Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea.

PURPOSE: There is limited information on the association between pre-treatment insomnia symptoms and dysfunctional sleep beliefs with continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA). Our aims were to describe demographic and sleep characteristics of veterans with and without comorbid insomnia and determine whether pre-treatment insomnia symptoms and dysfunctional sleep beliefs predict CPAP use after 6 months of therapy. METHODS: Hispanic veterans attending the Miami VA sleep clinic were recruited and completed the insomnia severity index, the dysfunctional sleep belief and attitude scale (DBAS), and other questionnaires. Participants were asked to return after 7 days and 1 and 6 months to repeat questionnaires and for objective CPAP adherence download. Hierarchical regression models were performed to determine adjusted associations of pre-treatment insomnia symptoms and DBAS sub-scores on 6-month mean daily CPAP use. RESULTS: Fifty-three participants completed the 6-month follow-up visit with a mean CPAP use of 3.4 ± 1.9 h. Veterans with comorbid insomnia had lower mean daily CPAP use (168 ± 125 vs 237 ± 108 min, p = 0.04) and lower percent daily CPAP use ≥ 4 h (32 ± 32 vs 51 ± 32%, p = 0.05) compared to participants without insomnia. In adjusted analyses, pre-treatment insomnia symptoms (early, late, and aggregated nocturnal symptoms) and sleep dissatisfaction were predictive of lower CPAP use at 6 months. Pre-treatment dysfunctional sleep beliefs were not associated with CPAP adherence. CONCLUSIONS: Pre-treatment nocturnal insomnia symptoms and sleep dissatisfaction predicted poorer 6- month CPAP use. Insomnia treatment preceding or concurrent with CPAP initiation may eliminate a barrier to regular use.

Use of immunotherapy in a primary care office.

Immunotherapy has been used for over 80 years. It is a safe and effective therapeutic intervention for allergic rhinitis, but its use in the treatment of asthma is more controversial. Patients with unstable asthma are at increased risk of adverse effects from immunotherapy; therefore, if immunotherapy is used in such patients, it should be instituted cautiously. Indications for immunotherapy include evidence of IgE-mediated disease and positive results on skin tests or radioallergosorbent test (RAST). In addition, before immunotherapy is considered, measures to avoid exposure to offending agents and drug therapy should have failed to provide relief of symptoms. Before administering immunotherapy in the office, physicians should be knowledgeable about the use of immunotherapy and the treatment of anaphylaxis, and should have ready access to the equipment needed to avert anaphylaxis.

Monoclonal antibodies directed against surface and intracellular antigens of mouse granulated metrial gland cells.

Rat monoclonal antibodies with reactivity directed against mouse GMG cells have been produced. One of the antibodies (GMG-1) reacts with a surface antigen of GMG cells and cross-reacts with T lymphocytes. Another (GMG-2) reacts with an intracellular antigen in GMG cells and with asialo-GM1 positive cells in the spleen. Three antibodies (GMG-3, -4, -5) bind to intracellular antigens in GMG cells. The cross-reactivity of these antibodies is discussed with reference to the lineage relationship of GMG cells to NK cells and T cells and the recent suggestion that NK cells and T cells have a common progenitor cell. It is proposed that GMG cells share this common progenitor cell but are otherwise independent of the NK or T cell lineages.

Inversion in the steady state: contrast optimization and reduced imaging time with fast three-dimensional inversion-recovery-prepared GRE pulse sequences.

PURPOSE: To evaluate the differences in contrast between 1-second delay and zero delay (for magnetization recovery) before the preparation radio-frequency pulse in three-dimensional, inversion-recovery (IR) fast gradient-echo (GRE) acquisitions. MATERIALS AND METHODS: Mathematical simulations and measurements of brain image contrast were performed with healthy volunteers and 10 patients. RESULTS: The zero-delay sequence generated T1-weighted contrast similar to that obtained with 1-second delay but was accompanied by a substantial reduction in imaging time. However, the zero delay prohibits full recovery of the longitudinal magnetization. Hence, the signal null characteristic of IR experiments is not easily observed, since it occurs (as a function of tissue T1) at very short inversion times (< 150 msec). CONCLUSION: T1-weighted contrast comparable with that of magnetization-prepared rapid GRE sequences with a 1-second delay and preparation time (TP) of 600-700 msec can be achieved in less time by using a zero delay and a shorter TP (400-500 msec).

Cytogenetic study of maturing granulocytes in bone marrow of patients with acute myelogenous leukemia.

To determine the cytogenetic origin of maturing granulocytes in the bone marrow of patients with acute myelogenous leukemia, bone marrow cells were studied using a modified cytogenetic technique, which does not disrupt the cell membrane, in conjunction with periodic acid-Schiff (PAS) staining. In four cases successfully studied, myeloblasts were PAS-negative and granulocytes were PAS-positive. In three cases successfully studied following 0-2 days of culture, metaphase spreads with abnormal karyotypes characteristic of the patients' leukemic clones were seen in five of five, six of nine, and four of four PAS-positive cells successfully studied. These patients' bone marrows were AN, AA, and AA, respectively, by standard cytogenetic study. Therefore, the cytogenetic status of PAS-positive cells did not necessarily correlate with presence or absence of normal metaphases determined by standard cytogenetic study. Bone marrow cells which underwent full and partial granulocytic maturation in suspension culture were studied following 2 weeks of culture. Abnormal karyotypes were seen in five of five and two of two metaphases in PAS-positive cells successfully studied in two patients. Therefore, we have demonstrated that when acute myelogenous leukemia cells undergo myeloid maturation in culture, the mature cells may be definitely proven to derive from leukemic progenitors rather than from normal stem cells.