Laparoscopic Findings of Asymptomatic Primary Biliary Cirrhosis —Particular investigation in early PBC—

Abstract: of 17 cases of asymptomatic primary biliary cirrhosis (PBC), seven cases whose ALP (alkaline phosphatase) was less than twice the upper limit of the normal range were defined as being “early PBC”, and ten cases whose ALP was more than twice the upper limit of the normal range were defined as being “classical PBC” in order to investigate their clinical pictures and laparoscopic findings. There were no significant differences between early PBC and classical PBC in terms of sex differences, age, a positive rate of antimitochondrial antibody and histological findings. On the other hand, apart from IgM being as high as 86%, laboratory studies indicated that early PBC cases showed relatively low abnormal levels of GOT (29%), ALP (43%), γ-GTP (57%), and erythrocyte sedimentation rate (ESR) (57%). Classical PBC cases exhibited almost 100% abnormal values. Laparoscopic examination of all the classical PBC cases revealed such specific characteristics of PBC as reddish patches, protuberance formations and mesh-like white markings. Early cases revealed one of the following nonspecific findings: proliferation of the portal veins, irregularity of the liver surface, dullness of the liver edge and enlargement of the liver. However, in terms of the specific findings, none of the patients had reddish patches, and half of the patients demonstrated protuberance formations and mesh-like white markings in part of the liver.     

Melatonin treatment for circadian rhythm sleep disorders

Abstract We administered 1–3 mg melatonin to 11 patients (eight men, three women, aged 16–46 years) with circadian rhythm sleep disorders; nine with delayed sleep phase syndrome and two with non-24-hour sleep-wake syndrome. Sleep logs were recorded throughout the study periods and actigraph and rectal temperature were monitored during treatment periods. Melatonin was administered 1–2 h before the desirable bedtime for expected phase-shifting, or 0.5-1 h before habitual bedtime for gradual advance expecting an hypnotic effect of the melatonin. Melatonin treatments were successful in 6/11 patients. Timing and dose of melatonin administration, together with its pharmacological properties for circadian rhythm sleep disorders, should be further studied.     

Gender differences in self-evaluated sleep quality and activity of middle-aged and aged subjects

Abstract In order to investigate the gender difference of sleep and activity in middle-aged and aged individuals, home-based sleep was self-evaluated for sleep quality and activity for 5 nights in 20 healthy adults (50–76 years old; 11 women, nine men). There was no significant gender difference for subjective sleep quality. However, the activity level and movement index at night were significantly higher in men than in women, and the activity level during the day was significantly lower in men than in women. The objective sleep quality of men was significantly worse than that of women, however, subjective sleep quality does not differ.     

Continuous measurement of temperature in non-24 hour sleep-wake syndrome

Abstract The onset of the low temperature (LT) zone which was defined as a period when the rectal temperature was below its daily mean is a convenient circadian phase marker. In this study, we document three cases of non-24 h sleep-wake syndrome in which identification of the LT zone as an evening circadian phase marker contributed to clinical judgments. We found that the LT zone was correlated well with dim light melatonin onset. Moreover, calculating the LT zone was useful in determining phase position in irregular sleep pattern and in determining the timing of bright light therapy.     

Human time production under constant routine

Abstract Previous reports have suggested that human time production of several seconds fluctuates across the day. In order to test whether human time production was controlled by the circadian process or by the homeostatic process, we investigate diurnal fluctuation of human time production under constant routine conditions. We found a common circadian feature in time production tests of 10 s by calculating Z-score for each subject; afternoon troughs and morning peaks. These results may suggest that human time production was modulated by the circadian process.     

A multicenter study of sleep-wake rhythm disorders: Therapeutic effects of vitamin B12, bright light therapy, chronotherapy and hypnotics

One hundred and six subjects with primary sleep-wake rhythm disorders [13 non-24 hour sleep-wake syndrome (non-24), 76 delayed sleep phase syndrome (DSPS), 11 irregular sleep-wake pattern (irregular) and six long sleepers] were treated with vitamin B₁₂, bright light, chronotherapy and/or hypnotics. These therapies caused moderate or remarkable improvement in 32% of the non-24, 42% of DSPS, 45% of irregular and 67% of long sleepers. A lack of adequate sleep, unpleasant feelings at waking and daytime drowsiness were also improved in DSPS.     

Twenty-four hour profiles of four hormones under constant routine

Abstract We studied the circadian features of melatonin, cortisol, thyroid stimulating hormone (TSH), and growth hormone (GH) together with rectal temperature during 36 h continuous forced wakefulness without physical exercise under dim light condition (constant routine). Subjects consisted of four healthy men aged 22–24 years. Blood sampling was conducted hourly, and food and water were supplied bi-hourly during the constant routine. Melatonin, TSH and cortisol displayed clear circadian rhythms under constant routine condition. While GH secretion was unlikely to be driven solely by the circadian pacemaker, its suppression round BT nadir may indicate that GH secretion was modulated to some extent by circadian rhythm.     

A multicenter study of sleep-wake rhythm disorders: Clinical features of sleep-wake rhythm disorders

A multicenter study of sleep-wake rhythm disorders (i.e. non-24 hour sleep-wake syndrome; non-24), delayed sleep phase syndrome (DSPS), irregular sleep-wake pattern (irregular sleepers), and long sleepers, was conducted with the co-operation of 25 institutions. One hundred and twenty-one primary sleep-wake rhythm disorders were diagnosed and were classified as 13 non-24, 90 DSPS, 12 irregular and six long sleepers. The mean onset age was about 20 years old and psycho-social factors associating the onset of the disorder were identified in 36% of these patients. The major factors of sleep-wake disorders were personal relationships, advancing to a higher level education, gaining employment, and changes in environment. Most patients were ‘night active’ prior to appearance of their symptoms. Increase in night activities of modern society seem to result in the occurrence of such sleep-wake rhythm disorders.