A gender-based comparison of academic rank and scholarly productivity in academic neurological surgery

The number of women pursuing training opportunities in neurological surgery has increased, although they are still underrepresented at senior positions relative to junior academic ranks. Research productivity is an important component of the academic advancement process. We sought to use the h-index, a bibliometric previously analyzed among neurological surgeons, to evaluate whether there are gender differences in academic rank and research productivity among academic neurological surgeons. The h-index was calculated for 1052 academic neurological surgeons from 84 institutions, and organized by gender and academic rank. Overall men had statistically higher research productivity (mean 13.3) than their female colleagues (mean 9.5), as measured by the h-index, in the overall sample (p < 0.0007). When separating by academic rank, there were no statistical differences (p > 0.05) in h-index at the assistant professor (mean 7.2 male, 6.3 female), associate professor (11.2 male, 10.8 female), and professor (20.0 male, 18.0 female) levels based on gender. There was insufficient data to determine significance at the chairperson rank, as there was only one female chairperson. Although overall gender differences in scholarly productivity were detected, these differences did not reach statistical significance upon controlling for academic rank. Women were grossly underrepresented at the level of chairpersons in this sample of 1052 academic neurological surgeons, likely a result of the low proportion of females in this specialty. Future studies may be needed to investigate gender-specific research trends for neurosurgical residents, a cohort that in recent years has seen increased representation by women.     

Gender differences in platelet brain derived neurotrophic factor in patients with cardiovascular disease and depression

Women have a higher prevalence of depression compared to men. Serum levels of Brain-derived neurotrophic factor (BDNF) are decreased in depression. BDNF may also have a protective role in the pathogenesis of coronary artery disease (CAD) or events. We examined whether there are gender differences in BDNF levels in patients with stable CAD and comorbid depression. We enrolled 37 patients (17 women) with stable CAD with and without depression from a single medical center. All patients had depression assessment with the Beck Depression Inventory-II questionnaire. Both plasma and platelet BDNF were measured in all patients using a standard ELISA method. Platelet BDNF levels were higher than plasma BDNF levels in the entire group (5903.9 ± 1915.6 vs 848.5 ± 460.5 pg/ml, p < 0.001). Women had higher platelet BDNF levels than men (6954.2 ± 1685.6 vs. 5011.2 ± 1653.5 pg/ml, p < 0.001). Women without depression (BDI-II < 5, n = 8) had higher platelet BDNF than men without depression (n = 8, 7382.8 ± 1633.1 vs 4811.7 ± 1642.3 pg/ml, p = 0.007). Women with no or minimal depression (BDI < 14, n = 14) had higher platelet BDNF levels than men with no or minimal depression (n = 18, 6900.2 ± 1486.6 vs 4972.9 ± 1568.9 pg/ml, p = 0.001). The plasma BDNF levels were similar between men and women in all categories of depression. In conclusion, women with stable CAD have increased platelet BDNF levels when compared to men with stable CAD regardless of their level of depression. Sex specific differences in BDNF could possibly indicate differences in factors linking platelet activation and depression in men and women.     

Gender-based differences in oxidative stress parameters do not underlie the differences in mood disorders susceptibility between sexes

The present study aimed to determine whether any gender-related difference exists concerning oxidative stress parameters in a population of 231 subjects, and if these changes might be related to gender-associated differences in major depressive disorder (MDD) or bipolar disorder (BD) vulnerability. This is a case-control nested in a population-based study. The initial psychopathology screen was performed with the Mini-International Neuropsychiatric Interview and the diagnostic was further confirmed with the Structured Clinical Interview for DSM-IV. Blood samples were obtained after the interview and the oxidative stress parameters such as uric acid, advanced oxidation protein product (PCC) and lipid hydroperoxides (TBARS) were determined. Our results indicated a higher prevalence of MDD and BD in women when compared to men. In addition, significant gender differences were found in the levels of PCC (0.27 ± 0.27 vs. 0.40 ± 0.31 nmol CO/mg protein, men vs. women, respectively; P = 0.02) and uric acid (4.88 ± 1.39 mg/dL vs. 3.53 ± 1.02 mg/dL, men vs. women, respectively; P = 0.0001), but not in TBARS (0.013 ± 0.01 nmol/mg of protein vs. 0.017 ± 0.02 nmol/mg of protein, men vs. women respectively; P = 0.243). After sample stratification by gender, no association was found between oxidative stress parameters and clinical diagnosis of MDD and BD for women (P = 0.516 for PCC; P = 0.620 for TBARS P = 0.727 for uric acid) and men (P = 0.367 for PCC; P = 0.372 for TBARS P = 0.664 for uric acid). In this study, women seem more susceptible to oxidative stress than male. However, these gender-based differences do not seem to provide a biochemical basis for the epidemiologic differences in mood disorders susceptibility between sexes.     

Prognostic factors of key outcomes for motor neuron disease in a multiracial Asian population

BackgroundKnowledge of prognostic factors related to the survival of Motor Neuron Diseases (MND) remains scarce in Southeast Asia.PurposeTo determine potential prognostic factors for survival, need for feeding and ventilation support in MND patients in a multi-racial Asian population.MethodsOne hundred and four MND patients from the Singapore General Hospital (SGH) between January 2004 and December 2017 were reviewed. All relevant clinical data, demographic information were collected. Kaplan-Meier and Cox regression model were performed to identify potential prognostic factors for crucial outcomes (survival, need for feeding support and ventilation support).ResultsMean age of onset was 59.54 ± 10.91 years, Mean age of onset in Malays was significantly younger than that of other ethnic groups (Malay: 54.18 ± 12.95 years; Non-Malay: 60.39 ± 10.38 years, p = 0.035). Fifty six of the male and 33of the female were diagnosed with ALS (90.3% vs. 78.6% p = 0.048). Mean overall survival duration from symptom onset was significantly longer in female than male patients (female: 39.2 ± 29.04 months; male: 29.4 ± 24.06 months, P = 0.03). In the multivariable Cox regression model, bulbar onset (aHR = 5.28, p = 0.035) correlated with poor survival outcome while longer duration from onset to second symptom (aHR = 0.96, P = 0.037) indicated better survival.ConclusionsBulbar onset was a significant risk predictor for survival. Slower disease progression correlated with better outcomes. Age of onset may differ among ethnic groups. Male patients are more likely to develop Amyotrophic Lateral Sclerosis (ALS) and have shorter survival duration.     

Effects of gait training with a voluntary-driven wearable cyborg,Hybrid Assistive Limb (HAL), on quality of life in patients with neuromuscular disease,able to walk independently with aids

Robot-assisted gait training using a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), has been shown to improve the mobility of patients with neurological disorders; however, its effect on the quality of life (QOL) of patients is not clear. The aim of this study was to assess the effects of HAL-assisted gait training on QOL and mobility in patients with neuromuscular diseases (NMDs). Ten patients with NMDs (seven men and three women, mean age: 57 ± 11 years), with impairment in mobility but could walk alone with aids underwent two courses of gait training with HAL over 6 months, and the single course consisted of nine sessions of training for 4 weeks. We compared the findings of the 2 min walk test, 10 m walk test, the Short Form-36 (SF-36) questionnaire, and the Hospital Anxiety and Depression Scale at baseline, after the 1st training, before the 2nd training, and after the 2nd training using the Friedman test. A significant improvement was observed in the 2 min walking distance from baseline (93 ± 50 m) to after the 2nd training (115 ± 48 m, P = 0.034), as well as in the domains of vitality (P = 0.019) and mental component summary score (P = 0.019) of SF-36. The improvement in 10 m walking speed was significantly correlated with that in the physical functioning (R = 0.831, P = 0.003) and role physical (R = 0.697, P = 0.025) domains in the SF-36. Our findings suggest that HAL-assisted gait training is effective in improving QOL associated with mental health as well as gait ability in selected patients with NMDs.     

Brain‐Derived Neurotrophic Factor and Substrate Utilization Following Acute Aerobic Exercise in Obese Individuals

Brain‐derived neurotrophic factor (BDNF) serves as a vital regulator of neuronal proliferation and survival, and has been shown to regulate energy homeostasis, glucose metabolism and body weight maintenance. Elevated concentrations of plasma BDNF have been associated with obesity and type 2 diabetes mellitus. Acute aerobic exercise transiently increases circulating BDNF, potentially correcting obesity‐related metabolic impairment. The present study aimed to compare acute aerobic exercise elicited BDNF responses in obese and normal‐weight subjects. Furthermore, we aimed to investigate whether acute exercise‐induced plasma BDNF elevations would be associated with improved indices of insulin resistance, as well as substrate utilization [carbohydrate oxidation (CHOoxi) and fat oxidation (FAToxi)]. Twenty‐two healthy, untrained subjects [11 obese (four men and seven women; age = 22.91 ± 4.44 years; body mass index = 35.72 ± 4.17 kg/m²) and 11 normal‐weight (five men and six women; age = 23.27 ± 2.24 years; body mass index = 21.89 ± 1.63 kg/m²)] performed 30 min of continuous submaximal aerobic exercise at 75% maximal oxygen consumption. Our analyses showed that the BDNF response to acute aerobic exercise was similar in obese and normal‐weight subjects across time (time: P = 0.015; group: P = not significant) and was not associated with indices of IR. Although no differences in the rates of CHOoxi and FAToxi were found between both groups, total relative energy expenditure was significantly lower in obese subjects compared to normal‐weight subjects (3.53 ± 0.25 versus 5.59 ± 0.85; P < 0.001). These findings suggest that acute exercise‐elicited BDNF elevation may not be sufficient to modulate indices of IR or the utilization of either carbohydrates or fats in obese individuals.     

Sexual dimorphism of physical activity on cognitive aging: Role of immune functioning

ObjectiveExercise is one of the most potent strategies available to support cognitive health with age, yet substantial variability exists. Sexual dimorphism is evident for brain and immune functioning, the latter being implicated as important pathway for exercise. We examined the moderating role of sex on the relationship between physical activity and systemic inflammatory and brain health outcomes in support of more personalized approaches to behavioral interventions.MethodsOur discovery cohort included 45 typically aging women matched on age (±5y) and education (±2y) to 45 men (mean age = 72.5; Clinical Dementia Rating = 0) who completed self-reported current physical activity (Physical Activity Scale for Elderly), blood draw, neuropsychological evaluation, and brain MRI. An independent sample of 45 typically aging women and 36 men who completed the same measures comprised a replication cohort. Plasma was analyzed for 11 proinflammatory cytokine and chemokine markers via MesoScale Discovery.ResultsDiscovery cohort: Reported physical activity did not differ between sexes (150 vs. 157, p = 0.72). There was a significant interaction between sex and physical activity on chemokine markers MDC, MIP-1b, MCP-4, and eotaxin-3 (ps < 0.03), with a similar trend for MCP-1 and INFγ (ps < 0.09). Men who reported greater activity demonstrated lower inflammatory markers, an effect attenuated-to-absent in women. An interaction between sex and physical activity was also observed for parahippocampal volumes (p = 0.02) and cognition (processing speed and visual memory; ps < 0.04). Again, the beneficial effect of physical activity on outcomes was present in men, but not women. Replication cohort analyses conferred a consistent effect of sex on the relationship between physical activity and immune markers; models examining neurobehavioral outcomes did not strongly replicate. Across cohorts, post-hoc models demonstrated an interaction between sex and activity-related inflammatory markers on total gray matter volume and visual memory. Men with higher inflammatory markers demonstrated poorer brain structure and function, whereas inflammatory markers did not strongly relate to neurobehavioral outcomes in women.ConclusionsGreater physical activity was associated with lower markers of inflammation in clinically normal older men, but not women – an effect consistently replicated across cohorts. Additionally, men appeared disproportionately vulnerable to the adverse effects of peripheral inflammatory markers on brain structure and function compared to women. Immune activation may be a male-specific pathway through which exercise confers neurobehavioral benefit.     

Duration of amyotrophic lateral sclerosis is age dependent

Since 1985, we prospectively followed 246 patients with ALS. The relation ship between the age of developing neurological impairment and disease duration was analyzed in 138 patients (86 men and 52 women) who died. Mean disease duration was 4.0 ± 3.8 years for men and 3.2 ± 2.5 years for women. There was an inverse, exponential, relationship between onset age and duration (goodness-of-fit P > 0.05). Mean duration at onset age 40 years was 8.2 ± 5.0 years compared with 2.6 ± 1.4 years for patients aged 61 to 70 years (P > 0.001). The ratio of young (40 years) men to women was 3.6:1. When matched for age, disease duration was the same for patients with bulbar and nonbulbar onsets. We conclude that onset age, but no sex, is the most significant predictor determining disesae duration in ALS. Longer survival in younger patients probably reflects their greater neuronal reserve. © 1993 John Wiley & Sons, Inc.     

Impaired contrast sensitivity is associated with more severe cognitive impairment in Parkinson disease

ObjectivesDopaminergic degeneration affects both nigrostriatal projection neurons and retinal amacrine cells in Parkinson disease (PD). Parkinsonian retinopathy is associated with impaired color discrimination and contrast sensitivity. Some prior studies described associations between color discrimination deficits and cognitive deficits in PD, suggesting that contrast discrimination deficits are due, at least in part, to cognitive deficits in PD. We investigated the relationship between cognitive deficits and impaired contrast sensitivity in PD.MethodsPD subjects, n = 43; 15F/28M; mean age 66.5 ± 8.2, Hoehn and Yahr stage 2.6 ± 0.6, and duration of disease of 6.2 ± 5.0 years underwent neuropsychological and Rabin contrast sensitivity testing.ResultsMean Rabin contrast sensitivity score was 1.34 ± 0.40. Bivariate analyses showed significant correlation between Rabin contrast sensitivity scores and global cognitive z-scores (R = 0.54, P = 0.0002). Cognitive domain Z-score post hoc analysis demonstrated most robust correlation between Rabin scores and executive functions (R = 0.49, P = 0.0009), followed by verbal learning (R = 0.44, P = 0.0028), visuospatial (R = 0.39, P = 0.001) and attention z-scores (R = 0.32, P = 0.036).ConclusionsImpaired contrast sensitivity in PD is robustly associated with cognitive deficits, particularly executive function deficits. These results suggest that contrast sensitivity may be a useful biomarker for cognitive changes in PD and may have implications for driving safety evaluations in PD.     

Sex differences in the prognostic value of the lipid profile after the first ischemic stroke

Post-stroke levels of total cholesterol (TC) appear to be negatively associated with stroke mortality. Statin pretreatment might affect this association. Sex differences in the prognostic value of the lipid profile have not yet been studied. We have evaluated the impact of TC, high- and low-density lipoprotein (HDL and LDL, respectively), and triglyceride (TG) levels on the 3-month outcome after a first ischemic stroke (IS) according to sex and previous statin use. The study group consisted of a hospital-based cohort of consecutive patients with a diagnosis of first IS. Poor outcome was defined as a modified Rankin Scale (mRS) score ≥3 at 90 days. The odds ration (OR) for poor prognosis was analyzed for each sex using logistic regression models adjusted for vascular risk factors and statin pretreatment. A total of 591 patients were included in the analysis (318 men). The predictors of a 90-day poor outcome were age and initial NIH Stroke Scale (NIHSS) score in women, and age, initial NIHSS, smoking, atrial fibrillation, and thrombolytic treatment in men. In women, none of the lipids studied affected the 90-day prognosis. Men falling in the last quintile of TC [OR: 0.68 95% confidence interval (95% CI) 0.52–0.88; p = 0.004] and LDL (OR 0.74, 95% CI 0.56–0.98; p = 0.04) have better outcome than men in the first quintile. Adjusting for statin pretreatment did not change the results. The results indicated that an association between poststroke lipids and prognosis may vary by sex. In women, lipids were not associated with the outcome; in men, lower TC and LDL were associated with worse prognosis. These differences can not be explained by statin use and require further research.     

Use of heated humidified high flow nasal cannula for obstructive sleep apnea in infants

ObjectiveHeated humidified high flow nasal cannula (HHHFNC) has gained popularity in the treatment of children with respiratory distress and bronchiolitis in the past decade. Its efficacy as a mode of non-invasive respiratory support has been demonstrated in both adults and children. However, reports on its use in the treatment of obstructive sleep apnea (OSA) in infants are limited. We aimed to evaluate the efficacy of HHHFNC therapy as treatment in infants with OSA.MethodsA retrospective analysis of OSA infants who had undergone polysomnographic titration between 2015 and 2017 was undertaken. Data about the age, gender, AHI, co-morbid conditions and flow used for each patient were retrieved.ResultsTen infants were included in this study (median age 34 weeks; IQR 27–38 weeks). The median optimal HHHFNC flow rate was 8.0 L/min (IQR 6.7–8.0 L/min). HHHFNC significantly reduced median obstructive apnea–hypopnea index (OAHI) from 9.1 (IQR 5.1–19.3) to 0.9 (IQR 0–1.6; P = 0.005) events/h; median obstructive apnea index (OAI) from 5.8 (IQR 1.1–13.4) to 0 (IQR 0–0.9; P = 0.021) events/h; median obstructive hypopnea index (OHI) from 4.1 (IQR 0.9–6.8) to 0.1 (0–0.9; P = 0.017) events/h; and median oxygen saturation (SpO2) nadir increased from 88% (IQR 83–94%) to 94% (IQR 93–96%; P = 0.040).ConclusionHHHFNC significantly reduced respiratory events and improved oxygenation in infants with OSA.     

Female,aging, difference formulations of DCI,or lower body weight increases AUC4hr of levodopa in patients with Parkinson's disease

IntroductionThere is considerable intra- and inter-individual variability in the pharmacokinetics (PK) of levodopa after oral administration. Inter-individual variability in levodopa PK has also been demonstrated in fasting single-dose studies. We examined the factors that affect levodopa PK in patients with Parkinson's disease (PD) and quantified the intensity of their respective effects.MethodsWe studied 220 patients who underwent PK assessment after administration of 1 tablet of levodopa/DOPA decarboxylase inhibitor (DCI) combination, which contained 10 mg carbidopa/100 mg levodopa or 25 mg benserazide/100 mg levodopa. PK was evaluated using non-compartmental analysis.ResultsIn total, 220 PD patients (including 112 men) were studied. The mean age (±standard deviation) and mean disease duration was 68.1 ± 8.9 and 7.7 ± 5.8 years, respectively. The Cmax of levodopa was 9.0 ± 4.0 ng/mL, Tmax was 41.4 ± 40.2 min, and area under the blood concentration–time curve up to 4 h (AUC_4hr) was 12.3 ± 3.7 ng/mL*4hr. Factors affecting AUC_4hr were analyzed using multiple linear regression models. Age (1.1 ± 0.23 per +10 years, p = 3.1E-8), sex (2.2 ± 0.5 for female, p = 1.9E-5), DCI (1.4 ± 0.4 for benserazide, p = 0.0028), and body weight (−0.77 ± 0.22 per +10 kg, p = 5.4E-4) were significantly related to AUC_4hr, while disease duration, dyskinesia status, and eGFR were not related to AUC_4hr and Cmax.ConclusionFemale, aging, difference formulations of DCI, or lower body weight independently contributes to increased AUC_4hr of levodopa in Japanese patients with PD in this study.     

Gender and other risk factors associated with risky behaviours among Nigerian adolescents

Risky behaviours in adolescents, apart from substance use, and their associate factors, have not been thoroughly investigated in Nigeria. Hence, there is a need to study the prevalence of risky behaviours and their relationship with gender and other potential risk factors. Data comprising socio-demographic, risky behaviours, personality traits, religious orientation and substance use were obtained from 300 randomly selected secondary school students. Two risk groups (low and high) based on the number of risky behaviours were determined. Male was a risk factor for theft (OR = 2.1; 95%CI = 1.17–3.95), bullying (OR = 2.76; 95%CI = 1.37–5.56) and fighting (OR = 2.14; 95%CI = 1.35–3.40). Fifty-two (17.3%) of the students were of high-risk behaviour group. Furthermore, private school (β = 1.05; P = 0.010), poor perceived relationship with teachers (β = 1.21; P = 0.002), polygamy (β = 1.20; P = 0.002) and lifetime cigarette use (β = 1.07; P = 0.027) were predictors of high-risk behaviour group. Substantial proportion of adolescents in Nigeria exhibit risky behaviours of which gender and other factors play a significant role.     

Delay in diagnosis of psychogenic nonepileptic seizures in adults: A post hoc study

PurposeThe aim of the current post hoc study was to investigate factors associated with delay in diagnosis of adult patients with psychogenic nonepileptic seizures (PNES).MethodsWe retrospectively investigated all patients with PNES admitted to the epilepsy-monitoring unit at the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We identified the median time to diagnosis of PNES and divided the patients into two groups. We studied factors associated with delay in diagnosis of PNES.ResultsIn all, 49 patients (39 women and 10 men) were studied. Mean age at the time of admission was 40 ± 16 years and at the onset of the seizures was 34 ± 16 years. Disease duration was 5.6 ± 8.2 years. The median for time to diagnosis was 3 years. Patients with early diagnosis (before 3 years after seizure onset) (21 patients) and patients with late diagnosis (delay of 3 years or more from onset) (28 patients) were compared. Only history of head trauma had significant association with the delay in diagnosis: 2 of 19 patients (7%) with an early diagnosis and 11 of 28 patients (39%) with a late diagnosis reported head trauma (P = 0.02).ConclusionDelay in diagnosis of PNES is common, and some factors (e.g., history of head trauma) may contribute to this delay. It is important that physicians involved in the management of seizures appreciate the importance of making an early and definitive diagnosis of PNES.     

Obsessive compulsive personality disorder in Progressive Supranuclear Palsy,Multiple System Atrophy and Essential Tremor

Introductionaim of the study was to evaluate the presence of the Obsessive Compulsive Personality Disorder (OCPeD) in Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP) and Essential Tremor (ET) and in a group of healthy subjects.Methodspatients affected by MSA, PSP and ET diagnosed according to currently accepted diagnostic criteria and a group of healthy controls were enrolled in the study. Patients with cognitive impairment were excluded from the study. The Structured Clinical Interview for Personality Disorders-II (SCID-II) has been performed to evaluate the presence of personality disorders (PeDs). The diagnosis of OCPeD was confirmed by a psychiatric interview.Resultsfifteen MSA patients (8 men and 7 women; aged 62.9 ± 7.6 years), 14 PSP patients (8 men and 6 women; aged 69.8 ± 4.4 years), 16 ET patients (10 men and 6 women; aged 70.4 ± 6.4 years) and 20 healthy subjects (10 men and 10 women; aged 65.5 ± 6.0 years) were enrolled. OCPeD was recorded in 5 (35.7%) PSP patients, 2 (13.3%) MSA patients, 2 (12.5%) ET patient and 2 (10%) controls.Conclusiona low frequency of OCPeD, close to those recorded in healthy subjects, was recorded in both MSA and ET patients. Conversely an higher frequency of OCPeD, similar to PD was found among PSP patients, supporting the possibility of an impairment of common basal ganglia network possibly involving the orbito-frontal circuits.     

Inhibitory effects of heterotopic noxious counter‐stimulation on perception and brain activity related to Aβ‐fibre activation

Heterotopic noxious counter‐stimulation (HNCS) inhibits pain and pain processes through cerebral and cerebrospinal mechanisms. However, it is unclear whether HNCS inhibits non‐nociceptive processes, which needs to be clarified for a better understanding of HNCS analgesia. The aim of this study was to examine the effects of HNCS on perception and scalp somatosensory evoked potentials (SEPs). Seventeen healthy volunteers participated in two counter‐balanced sessions, including non‐nociceptive (selective Aβ‐fibre activation) or nociceptive electrical stimulation, combined with HNCS. HNCS was produced by a 20‐min cold pressor test (left hand) adjusted individually to produce moderate pain (mean ± SEM: 42.5 ± 5.3 on a 0–100 scale, where 0 is no pain and 100 the worst pain imaginable). Non‐nociceptive electrical stimulation was adjusted individually at 80% of pain threshold and produced a tactile sensation in every subject. Nociceptive electrical stimulation was adjusted individually at 120% of RIII‐reflex threshold and produced moderate pain (45.3 ± 4.5). Shock sensation was significantly decreased by HNCS compared with baseline for non‐nociceptive (P < 0.001) and nociceptive (P < 0.001) stimulation. SEP peak‐to‐peak amplitude at Cz was significantly decreased by HNCS for non‐nociceptive (P < 0.01) and nociceptive (P < 0.05) stimulation. These results indicate that perception and brain activity related to Aβ‐fibre activation are inhibited by HNCS. The mechanisms of this effect remain to be investigated to clarify whether it involves inhibition of spinal wide‐dynamic‐range neurons by diffuse noxious inhibitory controls, supraspinal processes or both.     

Sex differences in Parkinson’s disease

Sex-related differences in Parkinson’s disease (PD) have been recognised, but remain poorly understood. We aimed to further clarify real-life differences in disease experience according to sex, by evaluating quality of life (QoL), demographic and clinical characteristics of PD patients. A cross-sectional survey was conducted on 210 PD patients (129 men, 81 women) attending specialist neurological clinics across three centres. Outcome measures included the motor examination of the Unified Parkinson’s Disease Rating Scale (UPDRS-III) and QoL as measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39). A male to female ratio of 1.6:1 was observed. Men reported a greater disease burden than women as noted by higher UPDRS-III scores (27 ± 13 versus 23 ± 13, p = 0.032), daily levodopa equivalent doses (898.1 ± 481.3 mg versus 750.7 ± 427.2 mg, p = 0.037) and caregiver reliance (44% versus 29.5%, p = 0.039). The UPDRS-III score was significantly associated with sex after controlling for age and disease duration, with men more severely affected (β = −0.165, r² = 0.101, p = 0.028). The PDQ-39 showed men reported lower QoL in activities of daily living (ADL), cognition and communication sub-scales (p < 0.05). An association was identified in men between PDQ-39 ADL and cognition sub-scales (r = 0.660, p < 0.001). Men with an appointed caregiver had a higher PDQ-39 Summary Index (t = 3.222, degrees of freedom = 122, p = 0.002). PD was found to have greater overall impact on the health and well-being of male patients in sub-specialty clinical practice. Our study further supports the need for increased sex-delineated clinical assessment and consideration of potential differences required in the management of PD.     

Effects of bilateral dorsolateral prefrontal cortex high-definition transcranial direct-current stimulation on time-trial performance in cyclists with type 1 diabetes mellitus

BackgroundHD-tDCS is capable to increase the focality of neuromodulation and has been recently applied to improve endurance performance in healthy subjects.Objective/hypothesisWhether these putative advantages could be exploited in active subjects with type 1 diabetes mellitus (T1D) remains questionable.MethodsIn a double-blind, randomized crossover order, 11 high-level cyclists (27 ± 4.3 years; weight: 65.5 ± 8.6 kg; height: 180 ± 8 cm; VO₂peak: 67.5 ± 2.9 mL min^?1 kg^?1) with T1D underwent either HD-tDCS (F3, F4) or control (SHAM) and completed a constant-load trial (CLT) at 75% of the 2nd ventilatory threshold plus a 15-km cycling time-trial (TT).ResultsAfter HD-tDCS, the total time to cover the TT was 3.8% faster (P < 0.01), associated with a higher mean power output (P < 0.01), and a higher rate of power/perception of effort (P < 0.01) and power/heart rate at iso-time (P < 0.05) than the SHAM condition. Physiological parameters during CLT and TT did not differ in both conditions.ConclusionsThese findings suggest that upregulation of the prefrontal cortex could enhance endurance performance in high-level cyclists with T1D, without altering physiological and perceptual responses at moderate intensity. Present data open to future applications of HD-tDCS to a wider population of active T1D-subjects.     

Cardiovascular consequences of obstructive sleep apnea in women: a historical cohort study

Objective/BackgroundEvidence on sex differences in the association between obstructive sleep apnea (OSA) and cardiovascular outcomes is limited and controversial. We conducted a historical cohort study to investigate this relationship.Patients/methodsClinical data on adults who underwent sleep study at a large urban academic hospital (Toronto, Canada) between 1994 and 2010 were linked to provincial health administrative data from 1991 to 2015. We fit Cox regressions to investigate the association between OSA severity and a cardiovascular composite outcome (all-cause mortality or hospitalization due to myocardial infarction, stroke, heart failure or atrial fibrillation), controlling for risk factors and stratifying by sex.ResultsA total of 10,149 subjects were included: median age of 49 years, 38% women. Over a median of 9.3 years, 1782 (18%) participants developed an outcome. The association between percentage of sleep time spent with oxygen saturation <90% and outcome was stronger for women (HR for IQR, 3 vs 0% = 1.30, 1.19–1.42) than for men (HR for IQR = 1.13, 1.06–1.21) (p for interaction = 0.01) in the adjusted model. Stratifying by sex, oxygen desaturations and heart rate in sleep were significant predictors in both men and women, while presence of daytime sleepiness, sleep efficiency and periodic leg movements in sleep were predictive in women but not in men.ConclusionsIn a large clinical cohort with suspected OSA, the impact of OSA as measured by the degree of nocturnal oxygen desaturation on the composite outcome was found to be greater in women than in men. We also found a different predictive ability of OSA-related factors by sex.