Holland Sleep Disorders Questionnaire: a new sleep disorders questionnaire based on the International Classification of Sleep Disorders‐2

The primary objectives of this study were to construct a self‐assessment questionnaire for sleep disorders based on the International Classification of Sleep Disorders‐2, and to evaluate the questionnaire’s psychometric properties with respect to its total score and the individual scores for each of the six sleep disorders. In total, 1269 patients, clinically diagnosed with a sleep disorder, and 412 subjects without sleep complaints were enrolled into this study. Principal components analysis confirmed that the Holland Sleep Disorders Questionnaire differentially represented the six symptom clusters associated with International Classification of Sleep Disorders‐2 classifications. The Holland Sleep Disorders Questionnaire’s total score distinguished patients with a clinically diagnosed sleep disorder from individuals without sleep complaints, with area under the receiver operating curve P(A) of 0.95. The internal reliability coefficient alpha was 0.90 and, applying the Youden criterion as cutoff score, the overall accuracy was 88% (κ: 0.75). Subsequently, the six diagnostic groups of sleep‐disordered patients could be differentiated reliably, with P(A) values ranging between 0.69 and 0.95, alpha coefficients ranging between 0.73 and 0.81 and an overall percentage of 85% correctly classified patients (κ = 0.80), indicating a substantial to excellent agreement between the primary diagnoses and the Holland Sleep Disorders Questionnaire classifications.     

Synthesis and biological activity of analogues of the C-terminal hexapeptide of substance P with modifications at glutaminyl and methioninyl residues

Analogues of [Orn⁶]-SP_6-11 have been synthesized in which the methionyl residue is replaced by glutamine γ-carboxamide substituted derivatives. These analogues where tested in three in vitro preparations representative of NK-1, NK-2 and NK-3 receptor types. Substitution of the SCH₃ group of the Met¹¹ side chain by CONHCH₃, CON(CH₃)₂, CONHPh and CONCH₃Ph groups results in analogues which are full agonists in NK-1 and NK-2 preparations with the exception of the Glu[N(CH₃)₂]¹¹ and the Glu(NHCH₃)¹¹ analogues, which are partial agonists at NK-1 and NK-2 receptors respectively. The Glu(NHCH₃)¹¹ analogue shows selectivity for the NK-1 receptor type and is equipotent to the Glu(NCH₃Ph)¹¹ analogue in the same receptor type. The latter analogue is 2.84 times more potent than the parent hexapeptide in the NK-2 preparation. The Glu(NHPh)¹¹ analogue is a full agonist in the NK-3 preparation and equipotent to the parent hexapeptide, in contrast to the other analogues in which Met has been replaced by glutamine γ-carboxamide substituted residues. It is concluded that for NK-1 receptor type the lipophilic character of Met¹¹ side chain is not a determining factor for activity but it is an important factor for activity in the NK-2 receptor type and has a stronger effect when a phenyl group is present, thus leading to analogues which are full agonists and more potent than the parent hexapeptide.     

Effects of Maternal Exposure to Polychlorobiphenyls (PCBs) on F1 Generation Behavior in the Rat

Effects of Maternal Exposure to Polychlorobiphenyls (PCBs) onFl Generation Behavior in the Rat.PANTALEONI, G., FANINI, D.,SPONNTA, A. M., PALUMBO, G., GIORGI, R., AND ADAMS, 5P. M. (1988).Fundam. Appl. Toxicol. 11, 440-449. The effect of Fenclor 42(PCB) exposure of female rats (Fischer 344 strain) was studiedthrough assessment of the behavioral development of their Flprogeny. Female rats were exposed to PCB according to the followingtreatment schedule: (A) (5 days) 2 weeks prior to mating, (B)during gestation (Days 6-15 of pregnancy), (C) during lactation(Days 1-21 after delivery). Behavioral endpoints of motor reflexes,motor coordination, activity (preweaning behaviors), and learning(postweaning behavior) were evaluated for PCB ip dosages of5-10 mg/kg/day for 5 days (preconception exposure), and PCBoral 3 dosages of 2-4 mg/kg/day for 10 days (in mero exposure)and of 1-2 mg/kg/day for 20 days (during lactation exposure).Dosage-dependentdifferences in the evaluated behaviors were found in the offspringof the PCB-exposed females when compared to the offspring ofcorn-oil (vehicle)-exposed females. Significant differencesin the development of cliffavoidance reflexive behavior, swimmingability, and open field activity were particularly evident.Furthermore the PCB exposure of female rats during gestationand lactation resulted in impaired acquisition of the activeavoidance behavior while preconceptional PCB exposure significantlyaffected active avoidance performance as reflected in increasednumber of avoidance responses to reach criterion for extinction.These results show that Fenclor 42 does possess a significantrisk to the offspring of exposed females, and further illustratethe sensitivity of progeny behavioral assessment in detectingsuspected functional teratogenesis.     

Transcutaneous Cardiac Pacing for Termination of Tachyarrhythmias

ALTAMURA, G., ET AL.: Transcutaneous Cardiac Pacing for Termination of Tachyarrhythmias. Transcutaneous cardiac pacing (TCP) was used for interruption of tachyarrhythmias in 31 patients: 20 with ventricular tachycardia (VT); eight with atrioventricular reentrant tachycardia (AVRT) and three had atrioventricular nodal tachycardia (AVNT). The stimulators used (Pace Aid 50/52) allow pacing at programmable rates (50–160 ppm) and output (10–200 mA at 20-msec pulse duration), when possible overdrive pacing was used. Short bursts of stimuli were delivered with increasing current intensity until interruption of the arrhythmia or to the maximum energy tolerated by the patient. VTs were interrupted in eight of the 20 patients: four of the six (67%) treated by overdrive pacing and four of the 14 (29%) were treated by underdrive pacing. Supraventricular tachycardias (SVT) were terminated in eight of the 11 patients: seven out of eight (88%) AVT, and one out of three AVNT (33%). We observed two cases of arrhythmia worsening: a VT acceleration and induction of ventricular fibrillation in a patient with AVNT. TCP was well tolerated by the majority of the patients. We conclude that TCP is an effective method for interruption of ventricular and supraventricular reentrant tachycardias, but the risk of arrhythmia worsening must be considered.     

The Diet Quality Index Revised: A Measurement Instrument for Populations

OBJECTIVE: To evaluate a revision of the Diet Quality Index called the Diet Quality Index Revised (DQI-R). DESIGN: The original Diet Quality Index was revised to reflect current dietary guidance, to incorporate improved methods of estimating food servings, and to develop and incorporate measures of dietary variety and moderation. The scoring of the original scale was reversed in direction and expanded to a 100-point scale to improve interpretability. METHODS/SUBJECTS: Data from the 1994 Continuing Survey of Food Intakes by Individuals were used. A sample of 3,202 adults aged 18 and older contributed 2 days of dietary intake data based on 24-hour recalls for the development and revision of various components of the DQI-R. STATISTICAL ANALYSES: Pearson correlation analyses, ordinary least squares regression analyses, and a nonparametric test to determine trends across ordered groups were used. RESULTS: The mean DQI-R score for the 1994 sample was 63.4 of a possible 100-point score. Sample respondents were more likely to have met dietary guidance in the areas of dietary cholesterol (66.9% met goal) and iron intakes (59.6% met goal) relative to the Recommended Dietary Allowances but less likely to have met goals related to fruit servings (19.6% met goal), grain servings (23.1% met goal), and calcium intakes (16.6% met goal) relative to the Recommended Dietary Allowance. There is a statistically significant quantitative and qualitative improvement in all components of the DQI-R as one moves from the lowest grouping of scores to the highest. For example, persons with DQI-R scores less than 40 consumed 43.9% of energy from fat, 72% of the Adequate Intake for calcium, and 6.7% of the recommended servings of fruit per day. In contrast, those with DQI-R scores greater than 80 consumed 24.2% of energy from fat, 101% of the Adequate Intake for calcium, and 137% of the recommended servings of fruit per day. APPLICATIONS: The DQI-R reflects the dietary guidance principles of macronutrient distribution, moderation, variety, and proportionality. Although the index was designed to monitor dietary changes in populations rather than individuals, each index component reflects an aspect of national dietary guidance. Calculation of DQI-R scores for an individual should provide an estimate of diet quality relative to national guidelines, and differences in scores over time should suggest improvement or decline in overall diet quality.     

Reliability of Minute Ventilation as a Parameter for Rate Responsive Pacing

A minute ventilation sensing rate responsive pacemaker was implanted in 11 patients with bradycardias. Their mean age was 59 +/- 4 years (mean +/- SEM). The pacemaker measures minute ventilation by sensing intravascular impedance using a standard bipolar electrode. The rate responsive programming was simple: apart from ascribing an upper and lower rate, the only programmable parameter was the slope of rate response. This could be derived approximately by assessing the suggested slope value during an exercise test in the 'adaptive VVI' mode. Compared with exercise in the VVI mode, symptom limited treadmill tests in the rate responsive mode showed a 33% improvement of exercise capacity and a 44% improvement of cardiac output as determined noninvasively by continuous wave Doppler measurements of the ascending aortic blood flow. The pacing rate was appropriately increased during a variety of daily activities such as walking at different speeds and gradients, and ascending and descending stairs. Voluntary interference of the respiratory pattern such as during coughing and hyperventilation increased the pacing rate from a resting rate of 70 bpm to 111 +/- 10 and 86 +/- 4 bpm respectively. Continuous talking during exercise attenuated the expected rate response. The pacemaker can sense activity induced by arm swinging. In conclusion, the Meta pacemaker improved cardiac output and exercise capacity in patients with bradycardias. Its rate response was related to workload. Although voluntary interference affected the pacing rate, excessive rate acceleration was not encountered.     

Initial Clinical Experience with a Minute Ventilation Sensing Rate Modulated Pacemaker: Improvements in Exercise Capacity and Symptomatology

A minute ventilation sensing rate modulated pacemaker was implanted in nine patients with bradycardia. Minute ventilation is sensed in this pacemaker by means of a standard bipolar pacing electrode. Compared with exercise in the constant rate ventricular pacing (WI) mode at 1 month after pacemaker implantation, rate responsive pacing resulted in an improvement of exercise capacity of 33 ± 5% (from 437 ± 42 s in the WI mode to 593 ±57 s in the rate modulated mode, P < 0.01, Bruce protocol). This improvement was maintained in the seven patients in whom an exercise test was repeated at 3 months after implantation. The pacing rate was significantly correlated with oxygen consumption (r = 0.8A ± 0.04) and measured minute ventilation (r = 0.76 ± 0.06), Symptomatology in these patients was assessed by means of self-assessment questionnaires in a double blind, randomized cross-over study in which the pacemaker was alternatively programmed into the WI and rate modulated modes. Significant improvements in "shortness of breath" and "energy during daily activities" were documented during rate modulated pacing and "palpitations" and "chest pain" were not worsened. Most patients preferred the rate modulated mode during the study. In conclusion, rate modulated pacing by sensing minute ventilation resulted in better exercise capacity and symptomatology. The pacing rate also showed good correlation with the individual's oxygen requirement.