No abstract

Background: Airway clearance techniques are an important part of the routine care of patients with bronchiectasis. The use of the Flutter, a hand held pipe-like device causing oscillating positive expiratory pressure within the airways, has been proposed as an alternative to more conventional airway clearance techniques. Methods: A randomised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home, in which 4 weeks of daily active cycle of breathing technique (ACBT) were compared with 4 weeks of daily physiotherapy with the Flutter device. Results: No significant differences between the two techniques were found. Median weekly sputum weights were similar with a median treatment difference of 7.64 g (p=0.77) and there was no evidence of treatment order or order interaction effects (p=0.70). Health status (Chronic Respiratory Disease Questionnaire) and ventilatory function did not change significantly during either treatment period. There was no significant change in peak expiratory flow rate or in breathlessness (Borg score) after individual physiotherapy sessions with either technique. A questionnaire indicated subjectively that patients preferred the Flutter (11/17) to ACBT for routine use. Conclusions: Daily use of the Flutter device in the home is as effective as ACBT in patients with noncystic fibrosis bronchiectasis and has a high level of patient acceptability.

S U IVl .VI .\ R YThe effects of shoot submergence on root aeration were examined using floodwater flushed with 1 or 2 kPa CO., plus 1 0 or 21 kPa ().,, or with air; the rooting media were stagnant. Oxygen regimes within the roots were evaluated from measurements ot radial ()., loss to polarographic electrodes sleeving the extension zone of nodal roots, or, from dissolved O., and ethanol in the rooting medium.With shoots submerged, root O^ and extension, as well as O., and ethanol concentrations in the rooting medium underwent marked diurnal changes. In the dark, the radial ()., loss fell rapidly until root surface O., became (0-001 mol m"'' (gas-phase equivalent <()'l kPa) and root extension slowed down or ceased. Oxygen, previously accumulated in the rooting medium, also declined markedly, whilst ethanol accumulated rapidly. When the lights come on, radial O., loss resumed within 3 min and surged to a peak at c. 30 min before decreasing gradually to a lower level. Root extension also resumed, and a steady rise in dissoh'ed ()., was accompanied by a decline in ethanol concentration. The expression of a diurnal cycling of O,, was attributed to high boutidary-layer resistance to gas exchange between leaf and water, to CO,^ supply and to a buffering eftect by oxygen in the floodwater. Thus, during the day the escape of photosynthetic ()., was hindered, while at night, ()., How from floodwater to leaf was restricted. Fluctuations in ethanol were attributed to the generation and subsequent consumption of ethanol by the roots in response to lower and higher internal O,, concentration. The O., surge at dawn was partly attributed to enhanced photosynthesis from accumulated internal CO.,, and partly to a decline in O,, demand during the night as a result of substrate depletion in the plant. Stagnant floodwaters around the shoots led to much higher daytime rates of radial O,^ loss from the roots, and to unexpected oscillations in radial O., loss attributed to pressurisation and de-pressurization during the expansion and subsequent release of O.,-enriched bubbles from the leaves.With non-submerged plants, the diurnal cycles in O., and ethanol concentrations were smaller and in the case of O,,, different in pattern: although, initially at night, radial O., loss declined, it often rose again later. T his trend would be consistent with a reduction in respiration during the night following rapid substrate depletion at the high temperatures. Short roots grew day and night, but as roots became longer, apical O., concentration declined and, because of this, growth ceased at c. 80 mm. The considerable influence of high temperatures on root aeration was confirmed by rapid increases in radial O., loss when temperatures were lowered from 32 to 23 °C.The ecological significance of the landings is discussed and it is concluded that {a) a diurnal periodicity ot root growth and of localized internal anoxia may be a normal feature of roots in submerged and even non-submerged rice, and (b) ethanol production may play an important role in ...

Somnolence is common in craniopharyngioma patients and in the majority is because of obstructive sleep apnoea. An additional group of somnolent craniopharyngioma patients benefits from modafinil.