Successful treatment of human non-24-hour sleep-wake syndrome

The authors report a case in which a non-24-h (hypernychthemeral) sleep-wake cycle appeared as a late complication of a more fundamental disturbance in the quality of sleep (difficulty falling asleep, frequent awakenings, nonrefreshing sleep). The sleep disturbance began abruptly after a series of stressful events. The patient reported that he extended his hours of bedrest in the morning in order to increase his total sleep time and feel mor rested, and that he gradually extended his hours of activity in the late evening in order to increase his drowsiness and ability to fall asleep. At first this behavior, which was a deliberate attempt to compensate for inefficient nighttime sleep, led to a delayed sleep period, as also occurs in the delayed sleep phase syndrome. After several years in which sleep efficiency progressively deteriorated, this behavior led to a non-24-h free-running sleep-wake cycle. After the patient was treated with thyroxine for borderline hypothyroidism, and then flurazepam and finally vitamin B12, his sleep disturbance progressively improved and his sleep-wake cycle shortened. After B12 treatment he was able to advance the timing of ;his sleep period for the first time in nearly 10 years and to follow a normal 24-h sleep-wake regimen.     

Larger phase angle between sleep propensity and melatonin rhythms in sighted humans with non-24-hour sleep-wake syndrome

STUDY OBJECTIVES: This study was aimed to clarify phase angle between sleep propensity and the circadian pacemaker in patients with non-24-hour sleep-wake syndrome (Non-24). DESIGN AND SETTING: A case-control study was underaken. PARTICIPANTS: Sighted patient with Non-24 (4 males and 1 female, aged 16 to 39 y), and sex- and age-matched healthy controls (12 males and 3 females, aged 19 to 35 y) participated the study. MEASUREMENT AND INTERVENTION: Following an actigraphic assessment of the sleep-wake cycle in their homes, the participants entered an ultra-short sleep-wake schedule together with simultaneous measurement of dim light melatonin rhythm after 24-hour sleep deprivation. RESULTS: The period of the sleep-wake cycle observed at home was longer in the Non-24 patients (25.12 hours) than in the controls (24.02 hours, p<0.0001). The interval from sleep propensity (SP) onset to the melatonin midpoint (MLmid) was significantly shorter in the Non-24 patients than in the controls. The interval from the MLmid to the SP offset was significantly longer in the Non-24 patients than in the controls. CONCLUSIONS: It was postulated that Non-24 sufferers' delayed SP onset relative to the circadian pacemaker may accelerate the light-induced phase-delay, leading to sleep-wake cycle that is longer than 24 hours.     

Clinical and pharmacokinetic concerns of 24-hour dosing with theophylline

Selection of the dosing interval for oral theophylline must consider the product's absorption rate, the patient's elimination rate, and the tolerated fluctuation in serum concentration. Attempts to produce formulations with ultra-slow absorption for "once daily" marketing have thus far resulted in incomplete and erratic absorption.     

Clinical biochemical evaluation of central fatigue with 24-hour continuous exercise

OBJECTIVE: The present study was conducted to clarify the effects of ultra-marathon (ultra long-term aerobic exercise in which people run long distances) on the brain; examine the issue of central fatigue; verify the serotonin hypothesis of exercise-induced brain fatigue, and ascertain relationships between central fatigue and oxidative stress. METHODS: Subjects consisted of 15 individuals (12 men, 3 women) who ran continuously for 24 h. Mean age was 44 +/- 9 years (range, 31 approximately 64 years). Blood tests were conducted: (1) before starting to run (around 09:00); (2) 16h after starting (02:00 the next day); and (3) just after the finish (around 10:00 the next day) to measure the serum levels of serotonin, melatonin, free tryptophan (f-Tp) and free fatty acid. At the same time, urine samples were collected to measure levels of urinary biopyrrins (BPn). Subjective symptoms were investigated using the Japanese version of the Profile of Mood States (POMS) instrument. RESULTS: (1) Participants ran a mean (+/- SD) distance of 162.6 +/- 18.3 km. (2) There were not marked changes in serum serotonin levels. Serum melatonin levels at 3 time points were 3.4 +/- 0.6 pg/ml, 57.2 +/- 15.2pg/ml and 7.8 +/- 8.9pg/ml, respectively(p < 0.01 before start vs. 16h after start). Serum f-Trp levels at the 3 time points were 5.4 +/- 0.9 nmol/ml, 9.7 +/- 2.1 nmol/ml and 11.5 +/- 4.9 nmol/ml, respectively (p< 0.05 before start vs. just before finish). Free fatty acid levels were 0.42 +/- 0.10 nmol/ml, 1.26 +/- 0.11 nmol/ml and 1.39 +/- 0.23 nmol/ml, respectively (p < 0.01 before start vs. 16 hours after start) (p < 0.05 before start vs. just after finish). (3) Urinary BPn levels increased with time, from 1.2 +/- 0.7 nmol/ml to 2.6 +/- 1.0 nmol/ml to 4.0 +/- 1.5 nmol/ml, respectively (p < 0.01 before the start vs. 16 hours after the start). (4) In terms of POMS scores, fatigue score (Factor F) increased, but vitality score (Factor V) was high at all time points and did not demonstrate any marked changes. Scores for anger and hostility were low (Iceberg profile-type: convex type). Urinary BPn levels were correlated significantly with both serum f-Trp level and Factor F:(y = 8.41x + 2.5, r = 0.708, n = 42) and (y = 2.82x + 5.9, r = 0.568, n = 42), respectively. Urinary BPn thus reflected the degree of subjective fatigue with a high level of sensitivity. CONCLUSIONS: The present results suggest that running continuously for 24h induces brain fatigue and that oxidative stress may be involved.     

Clinical and microbiological features of Actinotignum bacteremia: a retrospective observational study of 57 cases

The purpose of this study was to investigate the incidence, clinical presentation, and prognosis of Actinotignum bacteremia in southern Sweden. Actinotignum isolates in blood cultures were identified retrospectively between 1st January 2012 and 31st March 2016 through searches in the clinical microbiology laboratory database. The population covered by this laboratory is approximately 1.3 million. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for species determination. Etests were used for minimum inhibitory concentration (MIC) determination. The patients’ medical charts were reviewed. Fifty-eight episodes in fifty-seven patients with Actinotignum bacteremia were identified (A. schaalii = 53, A. sanguinis = 1, A. urinale = 2, and Actinotignum species = 3), which corresponds to an incidence of 11 cases per million inhabitants. Fifty-one percent of the isolates were in pure culture. The MICs were low for β-lactam antibiotics, whereas high MICs were recorded for ciprofloxacin and trimethoprim. Patients had a median age of 82 years, 72% were male, and a majority had underlying urological conditions. Thirty-six of the patients were diagnosed with a focus from the urinary tract. Thirty-one patients developed severe sepsis and nine patients died during the hospital stay. Our study is the largest of Actinotignum bacteremia and demonstrates that it is a condition with a significant fatality that affects elderly persons with underlying conditions. β-Lactams represent a rational treatment option.

     

The 24-hour sleep patterns interview: a pilot study of validity and feasibility

The purpose of this project was to examine the validity and feasibility of the 24-Hour Sleep Patterns Interview (24-Hour SPI) as a measure of sleep continuity (bedtime, wake time, sleep onset latency, total sleep time) and sleep quality. Two studies were completed. The first study (n = 154) compared the 24-Hour SPI with a 2-week sleep diary, and the second study (n = 32) compared the 24-Hour SPI with actigraphy, sleep diary, and the Pittsburgh Sleep Quality Index. Both studies found a significant relation between the 24-Hour SPI and established measures of sleep patterns and sleep quality. The sensitivity and feasibility were also examined by data completion rates, differences in weekday and weekend sleep patterns, and qualitative feedback from participants. This pilot study supports the use of the 24-Hour SPI as a valid and feasible measure of subjective sleep patterns for research, especially for researchers with limited budgets or who are primarily interested in subjective sleep outcomes. Additional research with larger and broader samples is needed to further validate this approach.     

Testicular atrophy in AIDS: a study of 57 autopsy cases

The pertinent clinical data and histologic features of the testes in 57 autopsied acquired immunodeficiency syndrome (AIDS) patients were analyzed and compared with those of 55 age-matched control patients without AIDS. The testes of the AIDS patients showed a significantly lower degree of spermatogenesis (determined by a testicular score count), as well as more prominent thickening of the basement membrane and interstitial fibrosis when compared with the controls. While the precise cause of testicular atrophy in AIDS patients remains to be determined, the chronicity of the disease, prolonged fever, malnutrition, testicular infection, and chemotherapy are all contributing factors. Since the vast majority of the studied AIDS patients were homosexual and most control patients were heterosexual, the observed testicular changes can be ascribed to AIDS and/or homosexuality. Because of a high prevalence of sexually transmitted diseases, antisperm antibodies, and possible zinc deficiency and endocrine disorders, homosexual men appear predisposed to tubular atrophy. Conversely, AIDS-related factors, such as a direct toxic effect of the human immunodeficiency virus on germinal epithelium or as yet undetermined endocrine imbalances might exert a detrimental effect on the testis independent of homosexuality.     

110例癫痫患者24hAEEG临床应用报告

目的对１１０例癫痫患者的２４ｈ动态脑电图（ＡＥＥＧ）的应用价值进行了初步探讨。方法使用英国的ＯｘｆｏｒｄＭｅｄｉｌｏｇ９２００型８导磁带记录仪进行２４ｈ描记后作离线回放分析，并与普通ＥＥＧ相比较。结果１１０例中ＡＥＥＧ异常６２例（５６．４％），９８例中ＥＥＧ发现异常３２例（３２．７％）。ＥＥＧ正常而ＡＥＥＧ异常３０例，ＥＥＧ异常而ＡＥＥＧ正常９例。结论ＡＥＥＧ明显优于ＥＥＧ，但有时ＡＥＥＧ也不能捕获到间歇期的发作波。分析ＡＥＥＧ记录必需注意将睡眠Ⅰ、Ⅱ期出现的高幅顶尖波、纺锤波与痫样波区分开来，以免导致错误诊断。ＡＥＥＧ对颞叶和额叶底面的致痫灶反应较差，需补做特殊电极的ＥＥＧ，如蝶骨电极。     

子宫浆液性乳头状癌24例临床病理分析

目的比较子宫浆液性乳头状癌(uterine papillary serous carcinoma,UPSC)和子宫内膜样癌(uterine endometrioid carcino-ma,UEC)的组织病理学和免疫组化表达,以了解两种肿瘤生物学行为的差异。方法对24例UPSC和54例UEC进行组织学复查和应用免疫组化SP法检测肿瘤的p53蛋白、ER和PR的表达。结果24例UPSC占子宫内膜癌的3·77%,平均年龄UP-SC组为60岁,UEC组为51·7岁(P<0·01),晚期癌(FIGOⅢ-Ⅳ)UPSC组占62·5%,UEC组占35·1%(P<0·025)。p53蛋白的表达UPSC组16例阳性(66·7%),UEC组10例阳性(18·5%),两组比较(P<0·01)。ER阳性表达UPSC组(8·3%),UEC组(42·5%),PR阳性表达UPSC组(12·5%),UEC组(35·2%),两组比较:ER(P<0·01),PR(P<0·05),差异有显著性。UPSC组p53蛋白表达与肿瘤分期、分级、及肌层浸润无明显关系,而UEC组Ⅲ~Ⅳ期肿瘤的p53蛋白的表达率高于Ⅰ-Ⅱ期(P<0·005)。UPSC的5年生存率为25%,UEC组5年生存率为80·9%(P<0.01),两组差异有显著性。结论UPSC为p53高表达,而缺乏雌激素和孕激素受体,为高度恶性的肿瘤。它的生物学行为不同于UEC,因而强调诊断时需和其他类型的子宫内膜癌相区别。     

风湿性多肌痛86例回顾性临床分析

目的探讨风湿性多肌痛的临床特点及男女患者之间的差别。方法回顾性分析86例风湿性多肌痛患者的临床表现和治疗反应。结果女性患者表现为颈后肌和肩胛带肌痛的比例高于男性(P<0.05)。而男性患者出现高热、关节痛、体质量下降、血清C反应蛋白水平、白细胞计数升高以及免疫球蛋白升高的比例均高于女性患者(P<0.05)。然而,女性患者的复发率高于男性(P<0.05)。结论男性患者部分全身症状和炎性反应重于女性,女性患者较男性更易复发。     

Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases.

Solitary fibrous tumors (SFTs), rare in extrapleural sites, can present difficulties in diagnosis at these locations. From the files of the M. D. Anderson Cancer Center, we accessed 24 cases of extrapleural SFT (14 females, 10 males, ages 19 to 85 yr) obtained for clinical, histologic, immunohistochemical, and follow-up findings. Tumor locations included the head and neck (n = 12), the abdomen (n = 10), and the extremities (n = 2). Tumors were 2 to 25 cm in greatest dimension (mean, 8.2 cm) and were well circumscribed or encapsulated. Histologic features were typical of their pleural counterparts, e.g., bland spindle cells with some hypercellular areas and myxoid to hyalinized backgrounds. A hemangiopericytic vascular pattern was present in 19 cases and prominent in 11. Mitotic activity ranged from 0 to 4 counts per 10 high-power fields. Necrosis was seen in two cases. Focally increased cellularity was seen in seven cases and margins were positive in another seven cases. Spindle cells were positive for vimentin (19 of 19) and CD34 (18 of 20), and negative for cytokeratin (0 of 19). Fibroblastic differentiation was present in the three cases studied by electron microscopy. Flow cytometry in three cases revealed diploid cell populations. Follow-up for 19 cases (9 to 99 mo) revealed no evidence of metastasis, although one patient had residual tumor after an incomplete excision, and one patient died of unrelated causes. Histologic findings such as mitotic counts, necrosis, cellularity, and marginal status were not associated with outcome. We conclude that extrapleural SFTs are clinically and histologically similar to their pleural counterparts. Although the length of clinical follow-up was short (mean follow-up, 41.4 mo), recognizing these lesions is important because they typically follow an indolent clinical course if completely excised. Although CD34 is nonspecific, it is usually positive in SFTs and may aid in their diagnosis.     

嗜铬细胞瘤患者血浆和24h尿CAs水平变化及临床应用分析

目的:探讨嗜铬细胞瘤患者血浆、24h尿儿茶酚胺(CAs)水平变化与诊断、治疗及预后相互关系。方法:用酶联免疫分析(血浆)和高效液相色谱分析(24h尿)的方法,对97嗜铬细胞瘤患者、30例正常对照者,血浆及24h尿液中儿茶酚胺含量进行检测分析。结果:正常对照组与嗜铬细胞瘤患者组比较,血浆和24h尿儿茶酚胺(E、NE、DA)都明显高于正常对照组,有显著性差异(P<0.01);嗜铬细胞瘤患者血浆与24h尿儿茶酚胺(E、NE、DA)水平变化呈明显的正相关(r①=0.892,P<0.001;r②=0.781 P<0.001;r③=0.912,P<0.001);嗜铬细胞瘤患者手术治疗后跟踪随访血、尿CAs水平与正常对照组无明显差异。结论:嗜铬细胞瘤患者血浆和24h尿CAs水平变化与诊断、治疗及预后密切相关,24h尿CAs检测优于血浆,检测结果对临床早期诊断、治疗及预后判断具有重要意义。     

Clinical study of 57 cases of infection with Trichophyton tonsurans examined at a dermatology clinic in Saga Prefecture, Japan]

This paper is a clinical study of 57 cases of infection with Trichophyton tonsurans (T. tonsurans) examined in our clinic between January 2004 and July 2006. The patients were 31 high school students, 19 junior high school students, 2 primary school students, 1 kindergartener, and 4 sports instructors. The male:female ratio was 51:6. Most patients were male Judo practitioners. Patients were clinically categorized as follows: 13 cases of tinea capitis {10 containing black dot ringworms (BDR), 2 scaled, and 1 with inflammation}, 41 cases of tinea corporis, 1 case of tinea manum, and 7 carriers. Five patients displayed both tinea capitis and tinea corporis. Among tinea corporis patients, 21 displayed annular erythemas, whereas 19 displayed small circular eythemas characterized by a lightly inflamed non-typical rush. In 3 tinea corporis cases, we sampled T. tonsurans from hair grown inside the skin rash. Eleven of the tinea corporis patients displayed multiple lesions. Compared to patients with singular lesions, these 11 cases had a larger degree of comorbidity with BDR or HB positivity. A 6-8 week treatment with griseofulvin was efficient in 90% of the tinea capitis cases. Tinea corporis patients were healed following a 4-9 week treatment with topical antifungals and griseofulvin. When examining T. tonsurans infections, patients with BDR or lightly inflamed tinea corporis as well as asymptomatic carriers can be easily overlooked or misdiagnosed. Therefore, we suggest that mycological examination, including careful observation of the rash and KOH mount, is essential in these cases.     

腕管综合征患者的临床与神经电生理研究

目的：观察神经电生理检测对腕管综合征(CTS)的诊断价值。方法：对腕管综合征的临床特征及病因进行了分析，并作神经传导速度(NCV)和肌电图检测和分析。结果：40条患病神经中8条正中神经诱发波形消失，32条正中神经感觉潜伏期延长、波幅降低或(和)感觉神经传导速度减慢。25例患者伴有30条正中神经运动末梢潜伏期延长或(和)动作电位波幅降低。22块正中神经支配肌有去神经电位。结论：神经电生理检查在腕管综合征的诊断与鉴别诊断中有重要意义。     

老年性重型颅脑损伤57例临床分析

目的探讨临床治疗老年性重型颅脑损伤的方法和效果。方法对57例老年重型颅脑损伤病例临床资料,包括入院时间、格拉斯哥昏迷计分(GCS)、原发疾病、并发症、合并症等进行回顾性综合分析。结果格拉斯哥预后分级(GOS)评定:良好19例,中残8例,重残7例,植物生存4例,死亡19例。结论入院时间、GCS、原发疾病、并发症、合并症等是影响预后的主要因素。重视原发病的治疗,掌握手术适应证,控制血糖,合理应用激素,积极处理合并症和并发症可提高生存率,降低残死率。     

骨间后神经综合征的临床及肌电图研究

目的：探讨骨间后神经（PIN）受员的临床及肌电图诊断方法。方法：对44例临床疑PIN受损患者作详细的临床检查和肌电图研究。结果：在肱桡肌、桡侧伸腕长肌肌电图及运动神经经传导速度（MCV）均正常。伸指总肌、食指固有伸肌肌电图均有不同程度异常;MCV测定分别有24例（54％）及34例（77％）异常。桡神经浅支的感觉神经传导速度（SCV）均可引出动作电位,其中7例传导速度轻度减慢。结论：肱桡肌、桡侧伸腕长肌无异常,其余前臂伸肌的肌电图改变。部分病例MCV异常,桡神经浅支SCV正常,即可诊断PNI受损。     

Signet-ring cell carcinoma of the breast: a clinicopathologic study of 24 cases

Twenty-four cases of signet-ring cell carcinoma of the breast are presented. These represented 4.5% of 535 cases of surgically treated breast cancer at Indiana University Medical Center. Twelve cases were associated with ductal carcinoma, nine with lobular carcinoma, one with colloid carcinoma, and four were pure signet-ring cell carcinoma. The mortality rate, incidence of axillary lymph nodal metastases, and number of involved lymph nodes were greater in cases of signet-ring cell carcinoma than with other forms of mammary carcinomas without signet-ring cells. It is proposed that signet-ring cell carcinoma can manifest as a pure lesion or as a variant of ductal, lobular, or colloid carcinoma, and that it is an aggressive histologic variant of mammary carcinoma.