary players in pathology, with their dysfunction being the key in Rett syndrome. While studies in mice have demonstrated a clear causative - and potential therapeutic - role for neurons in Rett syndrome, recent work has suggested that other tissues also contribute significantly to progression of the disease. Indeed, Rett syndrome is known to present with several common peripheral pathologies, such as osteopenia, scoliosis, gastrointestinal problems including nutritional defects, and general growth deficit. Mouse models assessing the potential role of non-neuronal cell types have confirmed both roles in disease and potential therapeutic targets. A new picture is emerging in which neurons both initiate and drive pathology, while dysfunction of other cell types and peripheral tissues exacerbate disease, possibly amplifying further neurologic problems, and ultimately result in a positive feedback loop of progressively worsening symptoms. Here, we review what is known about neuronal and non-neuronal cell types, and discuss how this new, integrative understanding of the disease may allow for additional clinical and scientific pathways for treating and understanding Rett syndrome.

  3. What is metabolic syndrome, and why are children getting it? (United States)

    Weiss, Ram; Bremer, Andrew A; Lustig, Robert H


    Metabolic syndrome comprises a cluster of cardiovascular risk factors (hypertension, altered glucose metabolism, dyslipidemia, and abdominal obesity) that occur in obese children. However, metabolic syndrome can also occur in lean individuals, suggesting that obesity is a marker for the syndrome, not a cause. Metabolic syndrome is difficult to define, due to its nonuniform classification and reliance on hard cutoffs in the evaluation of disorders with non-Gaussian distributions. Defining the syndrome is even more difficult in children, owing to racial and pubertal differences and lack of cardiovascular events. Lipid partitioning among specific fat depots is associated with insulin resistance, which can lead to mitochondrial overload and dysfunctional subcellular energy use and drive the various elements of metabolic syndrome. Multiple environmental factors, in particular a typical Western diet, drive mitochondrial overload, while other changes in Western society, such as stress and sleep deprivation, increase insulin resistance and the propensity for food intake. These culminate in an adverse biochemical phenotype, including development of altered glucose metabolism and early atherogenesis during childhood and early adulthood.

  4. Assessment of driving-related performance in chronic whiplash using an advanced driving simulator. (United States)

    Takasaki, Hiroshi; Treleaven, Julia; Johnston, Venerina; Rakotonirainy, Andry; Haines, Andrew; Jull, Gwendolen


    Driving is often nominated as problematic by individuals with chronic whiplash associated disorders (WAD), yet driving-related performance has not been evaluated objectively. The purpose of this study was to test driving-related performance in persons with chronic WAD against healthy controls of similar age, gender and driving experience to determine if driving-related performance in the WAD group was sufficiently impaired to recommend fitness to drive assessment. Driving-related performance was assessed using an advanced driving simulator during three driving scenarios; freeway, residential and a central business district (CBD). Total driving duration was approximately 15min. Five driving tasks which could cause a collision (critical events) were included in the scenarios. In addition, the effect of divided attention (identify red dots projected onto side or rear view mirrors) was assessed three times in each scenario. Driving performance was measured using the simulator performance index (SPI) which is calculated from 12 measures. z-Scores for all SPI measures were calculated for each WAD subject based on mean values of the control subjects. The z-scores were then averaged for the WAD group. A z-score of ≤-2 indicated a driving failing grade in the simulator. The number of collisions over the five critical events was compared between the WAD and control groups as was reaction time and missed response ratio in identifying the red dots. Seventeen WAD and 26 control subjects commenced the driving assessment. Demographic data were comparable between the groups. All subjects completed the freeway scenario but four withdrew during the residential and eight during the CBD scenario because of motion sickness. All scenarios were completed by 14 WAD and 17 control subjects. Mean z-scores for the SPI over the three scenarios was statistically lower in the WAD group (-0.3±0.3; P0.05). Assessment of driving in an advanced driving simulator for approximately 15min revealed

  5. Leopard syndrome

    Directory of Open Access Journals (Sweden)

    Dallapiccola Bruno


    Full Text Available Abstract LEOPARD syndrome (LS, OMIM 151100 is a rare multiple congenital anomalies condition, mainly characterized by skin, facial and cardiac anomalies. LEOPARD is an acronym for the major features of this disorder, including multiple Lentigines, ECG conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, and sensorineural Deafness. About 200 patients have been reported worldwide but the real incidence of LS has not been assessed. Facial dysmorphism includes ocular hypertelorism, palpebral ptosis and low-set ears. Stature is usually below the 25th centile. Cardiac defects, in particular hypertrophic cardiomyopathy mostly involving the left ventricle, and ECG anomalies are common. The lentigines may be congenital, although more frequently manifest by the age of 4–5 years and increase throughout puberty. Additional common features are café-au-lait spots (CLS, chest anomalies, cryptorchidism, delayed puberty, hypotonia, mild developmental delay, sensorineural deafness and learning difficulties. In about 85% of the cases, a heterozygous missense mutation is detected in exons 7, 12 or 13 of the PTPN11 gene. Recently, missense mutations in the RAF1 gene have been found in two out of six PTPN11-negative LS patients. Mutation analysis can be carried out on blood, chorionic villi and amniotic fluid samples. LS is largely overlapping Noonan syndrome and, during childhood, Neurofibromatosis type 1-Noonan syndrome. Diagnostic clues of LS are multiple lentigines and CLS, hypertrophic cardiomyopathy and deafness. Mutation-based differential diagnosis in patients with borderline clinical manifestations is warranted. LS is an autosomal dominant condition, with full penetrance and variable expressivity. If one parent is affected, a 50% recurrence risk is appropriate. LS should be suspected in foetuses with severe cardiac hypertrophy and prenatal DNA test may be performed. Clinical management should

  6. Metabolic Syndrome: Polycystic Ovary Syndrome. (United States)

    Mortada, Rami; Williams, Tracy


    Polycystic ovary syndrome (PCOS) is a heterogeneous condition characterized by androgen excess, ovulatory dysfunction, and polycystic ovaries. It is the most common endocrinopathy among women of reproductive age, affecting between 6.5% and 8% of women, and is the most common cause of infertility. Insulin resistance is almost always present in women with PCOS, regardless of weight, and they often develop diabetes and metabolic syndrome. The Rotterdam criteria are widely used for diagnosis. These criteria require that patients have at least two of the following conditions: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. The diagnosis of PCOS also requires exclusion of other potential etiologies of hyperandrogenism and ovulatory dysfunction. The approach to PCOS management differs according to the presenting symptoms and treatment goals, particularly the patient's desire for pregnancy. Weight loss through dietary modifications and exercise is recommended for patients with PCOS who are overweight. Oral contraceptives are the first-line treatment for regulating menstrual cycles and reducing manifestations of hyperandrogenism, such as acne and hirsutism. Clomiphene is the first-line drug for management of anovulatory infertility. Metformin is recommended for metabolic abnormalities such as prediabetes, and a statin should be prescribed for cardioprotection if the patient meets standard criteria for statin therapy.

  7. How mantle slabs drive plate tectonics. (United States)

    Conrad, Clinton P; Lithgow-Bertelloni, Carolina


    The gravitational pull of subducted slabs is thought to drive the motions of Earth's tectonic plates, but the coupling between slabs and plates is not well established. If a slab is mechanically attached to a subducting plate, it can exert a direct pull on the plate. Alternatively, a detached slab may drive a plate by exciting flow in the mantle that exerts a shear traction on the base of the plate. From the geologic history of subduction, we estimated the relative importance of "pull" versus "suction" for the present-day plates. Observed plate motions are best predicted if slabs in the upper mantle are attached to plates and generate slab pull forces that account for about half of the total driving force on plates. Slabs in the lower mantle are supported by viscous mantle forces and drive plates through slab suction.

  8. High Torque, Direct Drive Electric Motor Project (United States)

    National Aeronautics and Space Administration — Bear Engineering proposes to advance the development of an innovative high torque, low speed, direct drive motor in order to meet NASA's requirements for such...

  9. High Torque, Direct Drive Electric Motor Project (United States)

    National Aeronautics and Space Administration — Bear Engineering proposes to develop an innovative high torque, low speed, direct drive motor in order to meet NASA's requirements for such devices. Fundamentally,...

  10. Developing Castable Metal Harmonic Drives Project (United States)

    National Aeronautics and Space Administration — This effort utilizes the high elastic strain limit and net-shaped processing of metallic glasses to fabricate low-cost harmonic drives that outperform steel. ...

  11. Some Sleep Drugs Can Impair Driving (United States)

    ... For Consumers Home For Consumers Consumer Updates Some Sleep Drugs Can Impair Driving Share Tweet Linkedin Pin ... OTC) drugs. back to top Most Widely Used Sleep Drug Zolpidem—which has been on the market ...

  12. Hybrid Switch Reluctance Drives For Pump Applications

    DEFF Research Database (Denmark)

    Jakobsen, Uffe

    The initial research problem is to investigate an alternative motor drive to the existing permanent magnet synchronous and brushless DC-motor drives for pump applications. A review of different motor types showed that a possible candidate for another low cost permanent magnet motor may be the sin......The initial research problem is to investigate an alternative motor drive to the existing permanent magnet synchronous and brushless DC-motor drives for pump applications. A review of different motor types showed that a possible candidate for another low cost permanent magnet motor may...... a stroke. The changes of speed controller output during a stroke, may give rise to undesired low frequency oscillations in the speed controller output. A time variant speed controller is presented in the thesis that does not suffer from these issues. Like the brushless DC-motor (BLDC) and the permanent...

  13. Development of Sintered Iron Driving Bands

    Directory of Open Access Journals (Sweden)

    R. P. Khanna


    Full Text Available The present investigation reports some detailed studies carried out on the development testing and proving of sintered Iron Driving Bands. Sintering studies on two different types of iron powders together with a few Fe-Cu compositions have been made and based on the results there of, parameters for development iron driving bands have been standardised. The results obtained clearly demonstrate that substitution of copper by sintered iron is highly practicable alternative.

  14. Rotating Drive for Electrical-Arc Machining (United States)

    Fransen, C. D.


    Rotating drive improves quality of holes made by electrical-arc machining. Mechanism (Uni-tek, rotary head, or equivalent) attached to electrical-arc system. Drive rotates electrode as though it were mechanical drill, while an arc disintegrates metal in workpiece, thereby creating hole. Rotating electrode method often used in electric-discharge machining. NASA innovation is application of technique to electrical-arc machining.

  15. Self-Commissioning of AC Motor Drives


    Odhano, Shafiq Ahmed


    In modern motion control and power conversion applications, the use of inverter-fed electrical machines is fast growing with continuous development in the field of power electronics and drives. The Variable Voltage Variable Frequency (VVVF) supply for electrical machines gives superior performance in terms of speed control, efficiency and dynamics compared to the machines operated directly from the mains. In one of the most basic configurations, a drive system consists of a closed loop speed ...

  16. How to Drive CARS in Reverse (United States)


    and ‘heats’ this plasma creating an electron avalanche , analogous to the electric discharge used in traditional nitrogen lasers. These schemes are all... pulse . This pulse is then used to drive a coherent anti-Stokes Raman scattering scheme, resulting in a strong chemically specific signal propagating...generation of a backward propagating stimulated Raman pulse . This pulse is then used to drive a coherent anti-Stokes Raman scattering scheme, resulting in a

  17. Effective resonant interactions via a driving field

    Energy Technology Data Exchange (ETDEWEB)

    Klimov, A B [Departamento de FIsica, Universidad de Guadalajara, Revolucion 1500, Guadalajara 44420 (Mexico); Sainz, I [Departamento de FIsica, Universidad de Guadalajara, Revolucion 1500, Guadalajara 44420 (Mexico); Saavedra, C [Center for Quantum Optics and Quantum Information, Departamento de FIsica, Universidad de Concepcion, Casilla 160-C, Concepcion (Chile)


    Effective resonant quantum atom-field interactions are studied. These resonant interactions are induced by the presence of an external classical driving field. An adequate choice for frequencies of the driving field produces nonlinear effective Hamiltonians both for atom-field and for spin-spin interactions. It is shown that the exact numerical evolution for each resonance condition is well described by the corresponding effective Hamiltonian.

  18. Hypereosinophilic syndromes

    Directory of Open Access Journals (Sweden)

    Giuseppe Civardi


    Full Text Available Background: The last few years have seen a complete change in the etiopathogenetic features, classification and therapeutic approach of the hypereosinophilic syndrome (HES, a multiorgan targeted blood disease. The discovery of a genetic mutation and the occurrence of a new fusion gene, named FIP1L1-PDGFRA (FIP gene, in some patients allowed the identification of a new myeloproliferative disorder, M-HES: thereafter, the pivotal therapeutic role of the tyrosine kinase inhibitors, particularly, imatinib mesylate, was clearly detected. In the same period a new pathogenetic mechanism has been detected: some authors described the presence of a CD3-CD4 +Tcell clone correlating with the overproduction of IL5, a potent eosinophilic cell line stimulating cytokine. As a consequence an international consensus committee proposed a new classification for these syndromes, in accordance with these new pathogenetic features. The disease is characterized by an extensive tissue and organ damage due to an eosinophilic cell infiltration and leading to the release of toxic cytokines and subsequent organ dysfunction. The heart, lungs, gastrointestinal apparatus, skin and central nervous system are affected. Moreover the released cytokines can induce a thrombophilic status and thromboembolic events can occur throughout the body. Aim of the study: We describe the diagnostic procedures that are necessary in order to obtain a correct diagnosis and classification of the disease and to evaluate the presence of an organ and tissue damage. In particular, bone marrow biopsy and cytogenetic examination of blood and marrow are necessary for detecting M-HES cases that are positive for the FIP gene. In these patients, imatinib mesylate has a leading role for obtaining complete remission of the disease in a high percentage of cases. We also examine the therapeutic options for the other forms of the disease: prednisone, interferon, hydroxiurea are effective therapeutic tools in

  19. Cost of counterdiabatic driving and work output (United States)

    Zheng, Yuanjian; Campbell, Steve; De Chiara, Gabriele; Poletti, Dario


    Unitary processes allow for the transfer of work to and from Hamiltonian systems. However, to achieve nonzero power for the practical extraction of work, these processes must be performed within a finite time, which inevitably induces excitations in the system. We show that depending on the time scale of the process and the physical realization of the external driving employed, the use of counterdiabatic quantum driving to extract more work is not always effective. We also show that by virtue of the two-time energy measurement definition of quantum work, the cost of counterdiabatic driving can be significantly reduced by selecting a restricted form of the driving Hamiltonian that depends on the outcome of the first energy measurement. Lastly, we introduce a measure, the exigency, that quantifies the need for an external driving to preserve quantum adiabaticity which does not require knowledge of the explicit form of the counterdiabatic drivings, and can thus always be computed. We apply our analysis to systems ranging from a two-level Landau-Zener problem to many-body problems, namely, the quantum Ising and Lipkin-Meshkov-Glick models.

  20. Electromagnetic driving units for complex microrobotic systems (United States)

    Michel, Frank; Ehrfeld, Wolfgang; Berg, Udo; Degen, Reinhard; Schmitz, Felix


    Electromagnetic actuators play an important role in macroscopic robotic systems. In combination with motion transformers, like reducing gear units, angular gears or spindle-screw drives, electromagnetic motors in large product lines ensure the rotational or linear motion of robot driving units and grippers while electromagnets drive valves or part conveyors. In this paper micro actuators and miniaturized motion transformers are introduced which allow a similar development in microrobotics. An electromagnetic motor and a planetary gear box, both with a diameter of 1.9 mm, are already commercially available from the cooperation partner of IMM, the company Dr. Fritz Faulhaber GmbH in Schonaich, Germany. In addition, a motor with a diameter of 2.4 mm is in development. The motors successfully drive an angular gear and a belt drive. A linear stage with a motion range of 7 mm and an overall size as small as 5 X 3.5 X 24 mm3 has been realized involving the motor, a stationary spur gear with zero backlash and a spindle-screw drive. By the use of these commercially available elements complex microrobots can be built up cost-efficiently and rapidly. Furthermore, a batch process has been developed to produce the coils of micro actuator arrays using lithographic techniques with SU-8 resin. In applying these components, the modular construction of complex microrobotic systems becomes feasible.

  1. Optimal Control Development System for Electrical Drives

    Directory of Open Access Journals (Sweden)

    Marian GAICEANU


    Full Text Available In this paper the optimal electrical drive development system is presented. It consists of both electrical drive types: DC and AC. In order to implement the optimal control for AC drive system an Altivar 71 inverter, a Frato magnetic particle brake (as load, three-phase induction machine, and dSpace 1104 controller have been used. The on-line solution of the matrix Riccati differential equation (MRDE is computed by dSpace 1104 controller, based on the corresponding feedback signals, generating the optimal speed reference for the AC drive system. The optimal speed reference is tracked by Altivar 71 inverter, conducting to energy reduction in AC drive. The classical control (consisting of rotor field oriented control with PI controllers and the optimal one have been implemented by designing an adequate ControlDesk interface. The three-phase induction machine (IM is controlled at constant flux. Therefore, the linear dynamic mathematical model of the IM has been obtained. The optimal control law provides transient regimes with minimal energy consumption. The obtained solution by integration of the MRDE is orientated towards the numerical implementation-by using a zero order hold. The development system is very useful for researchers, doctoral students or experts training in electrical drive. The experimental results are shown.

  2. Study Sheds Light on Safety of Driving with Epilepsy (United States)

    ... Study Sheds Light on Safety of Driving With Epilepsy Those who had longer seizures during driving tests ... SUNDAY, Dec. 4, 2016 (HealthDay News) -- People with epilepsy who experienced longer seizures during a simulated driving ...

  3. ADHD and genetic syndromes. (United States)

    Lo-Castro, Adriana; D'Agati, Elisa; Curatolo, Paolo


    A high rate of Attention Deficit/Hyperactivity Disorder (ADHD)-like characteristics has been reported in a wide variety of disorders including syndromes with known genetic causes. In this article, we review the genetic and the neurobiological links between ADHD symptoms and some genetic syndromes such as: Fragile X Syndrome, Neurofibromatosis 1, DiGeorge Syndrome, Tuberous Sclerosis Complex, Turner Syndrome, Williams Syndrome and Klinefelter Syndrome. Although each syndrome may arise from different genetic abnormalities with multiple molecular functions, the effects of these abnormalities may give rise to common effects downstream in the biological pathways or neural circuits, resulting in the presentation of ADHD symptoms. Early diagnosis of ADHD allows for earlier treatment, and has the potential for a better outcome in children with genetic syndromes.

  4. First Trimester Down Syndrome Screen (United States)

    ... disorder such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18) . The first trimester screen is one ... chromosome material that results in Down syndrome or Edwards syndrome , the levels of PAPP-A tend to be ...

  5. Prenatal Tests for Down Syndrome (United States)

    ... PRENATAL TESTS FOR DOWN SYNDROME What Is Down Syndrome? Down syndrome is a common birth defect that includes mental retardation and— often— heart problems. Children with Down syndrome have round faces and almond-shaped eyes that ...

  6. Genetics Home Reference: Werner syndrome (United States)

    ... for This Condition Adult premature aging syndrome Adult Progeria Werner's Syndrome Werners Syndrome WS Related Information How ... BK, Monnat RJ Jr. Werner and Hutchinson-Gilford progeria syndromes: mechanistic basis of human progeroid diseases. Nat ...

  7. Driving Competence in Mild Dementia with Lewy Bodies: In Search of Cognitive Predictors Using Driving Simulation

    Directory of Open Access Journals (Sweden)

    Stephanie Yamin


    Full Text Available Driving is a multifactorial behaviour drawing on multiple cognitive, sensory, and physical systems. Dementia is a progressive and degenerative neurological condition that impacts the cognitive processes necessary for safe driving. While a number of studies have examined driving among individuals with Alzheimer’s disease, less is known about the impact of Dementia with Lewy Bodies (DLB on driving safety. The present study compared simulated driving performance of 15 older drivers with mild DLB with that of 21 neurologically healthy control drivers. DLB drivers showed poorer performance on all indicators of simulated driving including an increased number of collisions in the simulator and poorer composite indicators of overall driving performance. A measure of global cognitive function (i.e., the Mini Mental State Exam was found to be related to the overall driving performance. In addition, measures of attention (i.e., Useful Field of View, UFOV and space processing (Visual Object and Space Perception, VOSP, Test correlated significantly with a rater’s assessment of driving performance.

  8. Goldenhar Syndrome in Association with Duane Syndrome

    Directory of Open Access Journals (Sweden)

    U D Shrestha


    Full Text Available Goldenhar syndrome (GHS is also known as Oculo-Auriculo-Vertebral (OAV syndrome or Branchial arch syndrome. Duane retraction syndrome (DRS is a congenital disorder of ocular motility characterized by limited abduction, adduction or both. It is unilateral in 80% of cases. The important and interesting part of this eight months old child is presence of GHS with DRS. She has bilateral invol-vement, which is seen in only 5-8% of GHS, as compared to high incidence of unilateral involve-ment. This child also had refractive error of + 6.00/ - 1.5 * 180. At four year of age her vision with glass was 6/9. Children with GHS and DRS should have early eye examination done to treat the problem of refractive error. Keywords: Duane retraction syndrome; goldenhar syndrome, refractive error.

  9. Angelman Syndrome. (United States)

    Margolis, Seth S; Sell, Gabrielle L; Zbinden, Mark A; Bird, Lynne M


    In this review we summarize the clinical and genetic aspects of Angelman syndrome (AS), its molecular and cellular underpinnings, and current treatment strategies. AS is a neurodevelopmental disorder characterized by severe cognitive disability, motor dysfunction, speech impairment, hyperactivity, and frequent seizures. AS is caused by disruption of the maternally expressed and paternally imprinted UBE3A, which encodes an E3 ubiquitin ligase. Four mechanisms that render the maternally inherited UBE3A nonfunctional are recognized, the most common of which is deletion of the maternal chromosomal region 15q11-q13. Remarkably, duplication of the same chromosomal region is one of the few characterized persistent genetic abnormalities associated with autistic spectrum disorder, occurring in >1-2% of all cases of autism spectrum disorder. While the overall morphology of the brain and connectivity of neural projections appear largely normal in AS mouse models, major functional defects are detected at the level of context-dependent learning, as well as impaired maturation of hippocampal and neocortical circuits. While these findings demonstrate a crucial role for ubiquitin protein ligase E3A in synaptic development, the mechanisms by which deficiency of ubiquitin protein ligase E3A leads to AS pathophysiology in humans remain poorly understood. However, recent efforts have shown promise in restoring functions disrupted in AS mice, renewing hope that an effective treatment strategy can be found.

  10. Space Drive Physics: Introduction and Next Steps (United States)

    Millis, M. G.

    Research toward the visionary goal of propellantless ``space drives'' is introduced, covering key physics issues and a listing of roughly 2-dozen approaches. The targeted advantage of a space drive is to circumvent the propellant constraints of rockets and the maneuvering limits of light sails by using the interactions between the spacecraft and its surrounding space for propulsion. At present, the scientific foundations from which to engineer a space drive have not been discovered and, objectively, might be impossible. Although no propulsion breakthroughs appear imminent, the subject has matured to where the relevant questions have been broached and are beginning to be answered. The critical make-break issues include; conservation of momentum, uncertain sources of reaction mass, and the net-external thrusting requirement. Note: space drives are not necessarily faster- than-light devices. Speed limits are a separate, unanswered issue. Relevant unsolved physics includes; the sources and mechanisms of inertial frames, coupling of gravitation and electromagnetism, and the nature of the quantum vacuum. The propulsion approaches span mostly stages 1 through 3 of the scientific method (defining the problem, collecting data, and articulating hypotheses), while some have matured to stage 4 (testing hypotheses). Nonviable approaches include `stiction drives,' `gyroscopic antigravity,' and `lifters.' No attempt is made to gauge the prospects of the remaining approaches. Instead, a list of next-step research questions is derived from the examination of these goals, unknowns, and concepts.

  11. Semiclassical instability of dynamical warp drives

    CERN Document Server

    Finazzi, Stefano; Barceló, Carlos


    Warp drives are very interesting configurations in General Relativity: At least theoretically, they provide a way to travel at superluminal speeds, albeit at the cost of requiring exotic matter to exist as solutions of Einstein's equations. However, even if one succeeded in providing the necessary exotic matter to build them, it would still be necessary to check whether they would survive to the switching on of quantum effects. Semiclassical corrections to warp-drive geometries have been analyzed only for eternal warp-drive bubbles traveling at fixed superluminal speeds. Here, we investigate the more realistic case in which a superluminal warp drive is created out of an initially flat spacetime. First of all we analyze the causal structure of eternal and dynamical warp-drive spacetimes. Then we pass to the analysis of the renormalized stress-energy tensor (RSET) of a quantum field in these geometries. While the behavior of the RSET in these geometries has close similarities to that in the geometries associate...

  12. The drive revisited: Mastery and satisfaction. (United States)

    Denis, Paul


    Starting from the theory of the libido and the notions of the experience of satisfaction and the drive for mastery introduced by Freud, the author revisits the notion of the drive by proposing the following model: the drive takes shape in the combination of two currents of libidinal cathexis, one which takes the paths of the 'apparatus for obtaining mastery' (the sense-organs, motricity, etc.) and strives to appropriate the object, and the other which cathects the erotogenic zones and the experience of satisfaction that is experienced through stimulation in contact with the object. The result of this combination of cathexes constitutes a 'representation', the subsequent evocation of which makes it possible to tolerate for a certain period of time the absence of a satisfying object. On the basis of this conception, the author distinguishes the representations proper, vehicles of satisfaction, from imagos and traumatic images which give rise to excitation that does not link up with the paths taken by the drives. This model makes it possible to conciliate the points of view of the advocates of 'object-seeking' and of those who give precedence to the search for pleasure, and, further, to renew our understanding of object-relations, which can then be approached from the angle of their relations to infantile sexuality. Destructiveness is considered in terms of "mastery madness" and not in terms of the late Freudian hypothesis of the death drive.

  13. 'Outsmarting Traffic, Together': Driving as Social Navigation

    Directory of Open Access Journals (Sweden)

    Sam Hind


    Full Text Available The automotive world is evolving. Ten years ago Nigel Thrift (2004: 41 made the claim that the experience of driving was slipping into our 'technological unconscious'. Only recently the New York Times suggested that with the rise of automated driving, standalone navigation tools as we know them would cease to exist, instead being 'fully absorbed into the machine' (Fisher, 2013. But in order to bridge the gap between past and future driving worlds, another technological evolution is emerging. This short, critical piece charts the rise of what has been called 'social navigation' in the industry; the development of digital mapping platforms designed to foster automotive sociality. It makes two provisional points. Firstly, that 'ludic' conceptualisations can shed light on the ongoing reconfiguration of drivers, vehicles, roads and technological aids such as touch-screen satellite navigation platforms. And secondly, that as a result of this, there is a coming-into-being of a new kind of driving politics; a 'casual politicking' centred on an engagement with digital interfaces. We explicate both by turning our attention towards Waze; a social navigation application that encourages users to interact with various driving dynamics.   

  14. Sheehan's Syndrome (Postpartum Hypopituitarism) (United States)

    Sheehan's syndrome Overview By Mayo Clinic Staff Sheehan's syndrome is a condition that affects women who lose a life-threatening amount of blood in childbirth or who have severe low blood pressure ...

  15. The obstetric antiphospholipid syndrome

    NARCIS (Netherlands)

    Derksen, R. H. W. M.; de Grootb, Ph. G.


    The association of persistent presence of circulating antiphospholipid antibodies and thromboembolic events, (recurrent) pregnancy loss or both is termed antiphospholipid syndrome. Pregnancies in women with the syndrome should be regarded as at high-risk for complications. Optimal management consist

  16. Milk-alkali syndrome (United States)

    ... this page: // Milk-alkali syndrome To use the sharing features on this page, please enable JavaScript. Milk-alkali syndrome is a condition in which there ...

  17. Diabetic hyperglycemic hyperosmolar syndrome (United States)

    ... this page: // Diabetic hyperglycemic hyperosmolar syndrome To use the sharing features on this page, please enable JavaScript. Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of ...

  18. Acute respiratory distress syndrome (United States)

    ... page: // Acute respiratory distress syndrome To use the sharing features on this page, please enable JavaScript. Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that ...

  19. Restless Legs Syndrome Foundation (United States)

    ... Into Relieved Are you experiencing symptoms linked to restless legs syndrome (RLS)? Find tools and support to help get ... I couldn’t sleep. Fortunately, I found the Restless Legs Syndrome Foundation and learned what type of doctor to ...

  20. What Is Marfan Syndrome? (United States)

    ... 11:11 Size: 10.5 MB November 2014 What Is Marfan Syndrome? Fast Facts: An Easy-to- ... Being Done on Marfan Syndrome? For More Information What Is Connective Tissue? Connective tissue supports many parts ...