The Maintenance of Wakefulness Test in Pediatric Narcolepsy

Objective tools are needed to assess the response to treatment in pediatric narcolepsy. This article presents a single-center experience documenting the use of the maintenance of wakefulness test (MWT) in a pediatric series. This study reviewed the charts of children with narcolepsy who had an MWT performed between January 2008 and June 2012. A cutoff was used for mean sleep latency: <8 minutes for inadequate control of hypersomnia, and >20 minutes to indicate adequate control on medications. Thirteen tests were performed on 10 children (median age 15.8 years, range 8.7-20.3 years) with narcolepsy, of which six had cataplexy and three were boys. Comorbid conditions included Prader-Willi syndrome, bipolar affective disorder, and epilepsy (n = 1 each). The median mean sleep latency for all studies was 16 minutes (range 5.8-40 minutes). Sleep-onset rapid eye movement sleep events were seen in three of 13 studies. In seven patients, findings from the MWT resulted in changes in management. These data suggest that the MWT may be a useful and feasible test for assessing response to treatment in children with narcolepsy. Future research is needed to obtain normative MWT data on children with and without narcolepsy.     

Mononuclear gold(iii) complexes with diazanaphthalenes: the influence of the position of nitrogen atoms in the aromatic rings on the complex crystalline properties

A series of mononuclear gold(iii) complexes of the general formula [AuCl₃(diazanaphthalene)], where diazanaphthalene is quinazoline (qz, 1), phthalazine (phtz, 2), 1,5-naphthyridine (1,5-naph, 3), 1,6-naphthyridine (1,6-naph, 4) or 1,8-naphthyridine (1,8-naph, 5), were prepared and fully characterized. The complexes 1–5 consist of discrete monomeric species with the Au(iii) cation in a square planar coordination geometry surrounded by three chloride anions and one diazanaphthalene ligand. Crystallographic studies indicate the presence of an extended 4 + 1 or 4 + 2 geometry around the square planar [AuCl₃(diazanaphthalene)] center due to Au⋯Cl and Au⋯N interactions. The crystal structures of these complexes are controlled by a variety of intermolecular interactions that utilize the amphiphilic properties of the coordinated chloride anions and involve C–H groups, π-electrons, and an uncoordinated nitrogen atom of the diazanaphthalene ligand. The usual offset π-stacking between the N-heteroaromatic ligands appears to be completely hindered between the 1,5-naph fragments and significantly weakened between the 1,6-naph and 1,8-naph in their respective complexes 3, 4 and 5, for which the average molecular polarizability (α) values are the lowest in the series. It is remarkable that the [AuCl₃(benzodiazine)] complexes 1 and 2 form centrosymmetric crystals, but the [AuCl₃(naphthyridine)] complexes 3–5 assemble into non-centrosymmetric aggregates, making them potential alternatives to the previously studied systems for application in various fields by taking advantage of their polarity.

The [AuCl₃(benzodiazine)] complexes form centrosymmetric crystals, while the [AuCl₃(naphthyridine)] complexes assemble into non-centrosymmetric aggregates, making them potential alternatives for advanced nonlinear optical materials due to their polarity.     

Nineteen-year single-center experience in 76 patients with penile cancer treated with high-dose-rate brachytherapy

PURPOSETo report the outcomes for 76 patients with penile cancer treated with high-dose-rate brachytherapy (HDR-BT) at a single institution.METHODSSeventy-six patients with penile cancer treated with HDR-BT in our department between October 1998 and September 2018 were analyzed. Seventy underwent interstitial HDR-BT (fractionation dose range of 3–3.5 Gy given twice a day with an interval of at least six hours between the fractions), and six underwent superficial treatment with mold applicators (fractionation dose range of 4–7 Gy given once or twice a week).RESULTSMedian follow-up was 76 months (7–204 months). In the whole group, 22/76 local failures (28.9%) were observed: 14/76 (18.4%) local recurrences and 8/76 (10.5%) cases of persistent disease. Median time to recurrence was 24 months (9–54 months). Inguinal lymph node metastases were observed in 18/76 cases (23.7%). Distant metastases occurred in 12/76 (15.8%) cases. Patients with local recurrence and persistent disease underwent salvage penectomies, except four who refused surgery and underwent a second course of interstitial HDR-BT. Five- and 10-year cause-specific survival were 85.0% and 77.8%, respectively. Local control at 5 and 10 years was 65.6%. Five- and 10-year penile preservation were 69.5% and 66.9%, respectively. There was no G3 or G4 acute toxicity. One urethral stenosis (1.3%) occurred in a patient with a T3 tumor and was treated successfully with dilatation.CONCLUSIONSHDR-BT provides good local control of penile cancer and is a good option for penis preservation therapy and in our experience achieves a penile preservation rate at 10 years of 66.9%.     

Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability

Purpose

The main purpose of this study is to establish which of two methods is more reliable in glenoid assessment for instability in pre-operative planning. Accordingly, we have studied the intra- and inter-observer reliability of glenoid parameters with the use of two-dimensional (2D) and three-dimensional (3D) reconstructed computed tomography (CT) images.

Methods

One hundred glenoids were measured with the use of 2D-CT and 3D-CT (in 3D orientation) by two independent observers (one experienced and one inexperienced). Measurements were repeated after one week for 30 randomly selected glenoids.

Results

The intra-class correlation coefficient (ICC) for inter-observer reliability was significantly greater for 3D-CT (0.811 to 0.915) than for 2D-CT (0.523 to 0.925). All intra-observer reliability values for 3D-CT were near perfect (0.835 to 0.997), while those for 2D-CT were less reliable (0.704 to 0.960). A dependent t-test showed that, for both observers, almost all glenoid parameters (except R and d) differed significantly (p?<?0.05) between 2D and 3D measurement methods.

Conclusions

Therefore, it can be concluded that 3D glenoid reconstructions are more reliable for glenoid bone loss assessment than 2D-CT. The results suggest that quantifying a glenoid defect with the use of 2D image only—even if performed by an experienced orthopaedic surgeon—is prone to errors. Differences in measurements between and within observers can be explained by plane setting and identifying glenoid rim in 2D-CT. Accordingly, we recommend that glenoid measurements should be performed in 3D orientation using 3D reconstruction obtained from CT images for pre-operative assessments, which are crucial for surgical planning.

     

Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve

Purposes

Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury.

Methods

An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation.

Results

The mean S1 amplitude acquired was 259+/67 (180–421), 321 +/79 (192–391), 371 +/38 (200–551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared.

Conclusions

The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.

     

The analysis of densitometry image of bone tissue based on computer simulation of X-ray radiation propagation through plate model

In this work, we have presented an attempt at the computer modelling of the attenuation effect of X-ray radiation which occurs in the densitometry test. The purpose of the modelling is to examine the extent to which the parameters of the plate model of bone tissue affect bone mineral density (BMD) parameter. In the modelling the fundamental functions realised by a densitometry device have been taken into consideration. Certain necessary assumptions simplifying the computation of the complex physical processes that occur during the transition of X-ray radiation through an object have been made. In order to compute the image produced by interaction of radiation the attenuation law is applied. The modelling of an object consists in defining its dimensions and its material characteristics. In the presented simulation the material characteristics of the object are limited to its attenuation coefficient. A different value of the coefficient can be defined for each voxel. The result image is produced by the calculation of partial attenuation in the individual voxels. The levels of grey in the image represent the value of the computed radiation intensity which is recorded in the "detector" after transition through the object. The simulation has been performed for the plate model representing trabecular bone tissue with 0.1mm porosity compartments. The results of the simulation of the plate model are presented. It can be observed that for certain modelled porosity compartments the size, structure and spatial arrangement are not properly recorded in the two-dimensional "detector". The recorded simulation results may be found useful for explaining difference that has been noticed between the BMD obtained from the densitometry test and the bone susceptibility to fracture.     

Impact of dietary fat on gut microbiota and low-grade systemic inflammation: mechanisms and clinical implications on obesity

Dietary fat strongly affects human health by modulating gut microbiota composition and low-grade systemic inflammation. High-fat diets have been implicated in reduced gut microbiota richness, increased Firmicutes to Bacteroidetes ratio, and several changes at family, genus and species levels. Saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and conjugated linolenic fatty acids share important pathways of immune system activation/inhibition with gut microbes, modulating obesogenic and proinflammatory profiles. Mechanisms that link dietary fat, gut microbiota and obesity are mediated by increased intestinal permeability, systemic endotoxemia, and the activity of the endocannabinoid system. Although the probiotic therapy could be a complementary strategy to improve gut microbiota composition, it did not show permanent effects to treat fat-induced dysbiosis. Based upon evidence to date, we believe that high-fat diets and SFA consumption should be avoided, and MUFA and omega-3 PUFA intake should be encouraged in order to regulate gut microbiota and inflammation, promoting body weight/fat control.     

Sound fields for coded excitations in water and tissue: experimental approach

Coded ultrasonography is intensively studied in many laboratories due to its remarkable properties, particularly increased penetration depth and signal-to-noise ratio (SNR). However, no data on the spatial behavior of the pressure field generated by coded bursts transmissions in the tissue were yet reported. This paper reports the results of investigations of the field structure in water, in degassed beef liver and in pork tissue using four different excitations signals, two and 16 periods sine bursts and sinusoidal sequences with phase modulation using 13-bits Barker code and 16-bits Golay complementary codes. The results of measured pressure field distributions before and after compression were compared with those recorded using short pulse excitation.     

Chronic antidepressant-like effect of EMD386088, a partial 5-HT6 receptor agonist,in olfactory bulbectomy model may be connected with BDNF and/or CREB signalling pathway

Background

The removal of the olfactory bulbs has been attributed to behavioral changes and neuroplasticity manifesting themselves among others like increases in brain neurotrophin expression and neurogenesis. Earlier data presented that EMD386088, a 5-HT₆ receptor partial agonist, exerts antidepressant-like properties after chronic administration in olfactory bulbectomy (OB) model as was it compared with amitriptyline (AMI). The aim of this study was to compare acute and chronic biochemical effects of EMD386088, administered in its antidepressant active (2.5 mg/kg) and non-active (1.25 mg/kg) doses, found in the open field test in OB rats, with those of AMI (10 mg/kg). The levels of 5-HT₆ receptor protein and selected neurotrophins in prefrontal cortex (PFC) and hippocampus (Hp) of rats have been examined.