Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome

STUDY OBJECTIVE: To characterize the function and quality of sleep in patients with irritable bowel syndrome (IBS). DESIGN: A prospective study with a historic comparison group. SETTING: A regional hospital that also serves as a tertiary referral center. PATIENTS: Eighteen patients with IBS and a comparison group of 20 matched adults with mild benign snoring. INTERVENTIONS: A polysomnography study and a wrist actigraphy study. MEASUREMENTS: All subjects underwent sleep studies and completed self-report questionnaires (IBS severity, psychosocial variables, sleep function, and Epworth Sleepiness Scale). Fourteen IBS and 11 comparison patients underwent actigraphy. RESULTS: The IBS patients had more than 70% less slow-wave stage sleep (4.5 +/- 7.3% vs 19.3 +/- 12.9%; P = 0.006), compensated by increased stage 2 sleep (72.2 +/- 6.6% vs 60.1 +/- 16.8%; P = 0.01). The IBS group had significant sleep fragmentation with a significantly higher arousal and awakening index (P < 0.001), a longer wake period after sleep onset (P = 0.02), and more downward shifts to lighter sleep stages (P = 0.01). The 4-night actigraphy study supported the polysomnography findings. The sleep fragmentation index was significantly higher (P = 0.008) in the IBS group. The IBS patients reported greater daytime sleepiness (9.0 +/- 4.8 vs 6.4 +/- 4.8, Epworth Sleepiness Scale score, P < 0.01) and greater impairment in quality of life, which correlated significantly with the sleep fragmentation indexes. The difference between the groups was not due to differences in baseline anxiety/depression levels. CONCLUSIONS: Patients with IBS have impaired sleep quality, reduced slow-wave sleep activity, and significant sleep fragmentation. The cause-and-effect relationship of these findings with patients' daytime symptoms should be studied further.     

Effect of cadmium and bombesin on exocrine pancreatic secretions and plasma levels of gastrin and cholecystokinin (CCK) in rats

The effects of cadmium and bombesin on exocrine pancreatic secretions and plasma levels of gastrin and cholecystokinin (CCK) were studied in anesthetized rats with pancreatic and gastric fistulas. Rats treated only with saline were used as controls. Both control and cadmium (0.1 mg per kg) treated rats were infused with saline, secretin, and bombesin (BBS). Blood and pancreatic juice samples were collected at regular time intervals. Plasma levels of gastrin and CCK were measured in blood samples by specific radioimmunoassay. Pancreatic juice samples were measured for volume, protein, and trypsin outputs. Compared to saline treated rats, outputs of volume, protein, and trypsin were significantly greater in cadmium treated rats. Plasma levels of gastrin were suppressed with secretin but significantly elevated with BBS. Plasma CCK levels were not different from basal after secretin or BBS in rats treated with either cadmium or saline. The results suggest that the administration of cadmium stimulated exocrine pancreatic secretion by a mechanism that does not involve gastrin or CCK. Bombesin may have a direct influence on the stimulation of exocrine pancreatic secretion in rats.     

Differential sensitivities of severe acute respiratory syndrome (SARS) coronavirus spike polypeptide enzyme-linked immunosorbent assay (ELISA) and SARS coronavirus nucleocapsid protein ELISA for serodiagnosis of SARS coronavirus pneumonia

The use of recombinant severe acute respiratory syndrome-coronavirus (SARS-CoV) nucleocapsid protein (N) enzyme-linked immunosorbent assay (ELISA)-based antibody and antigen tests for diagnosis of SARS-CoV infections have been widely reported. However, no recombinant SARS-CoV spike protein (S)-based ELISA is currently available. In this article, we describe the problems and solutions of setting up the recombinant SARS-CoV S-based ELISA for antibody detection. The SARS-CoV S-based immunoglobulin M (IgM) and IgG ELISAs were evaluated and compared with the corresponding N-based ELISA for serodiagnosis of SARS-CoV pneumonia, using sera from 148 healthy blood donors who donated blood 3 years ago as controls and 95 SARS-CoV pneumonia patients in Hong Kong. Results obtained by the recombinant S (rS)-based IgG ELISA using the regenerated S prepared by dialysis with decreasing concentrations of urea or direct addition of different coating buffers, followed by addition of different regeneration buffer, identified 4 M urea and 1 M sarcosine for plate coating and no regeneration buffer as the most optimal conditions for antibody detection. The specificities of the S-based ELISA for IgG and IgM detection were 98.6% and 93.9%, with corresponding sensitivities of 58.9% and 74.7%, respectively. The sensitivity of the rN IgG ELISA (94.7%) is significantly higher than that of the rS IgG ELISA (P < 0.001), whereas the sensitivity of the rS IgM ELISA is significantly higher than that of the rN IgM ELISA (55.2%) (P < 0.01). An ELISA for detection of IgM against S and N could be more sensitive than one that detects IgM against N alone for serodiagnosis of SARS-CoV pneumonia.     

Magnetic resonance imaging in multiple sclerosis. Sensitivity and correlation with the clinical picture

The aim of imaging the brain in Multiple Sclerosis (MS) is to prove the dissemination of lesions, so critical for the diagnosis and so difficult to ascertain clinically. Our study included 21 patients with clinically definite (12) and probable (9) MS. A 21 patients underwent a neurological standard examination, a double-dose delayed CT scan and a Magnetic Resonance Imaging with a superconducting 0.5 Tesla magnet. Jointed slices were performed with a T2-weighted Spin-Echo sequence (TE 60, 120; TR 2000 msec). MRI detected 640 lesions in 20 patients while CT scan detected only 24 lesions in 9 patients. Technical limiting factors are discussed. Abnormalities in MRI were high-intense spots, blotches and streaks, located predominantly in the periventricular area. Capping lesions were common around the ventricular horns. "Plaques" were visualized in the posterior fossa. For each patient, the total surface of the lesions was calculated and was found to be related with the presence of lesions and with the cortical atrophy on CT scan. A correlation between the surface of lesions calculated by MRI and the disability scale was found especially in the group of patients with clinically proven cerebral lesions, while patients with predominantly spinal forms had a significantly lower surface of lesions. This finding could yield a new quantitative evaluation of the MS pathologic process which could be used to assess therapeutic efficacy.     

Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease

In a prospective, randomized, controlled, double-blind trial we compared the effectiveness of endonasal irrigations with Ems salt solution to that with sodium chloride solution in the treatment of adult patients with chronic paranasal sinus disease. Subjects (n = 40) were randomly allocated to treatment either with isotonic Ems salt solution or with isotonic sodium chloride solution. The treatment consisted of endonasal irrigation twice daily and additional nasal spray as required. Nasal endoscopy, plain radiography of the paranasal sinuses, olfactometry, anterior rhinomanometry, and a saccharin-clearance test were carried out on days 1 and 7. Patients recorded rating scales of general discomfort, nasal airway obstruction, agreeableness of the irrigation, duration of improved nasal resistance after each irrigation, and the amount of additional nasal spray in a diary. Nasal air flow was not improved significantly. Subjective complaints, endonasal endoscopy, and radiography results revealed a significant improvement in both groups (P = 0.0001). In comparison, the two groups were not significantly different in outcome. Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis, and a significant difference between Ems salt and sodium chloride was not observed. Received: 18 January 2000 / Accepted: 20 July 2000     

The Israeli Sexual Behavior Inventory (ISBI): Scale Construction and Preliminary Validation

This study describes the construction and preliminary validation of the Israeli Sexual Behavior Inventory (ISBI). The ISBI was primarily designed to assess the impact of sexual problems, chronic illness and disability on sexual functioning and experience. Scales were designed to measure three areas of healthy sexual functioning and three areas of sexual dysfunction for both males and females. To provide normative data to which clinical samples can be compared, a large randomly selected sample from an adult male and female population was used for scale construction and preliminary validation. Scale reliabilities, intercorrelations between the ISBI scales, comparisons between the above sample and a clinical sample provide evidence of the ISBI's reliability and validity.     

The ratio between carcinoma antigen-125 levels in the seminal plasma and serum may be a marker for fertilization in intracytoplasmic sperm injection

Objective: To assess the relationship between tumor marker carcinoma antigen-125 levels in seminal plasma and serum and fertilization rates in an IVF program, using intracytoplasmic sperm injection (ICSI).

Design: A prospective study.

Setting: IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Patient(s): Twenty-five infertile patients with severe oligo-terato-asthenospermia syndrome and 25 fertile male donors.

Intervention(s): None.

Main Outcome Measure(s): Serum and seminal plasma carcinoma antigen-125 concentrations and fertilization rate per cycle.

Result(s): In the infertile group, the seminal plasma carcinoma antigen-125 levels ranged from 22.0 to 1,284.0 U/mL (mean level ± SD, 229.9 ± 274.2 U/mL). In the normospermic fertile male donors, the seminal plasma carcinoma antigen-125 concentrations ranged from 12.2 to 336.7 U/mL (mean level ± SD, 110.1 ± 91.6 U/mL). This difference was statistically significant. The mean ± SD ratio between the seminal plasma/serum carcinoma antigen−125 levels differed significantly between the infertile group (47.9 ± 61.3) and the fertile male donors (5.7 ± 3.5). In the infertile group, the ratio between the seminal plasma/serum carcinoma antigen-125 levels was found to be negatively correlated with the oocyte fertilization rate.

Conclusion(s): The ratio between carcinoma antigen−125 levels in the seminal plasma and serum may be an indirect marker for male infertility and fertilization rate in IVF treatment using ICSI.