Sympathetic and cardiovascular activity during cataplexy in narcolepsy

Autonomic nervous system activity changes have been described during cataplexy as playing a role in triggering it. To confirm these previous findings, we investigated the time course of sympathetic and cardiovascular activities during cataplexy. We made for the first time microneurographic recordings of 10 cataplectic episodes in three patients with hypocretin‐deficient narcolepsy. During microneurography, muscle sympathetic nerve activity (MSNA) was recorded simultaneously with heart rate (HR), respiratory movements, arterial finger blood pressure (BP), electroencephalography, electro‐oculogram and superficial electromyogram. Results showed no significant autonomic changes before the onset of the cataplectic episodes. Cataplexy was associated with a significant increase in MSNA and BP compared with baseline, whereas HR was markedly decreased. An irregular breathing pattern mainly characterized by apnea typically occurred during the attacks. In conclusion, our findings did not show significant changes in autonomic activity prior to cataplexy onset, ruling out a triggering role of the autonomic system. However, cataplexy was associated with co‐activation of sympathetic and parasympathetic autonomic systems, a pattern reminiscent of that reported during the vigilance reaction in animals.     

ROLE OF ALCOHOLIC BEVERAGES IN ESSENTIAL HYPERTENSIVE PATIENTS

To evaluate the importance of alcohol and other environmentalfactors in essential hypertensives, we conducted a cross-sectionalstudy on 627 patients (322 women, 305 men) subdivided in foursubgroups according to sex and presence or absence of drug therapy,to evaluate differences due to drugs and changes in life style.Multiple regression analyses were run where systolic and diastolicblood pressures were considered as separate dependent variableswith the following independent variables: age, body mass index,physical activity, alcohol and coffee consumption, smoking,educational level; considered as continuous or categorical variables.Eighty-eight per cent of all patients showed a moderate-lowalcohol intake (1–50 g/day); wine was the preferred beverage.We found a negative independent relationship between mild/moderatealcohol consumption levels and systolic blood pressure in untreatedmen and untreated women, and no relationship between alcoholand diastolic blood pressure in all subgroups considered. Bodymass index and age were positively associated with both systolicand diastolic blood pressure. Our data suggest that mild tomoderate alcohol consumption does not affect blood pressurecontrol in either treated or untreated hypertensive patients.     

SERUM {gamma}-GLUTAMYL-TRANSPEPTIDASE ISOFORMS IN ALCOHOLIC LIVER DISEASE

-Glutamyltranspeptidase (GT) appears in serum in multiple forms;their significance and clinical utility in hepatobiliary andpancreatic diseases are still a matter of controversy. Electrophoreticseparation of the multiple forms of GT on agarose gel was performedin 20 alcoholic patients (six with cirrhosis and 14 with fattyliver) and the results compared with those obtained in 50 healthyvolunteers, 43 patients affected with chronic hepatitis C, 36patients with posthepatitic cirrhosis and in 52 epileptic patientson long-term anti-epileptic medication. Multiple forms of GTwere separated into several bands (up to 11), labelled 0a, 0b,la, lb, 2a, 2b, 2c, 3a, 3b, 4a, 4b. In the alcoholic patientsnine fractions were detected, and the electrophoretic patternobserved was significantly different from that observed in healthyvolunteers and in patients with chronic hepatitis C or posthepatiticcirrhosis. No differences were observed in the electrophoreticpatterns in the alcohol abusers and epileptic patients. In alcoholicpatients significant differences were observed in the electrophoreticpatterns in relation to the degree of liver injury; the electrophoreticpatterns in patients with alcohol-related cirrhosis and posthepatiticcirrhosis differed significantly. The separation of multipleforms of GT has high sensitivity and good reproducibility. Itmay be proposed as a complementary test in the diagnosis ofalcoholic liver disease.     

Behavioural Subsensitivity Induced by Long-term Administration of a Low Dose of Haloperidol to Rats

This study examines the effects on open-field and stereotyped behaviour of rats of abrupt withdrawal from repeated treatment with a low (0.03 mg kg^?1) dose of haloperidol. Single administration of this low dose of haloperidol significantly increased open-field locomotion without modifying apomorphine (0.5 or 2.0 mg kg^?1)-induced stereotyped behaviour. Forty-eight hours after abrupt withdrawal from 0.03 mg kg^?1 haloperidol (twice daily for 15 days) a significant decrease in locomotion frequency was observed, but no change was observed in apomorphine-induced stereotypy. Our results suggest that dopamine autoreceptor supersensitivity might be evaluated in a behavioural situation of absence of postsynaptic dopamine receptor supersensitivity.     

Artificial Hair Fiber Restoration in the Treatment of Scalp Scars

BACKGROUND: There is presently no treatment for scalp scars that is fully satisfactory. The modalities of treatment currently in use are surgery, hair transplantation, and micropigmentation. Scalp implantation with artificial hair fibers is used by some physicians as an adjunctive treatment. OBJECTIVE: The objective was to assess the utility of artificial hair fibers to treat scalp scars. METHODS: Data were collected by the principal author from 10 hair restoration practitioners who tested polyamide hair fiber (Biofibre CE 0373/TGA by Medicap Ltd., Carpi (MO), Italy) implantation for scalp scars. RESULTS: Artificial hair fiber implantation occurred between June 1996 and December 2000, and observations continued until December 2004. Data from 54 scars from 44 patients treated showed: (1) no complications in 49 scars (90.7%); (2) mild adverse outcomes in 4 scars (7.4%)-temporary superficial inflammation-infection that subsided following topical cortisone and local/systemic antibiotic treatment; and (3) moderately adverse outcomes in 1 scar (1.9%)-significant inflammation and generalized infection requiring removal of artificial implant to alleviate. Occasional minor skin reactions, sebum plugs, and hyperseborrhea were successfully controlled and well accepted by patients. Fiber fall rate was 20% on average per annum. CONCLUSION: Data show that polyamide hair fiber restoration can be considered an adjunctive treatment for scalp scars in selected cases.     

The Impact of Modern Noninvasive Cardiac Imaging on Coronary Intervention Rates

Objectives

It remains still unclear whether the use of modern noninvasive diagnostic modalities for evaluation of coronary artery disease (computed tomography coronary angiography (CTCA), nuclear myocardial perfusion imaging (MPI)) were able to change the “diagnostic yield” of invasive coronary angiography (ICA).

Methods

The total number of ICA in the years 2000–2009 was related to the number of percutaneous interventions (PCIs) and we assessed whether there was a significant trend over time using time series analyses. We compared these data with the number of patients undergoing CTCA and nuclear MPI in the same time period.

Results

During the 10‐year observational period, 23,397 ICA were performed. The proportion of purely diagnostic ICA (without PCI) remained stable over the whole study period (tau = ?0.111, P = 0.721). A CTCA program was initiated in 2005 and 1,407 examinations were performed until 2009. Similarly, the number of nuclear MPI increased from 2,284 in the years 2000–2004 to 5,260 in the years 2005–2009 (P = 0.009).

Conclusion

Despite increasing availability, noninvasive testing modalities did not significantly alter the rate of purely diagnostic ICA, and still are underused as gatekeeper to ICA. Further effort is needed to optimize the use of noninvasive imaging modalities in the work‐up process for coronary artery disease. (J Interven Cardiol 2014;27:50–57)

     

Mathematical Descriptions of AV Nodal Function Curves in Dogs

Thirty-four anaestheized mongrel dogs subjected to thoracotomy were used to study AV node conduction during atrial pacing at increasing rates. Eplcardial atrial electrodes were used, together with endocavitary recordings of His bundle electrogram. An analysis was made of the repercussions involved in using four different mathematical functions describing nodal conduction; three were nonlinear (exponential and hyperbolic A and B) and one linear. In the case of the first three, the consequences of using a direct nonlinear data-fitting procedure or an indirect procedure by linear transformations of the functions were studied. The exponential and hyperbolic B functions provided the least mean squared residual in quantifying nodal conduction (8.6 ± 10.8 ms² and 10.8 ± 13.9 ms², respectively). The use of nonlinear function transformation into a linear representation caused Joss of precision in the fit to the data in the case of the exponential function (18.3 ± 22.2 ms² versus 8.Q ± 10.8 ms², p < 0.01] and, to a lesser extent, in the case of the hyperbolic B function [12.5 ± 16.4 ms² versus 10.8 ± 13.9 ms², P < 0.05).     

IDENTIFICATION OF DERMORPHIN AND HYP6-DERMORPHIN IN SKIN EXTRACTS OF THE BRAZILIAN FROG PHYLLOMEDUSA RHODEI

Methanol extracts of the skin of the Brazilian frog Phyllomedusa rhodei contain approximately equal amounts of dermorphin and its analogue Hyp⁶-dermorphin, two opiate-like heptapeptides. A unique feature of their sequence is the presence of a D-amino acid residue at position 2. Hyp⁶-dermorphin possesses a spectrum of central and peripheral bioactivity very similar to that of dermorphin.