Klotho gene promoter polymorphism and cognitive impairment

Aim:   To study the association between the klotho gene polymorphism and cognitive impairment in community-living men and women.
Methods:   The subjects consisted of 2234 community-living Japanese men and women aged 40–79 years. The klotho gene promoter polymorphism G- 395 A was identified and cognitive function was assessed using the Japanese Wechsler Adult Intelligence Scales – Revised Short Forms ( JWAIS-R SF) and Mini-Mental State Examination (MMSE). Brain infarction and atrophy were assessed by brain magnetic resonance imaging (MRI). The differences in cognitive function, infarction and atrophy were compared between the GG type and GA/AA type of the klotho gene G- 395 A polymorphism.
Results:   The distribution of the klotho gene G- 395 A polymorphism was GG 1639 (73.4%), GA 539 (24.1%), and AA 56 (2.5%). There was no significant difference in intelligence quotient (IQ) between the GG type and GA/AA type in the subjects aged 40–59 years. However, the IQ level was significantly different in terms of the klotho genotype for subjects aged 60–79 years ( P  = 0.004). The mean and SE of IQ levels of the subjects with the GG type and the GA/AA type at nucleotide −395 were 99.8 ± 0.5 and 102.6 ± 0.8, respectively. There were also significant differences in three subtests of JWAIS-R SF – Information, Similarities, and Picture Completion – for subjects aged 60–79 years. Also, the MMSE score was slightly lower for the GG type than for the GA/AA type ( P  = 0.099). However, there were no differences in the findings of brain MRI.
Conclusion:   There were statistically significant differences in cognitive function for klotho gene promoter polymorphism G- 395 A only in subjects aged 60 or over. This polymorphism may be associated with age-related cognitive impairment.     

Predictors of functional status in Japanese community-dwelling older persons during a 2-year follow up

Aims:   To clarify baseline sociodemographic and health characteristics that predict subsequent functional outcome in community-dwelling Japanese older persons.
Methods:   All subjects were enrolled from the April 2001 resident registry of Nomura-cho, Seiyo-city in Ehime prefecture. Of 1392 community-dwelling persons aged 65 and older who could provide complete responses to questionnaires including functional status in the first survey, 1105 subjects were also able to provide complete answers in the second survey. Functional status was categorized according to a hierarchical scale as: completely functional; with functional limitations; and with disabilities in instrumental activities of daily living (IADL). A multivariate logistic regression model was used to estimate the ability of selected 2001 sociodemographic and health status variables to predict 2003 functional status.
Results:   Subjects consisted of 470 men (mean age ± standard deviation, 72 ± 5.9 years) and 635 women (73 ± 7.1 years). During the 2-year follow up, significant independent predictors of future functional status by multiple logistic regression analysis included: (i) age (odds ratio: 0.511, 95% confidence interval [CI]: 0.329–0.791); (ii) spouse (1.655, 1.044–2.621); (iii) activities of daily living (3.231, 2.008–5.199); (iv) baseline instrumental self-maintenance (14.62, 9.065–23.57); and (v) social role (2.176, 1.419–3.337) after controlling for baseline functional status.
Conclusion:   These results indicate that many background factors are predictive of subsequent physical function in community-dwelling older persons. Thus, early prevention and intervention regarding these background factors might be critical to promote and maintain functional status.     

Cardiac sympathovagal modulation evaluated by short-term heart interval variability is subtly impaired in Alzheimer's disease

Aim:   Alzheimer's disease affects several nervous structures involved with the autonomic nervous system. Therefore, the still scarce evaluation of the cardiac autonomic function in this disease is of great functional, clinical, prognostic and therapeutic relevance.
Methods:   Time- and frequency-domain variability of 5-min R-R interval series in supine and standing positions was comparatively evaluated in 22 Alzheimer's disease subjects, aged 60–87 years (mean ± standard error of the mean, 79.6 ± 1.4) with variable cognitive impairment, and 24 healthy individuals, aged 60–91 years (68.6 ± 1.6). The Student's t -test was used to compare the variability indices between the groups and logistic regression excluded the effects on these indices in the Alzheimer's group of confounding variables different from the control group (age, physical activity and caffeinated intake), at a significance level of P  ≤ 0.05.
Results:   No difference was observed between the groups ( P  = 0.12–0.72) for each time-domain mean indices and for the frequency-domain indices of overall and absolute sympathetic modulation in both positions ( P  = 0.21–0.78). Absolute parasympathetic modulation showed borderline decrease in supine position ( P  = 0.07) and was reduced in the standing ( P  = 0.05). The sympathovagal balance was altered ( P  = 0.05) toward relative parasympathetic borderline depression ( P  = 0.07) and sympathetic exacerbation ( P  = 0.04) only in the supine posture.
Conclusion:   Data indicate that Alzheimer's disease subjects with mild-to-severe cognitive dysfunction showed subtle, absolute and relative parasympathetic depression and relative sympathetic exacerbation, which may even so contribute to distinctive functional and cognitive disturbances.     

Natural history of hepatic fibrosis progression in chronic hepatitis C virus infection in India

Background and Aim:  The rate of fibrosis progression per year can predict the time for the development of cirrhosis in chronic hepatitis C (CHC). We assessed the rate of fibrosis progression and the predictors of disease severity in Indian CHC patients.
Methods:  Of the 355 treatment-naïve, histologically-proven CHC patients, the precise duration of infection (from the time of exposure to HCV until liver biopsy) could be determined in 213 patients (age = 41.6 ± 14.7 years, male : female = 139 : 74, genotype 3 = 75%). The rate of fibrosis progression per year was calculated. The correlation of the advanced degree of fibrosis and age, duration of infection, age at the onset of infection, sex, mode of infection, hepatitis C virus (HCV) genotype, histological activity index (HAI), and the presence of diabetes mellitus were studied.
Results:  The median rate of fibrosis progression per year was 0.25 (0.0–1.5) fibrosis units. The fibrosis progression rate was higher in patients who acquired infection at > 30 years of age, those < 30 years (0.33 vs 0.15; P  < 0.001), and those who acquired HCV infection with a history of blood transfusion than with other modes of transmission (0.25 vs 0.19; P  = 0.04). The median time to progress to cirrhosis was 16 years. The multivariate analysis found that the HAI score (odds ratio [OR]= 14.03; P  < 0.001) and the duration of infection > 10 years (OR = 4.83; P  < 0.001) correlated with severe liver disease (fibrosis ≥ 3).
Conclusion:  The median rate of fibrosis progression per year in Indian CHC patients is 0.25 fibrosis units. A higher HAI and longer duration of infection are associated with a significant risk of advanced liver disease, and merit early therapeutic interventions.     

Impact of low cost strength training of dorsi- and plantar flexors on balance and functional mobility in institutionalized elderly people

Aim:   To evaluate the effects of a low cost strength training program of the dorsi- and ankle plantar flexors on muscle strength, balance and functional mobility, in elderly institutionalized subjects; and to determine the association between strength gain and balance and/or functional mobility gain.
Methods:   Forty-eight volunteers were recruited and equally divided into two groups: intervention (aged 78.44 ± 3.84 years) and control (aged 79.78 ± 3.90 years). Both groups were tested at baseline and outcome for ankle dorsi- and plantar flexors muscle strength, balance and functional mobility. The intervention group participated in a 6-week program, three-sessions-per-week, of resisted ankle dorsi- and plantar flexion exercises using elastic bands.
Results:   In the intervention group, maximal isometric dorsi- (from 8.4 ± 0.45 to 12.6 ± 0.95 kg; P  ≤ 0.001) and plantar flexors strength (from 13.0 ± 0.85 to 17.5 ± 0.93 kg; P  ≤ 0.001), balance (from 14.6 ± 0.54 to 22.3 ± 1.81 cm; P  ≤ 0.001) and functional mobility (from 18.4 ± 0.51 to 11.0 ± 0.66 s; P  ≤ 0.001) increased significantly after the 6-week strength training program. In the control group, no significant differences were detected. In the intervention group, a significant correlation between plantar flexor strength gain and balance gain was found ( r  = 0.826; P  = 0.01).
Conclusion:   The proposed low cost strength training of dorsi- and plantar flexors improved strength, balance and functional mobility in institutionalized elderly people; moreover, the improvement in plantar flexor strength was associated with the improvement in balance.     

Clinical features predicting the detection of abnormalities by double balloon endoscopy in patients with suspected small bowel bleeding

Background and Aim:  Although double balloon endoscopy (DBE) has demonstrated a high diagnostic yield in suspected small bowel bleeding, it is not known whether DBE is of equal value to all patients with suspected small bowel bleeding or of greater benefit in selected subgroups. We aimed to determine whether any clinical features predict an increased likelihood of finding a lesion in patients with suspected small bowel bleeding.
Methods:  We retrospectively analyzed clinical features of 43 consecutive patients (M : F = 26:17, age 13–82 years) who underwent DBE because of suspected small bowel bleeding. Data associated with DBE procedure were collected prospectively. Predictive factors for the detection of a lesion were determined by comparison of clinical features between patients with positive DBE findings and those with negative findings.
Results:  Potential bleeding sources were discovered in 30 patients (69.8%) out of 43. Duration of bleeding was longer in patients with positive DBE findings than in those with negative findings (195 ± 311 vs 18 ± 17 days, P  = 0.015). Number of bleeding episodes was higher in patients with positive DBE findings (2.2 ± 1.2 vs 1.3 ± 0.5, P  = 0.011). The odds ratio for the detection of bleeding focus on DBE for patients with two or more bleeding episodes, relative to those with only one current bleeding episode was 5.67 (95% CI: 1.12–28.81, P  = 0.036) in multivariate analysis.
Conclusion:  DBE may be the most useful in patients with suspected small bowel bleeding if they have a history of frequent bleeding episodes over a long period.     

Interleukin-6 (IL-6) –572C→G promoter polymorphism is associated with type 2 diabetes risk in Koreans

Objective  Increased levels of inflammatory markers, such as interleukin-6 ( IL -6), are associated with type 2 diabetes (T2DM). We investigated the association of IL-6 gene polymorphisms with T2DM and circulating levels of IL -6 in Koreans.
Subjects  A total of 1477 subjects with normal glucose tolerance and 476 T2DM patients were included.
Measurements  We examined IL-6 – 174G→C, –572C→G, –597G→A and –1363G→T promoter region polymorphisms. The main outcome measures were the odds ratio (OR) on T2DM risk and serum concentrations of IL -6 and high-sensitivity C-reactive protein (hs-CRP).
Results  Homozygosity for the rare G allele IL-6 – 572C→G was associated with a higher risk of T2DM [OR 1·69 (95%CI 1·11–2·58), P  = 0·015]. Serum IL -6 concentrations were associated with the IL-6 – 572C→G genotype in control subjects (G/G: 2·33 ± 0·41: C/G: 1·53 ± 0·09: C/C: 1·72 ± 0·08 ng/l, P  = 0·023). Also in the control group, subjects homozygous for the rare G allele showed significantly higher concentrations of hs-CRP than C/C and C/G carriers (G/G: 13·6 ± 2·9: C/G: 9·2 ± 0·6: C/C: 7·8 ± 0·4 mg/l, P  = 0·003). The C-allele at the IL-6 – 174 SNP was very rare (< 0·01) and –597G→A and –1363G→T were monomorphic in this population.
Conclusions  Our data demonstrate that the IL-6 – 572G/G genotype is associated with higher serum IL -6 and hs-CRP concentrations and with increased risk for T2DM.     

Gender differences in health-related quality of life among stroke patients

Background:   To determine whether differences in health-related quality of life (HRQOL) exist between male and female stroke patients and, if present, to identify factors influencing these differences.
Methods:   A questionnaire assessing HRQOL, measured by the EuroQol questionnaire, and functional outcome was mailed to 792 stroke patients and responded by 604 patients 39.6 ± 18.4 (mean ± standard deviation) months after stroke onset. A total of 480 patients who lived at home after discharge were considered eligible for the analysis.
Results:   The mean quality of life (QOL) utility score for men (0.79 ± 0.22) was significantly higher than that for women (0.69 ± 0.26; P  < 0.001). At discharge, men had a significantly better ability to walk than women ( P  < 0.001). The ability to perform activities of daily living (ADL) was also better among men than women after discharge ( P  < 0.01). A close relationship was observed between QOL utility scores and performance of ADL in both genders. A higher proportion of women were found to be in a state of anxiety or depression. Multiple regression analysis revealed that the QOL utility scores for men and women were influenced by functional changes, and the ADL items walking and dressing ability after discharge. In addition, the score for women was influenced by walking ability at discharge.
Conclusions:   HRQOL among men was significantly better than that among women. The difference in QOL scores appears to be influenced by the poorer outcome of ADL and the higher proportion of post-stroke anxiety and depression among women.     

GH receptor d3 polymorphism in Dutch patients with MPHD and IGHD born small or appropriate for gestational age

Objective  GH acts through the GH receptor (GHR). The GHR gene contains a genetic polymorphism caused by a deletion of exon 3 ( d3 ), with high frequency in the normal population. There is a continuing controversy whether the presence or absence of the exon 3 deletion ( d3+ vs. d3– ) affects the effect of GH in human growth.
Design, patients and measurements  For 144 patients with idiopathic isolated GH deficiency (IGHD, n  = 72) or multiple pituitary hormone deficiency (MPHD, n  = 72), amplification of the region around exon 3 of the GHR gene was performed. Clinical data and response to GH treatment were compared between GHR d3+ and d3– IGHD and MPHD patients born either small for gestational age (SGA) or appropriate for gestational age (AGA).
Results  IGHD patients born SGA had a significantly higher d3+ frequency (82%) than IGHD patients born AGA (35%, P  = 0·006). Within the group of IGHD patients born SGA, d3 – patients showed a slightly better spontaneous catch up growth before start of GH treatment than d3 + patients (1·1 ± 1·1 SD vs. 0·6 ± 1·1 SDS, P  = 0·040) There was no difference in patients first year's response to GH treatment between GHR d3 + and d3– patients.
Conclusions  In IGHD and MPHD patients, response to GH treatment was independent of GHR genotype. GHR- d3 was significantly more frequent among IGHD patients born SGA. As we are the third to report an association between birth size and GHR d3 status, it is conceivable that the GHR- d3 might affect prenatal growth in IGHD patients by a yet unknown mechanism.     

Prospective study of early bereavement on psychological and behavioural cardiac risk factors

Background: Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long-term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes.
Methods: Bereaved ( n = 62) and non-bereaved individuals ( n = 50) were evaluated within 2 weeks and at 6 months following loss using the Centre for Epidemiologic Studies – Depression, Spielberger State Anxiety and Anger, Social Support Questionnaire and changes in appetite, cigarette and alcohol consumption, cortisol and lipids.
Results: Compared with non-bereaved, acutely bereaved had increased symptoms of depression (26.7 ± 1.7 vs 5.9 ± 0.7, P < 0.001), anxiety (47.4 ± 2.0 vs 28.2 ± 1.4, P < 0.001) and anger (median 16.0 vs 15.0, P < 0.001). Greater depressive symptoms were associated with being unprepared for the death, decreased sleep duration and younger age. Acutely, bereaved slept less than non-bereaved (5.8 ± 0.2 vs 7.2 ± 0.2 h, P < 0.001). Reduced sleep time was associated with increased anger and depression and decreased satisfaction with social support. Compared with the non-bereaved, the acutely bereaved had higher cortisol (median 306 vs 266, P = 0.003), reduced appetite ( P < 0.001) and lower total cholesterol (median 4.9 vs 5.4, P = 0.006) and low-density lipoprotein (median 2.4 vs 2.9, P < 0.001).
Conclusion: These results offer insight into the psychological, behavioural and physical changes that may contribute to cardiovascular risk in bereavement.     

They just don't get enough! Variable intern experience in bedside procedural skills

Background: Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures.
Methods: Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined.
Results: For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44–84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation ( β  = 0.17, 95% confidence interval (CI) 0.02–0.21, P  = 0.03) and age >30 years on commencing internship ( β  = 8.44, 95%CI 3.03–14.06, P  = 0.003. Adjusted R ² = 0.08, P  = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme ( β  = 0.48, 95%CI 0.34–0.62, P  < 0.001), intern experience with patient procedures ( β  = 0.34, 95%CI 0.21–0.47, P  < 0.001) and a clear decision to enter a postgraduate training programme ( β  = 0.13, 95%CI 0.04–0.22, P  = 0.007, Adjusted R ² = 0.50, P  < 0.001).
Conclusion: Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.     

Development of a short neuropsychological battery to screen early dementia in the elderly

Background:   The purpose of the present study was to develop a short screening neuropsychological battery for patients with very mild and mild dementia.
Methods:   The participants involved in the present study consisted of 162 persons who were 65 years and older. Fifty-four of the patients had very mild or mild dementia and had a mini-mental state examination (MMSE) score of 19 or above. Normal control samples were community-dwelling volunteers, or persons recruited from outpatients who did not suffer from any cognitive problems. Mini-mental state examination, the category cued memory test (CCMT) – a modified brief memory test in which category cues were given for both acquisition and retrieval – verbal fluency test (VFT) and clock drawing test (CDT) were carried out. Using logistic regression models, the best battery was selected. The validity and reliability of the battery were also assessed.
Results:   The combination of CCMT, VFT and CDT was the best screening battery and could be accomplished in about 10 min. The battery had a high degree of sensitivity (94.4%), specificity (99.1%), positive and negative predictive values. Test-retest, interrater and alternate forms reliabilities were substantial using the intraclass correlation coefficient, and all of the P -values analyzed by the Pearson correlation coefficient were below 0.005.
Conclusions:   This short battery has enough validity, reliability and efficiency to detect early dementia especially in an elderly primary care setting. The CCMT is also a useful memory test even if used alone.     

Daily living functions of the elderly requiring home visits: A study at a comprehensive assessment clinic for the elderly

Background:   To elucidate the characteristics of daily living functions of the elderly requiring home visits.
Methods:   Fifty-two elderly individuals (17 men and 35 women; age range, 72–95 years; average age, 82.2 ± 5.4 years) who visited a clinic for the elderly underwent comprehensive geriatric assessment. Activities of daily living were assessed using the Barthel Index and Lawton Scale. Cognitive function was assessed using the clock-drawing test (modified Shulman method), Mini-Mental State Examination, and the revised version of Hasegawa's Dementia Scale. Depression was assessed using the 15-item Geriatric Depression Scale. Volition was assessed using the Vitality Index. The 52 participants were divided into two groups: 41 who continued clinic visits after assessment (clinic group: 15 men and 26 women; age range, 72–95 years; average age, 81.5 ± 5.4 years), and 11 who required home visits (visit group: two men and nine women; age range, 75–91 years; average age, 84.7 ± 4.5 years). Various daily living functions were compared between the two groups.
Results:   Barthel Index, Lawton Scale, Mini-Mental State Examination, and Vitality Index scores were significantly lower in the home group. Moreover, Vitality Index score was low at the start of home visits.
Conclusions:   It is difficult for the elderly with cognitive and physical disorders to make periodical visits to medical institutions and they eventually require home visits. For effective prevention of dependence on nursing care, fragile elderly persons themselves must understand and actively participate in interventions, emphasizing the underlying difficulties associated with such interventions.     

Procalcitonin as a prognostic factor in severe acute exacerbation of chronic obstructive pulmonary disease

Background and objective:   Little is known about the value of procalcitonin in predicting mortality in patients with an exacerbation of COPD. This study evaluated the clinical and biological predictors of intensive care unit (ICU) mortality in patients with a severe acute exacerbation of COPD.
Methods:   A prospective observational cohort study was conducted of consecutive patients with severe acute exacerbation of COPD requiring intubation and mechanical ventilation. At ICU admission, data were collected on the patients' clinical condition, blood leukocyte count, C-reactive protein and procalcitonin. Cox proportional hazards model was used to determine the risk factors for ICU mortality.
Results:   One hundred and sixteen patients were included in this study. Mean age was 67 years. The mean simplified acute physiology score was 43. Sixty-five per cent of study patients had chronic respiratory insufficiency. Bacteria were cultured at levels considered significant in 36% of study patients. Logistic organ dysfunction score (hazard ratio (95% CI) = 1.19 (1.03–1.37), P  = 0.013), rapidly fatal underlying disease (3.33 (1.40–7.87), P  = 0.003) and procalcitonin level (1.01 (1–1.03), P  = 0.018) were independently associated with increased risk for ICU mortality. Non-invasive mechanical ventilation use before intubation was independently associated with reduced risk for ICU mortality (0.34 (0.14–0.84), P  = 0.020).
Conclusions:   In patients with severe acute exacerbation of COPD requiring intubation and mechanical ventilation, logistic organ dysfunction score, rapidly fatal underlying disease and procalcitonin are independently associated with increased risk for ICU mortality. Non-invasive mechanical ventilation use before intubation was independently associated with reduced risk for ICU mortality.     

Quantitative analysis of carotid atherosclerotic lesions and high-sensitivity C-reactive protein in community-dwelling elderly 80 years or older

Aim:   To investigate the association between the carotid atherosclerotic lesions assessed by high-resolution ultrasonography and high-sensitivity C-reactive protein (hs-CRP) in the community-dwelling elderly aged 80 years or older.
Methods:   One hundred and seventy-nine community-dwelling elderly aged 65 years or older (78 ± 6 years, 69 men and 113 women) participated in this study. High-resolution B-mode ultrasonography was performed on the common carotid arteries. Intima-media thickness (IMT) was measured using automatic measuring system and compared with standardized examinations included blood pressure, body mass index, hemoglobin-A1c, cholesterol, creatinine, uric acid, fibrinogen and hs-CRP.
Results:   Subjects were divided into two age groups: young-old aged 65–79 years (113 subjects, 74 ± 3 years) and old-old aged 80 years or older (66 subjects, 84 ± 3 years). The maximum (max) IMT was significantly increased in the old-old compared to that of the young-old (1.7 ± 1.0 vs 1.4 ± 0.6 mm; P  = 0.02). Multivariate analysis showed that hs-CRP was the strongest predictor of thickened max IMT in the young-old ( P  = 0.022). However, it was not the predictor of thickened max IMT in the old-old.
Conclusions:   Depending on age, hs-CRP may have different meanings in the atherosclerotic process. In particular, the predictive power of hs-CRP as a marker of atherosclerotic process was less significant in subjects aged 80 years or older.     

Efficacy of the 'tennis ball technique' versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome

Background and objective:   Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP).
Methods:   Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI ± SD) 22.7 ± 12.0/H (range 6.0–51.2); AHI supine, 59.6 ± 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI ≤ 10/H.
Results:   Mean AHI was 12.0 ± 14.5/H with the TASB and 4.9 ± 3.9/H with nCPAP ( P  = 0.02; 95% confidence interval for the difference: −13.1 to −1.0). With the TASB, treatment 'success' was achieved in 13/18 subjects, whereas 'success' was achieved in 16/18 subjects using nCPAP ( P  = 0.004). In the two subjects with baseline AHI < 10/H, AHI remained below 10 for both therapies. The TASB successfully reduced time spent in the supine position. Mean percentage supine sleep time was 6.3 ± 5.9% with the TASB, and 35.4 ± 34.1% with nCPAP ( P  < 0.001). No significant differences in sleep efficiency or subjective responses were observed between treatments.
Conclusions:   Control of body position during sleep using an anti-supine device mimicking the so-called 'tennis ball technique' provides benefit in the management of position-dependent OSAHS in subjects who meet strict inclusion criteria. The overall improvement is, however, less than for nCPAP.     

Pegvisomant-primed GH stimulation test

Objective  Provocative stimulation tests for GH assessment have poor reproducibility and can often elicit false positive results in normal children. The aim of our study was to evaluate the capability of pegvisomant, as an enhancer of GH secretion, in unmasking false-positive results in short children undergoing GH testing.
Design  A prospective study was conducted between March 2005 and April 2006.
Patients  Twenty-one short children (8 males and 13 females), aged 1·0–14·5 years, with a height of < 2 SD scores below the mean were included in the study.
Methods  All subjects underwent an l -DOPA stimulation test with evaluation of GH. At the end of the test, 1 mg/kg of pegvisomant was given subcutaneously and 3 days later an l -DOPA stimulation test was repeated.
Results  There was a significant decrease of IGF-I SDS following pegvisomant (–1·75 ± 0·24 vs. –2·65 ± 0·23; P  < 0·0001) and a significant increase of the GH-peak (6·2 ± 0·91 vs. 15·3 ± 2·30 µg/l; P  < 0·0001). Among the 21 patients examined, 18 (85·7%) had an insufficient response (< 10 µg/l) at the first stimulation. Ten of them (55·5%) showed normal secretion after priming with pegvisomant, while insufficient secretory reserve was confirmed in the remaining eight.
Conclusions  Pegvisomant priming before GH stimulation tests can be used to improve the reliability of the diagnostic work up in GH deficiency. Further studies are required, however, to clarify whether this procedure should be recommended in the routine evaluation of GH status.