Increased prevalence of obstructive sleep apnoea in patients with Charcot-Marie-Tooth disease: a case control study

Obstructive sleep apnoea (OSA) has previously been described in a large family suffering from Charcot-Marie-Tooth disease type 1 (CMT1). In the present study, we used a case control design to establish whether this suggested link between OSA and CMT1 may also be found when studying genetically non-related patients. 12 patients with CMT1 and 24 control patients matched for age, sex and body mass index (BMI) were included in the study. Neurological disability was graded with a previously established 6 point score. All patients underwent overnight polysomnography. The mean apnoea-hypopnoea index (AHI) of patients with CMT1 was 10.5 (16.3) which was significantly higher than that of the control group (1.5 (1.3)). Five out of 12 patients with CMT1 had an AHI > or =10/h compared with 1 of 24 control patients (p<0.01). In patients with CMT1, a significant correlation between AHI and neurological disability was found (Spearman r = 0.62; p = 0.031) while BMI and age were not related to AHI. CMT1, in particular CMT1A, predisposes with disease progression to the development of OSA. Pathophysiologically, one may assume that CMT1 related pharyngeal neuropathy increases the collapsibility of the upper airway which in turn leads to recurring obstructive respiratory events.     

Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine

BACKGROUND: Ropivacaine is primarily a local anesthetic, but it also acts as a vasoactive agent. Case reports have described a critical reduction in blood flow when higher concentrations of ropivacaine were used for peripheral-nerve blocks. One hypothesis is that local application of ropivacaine in tissues supplied by end arteries reduces tissue blood flow because of arterial vasoconstriction. METHODS: Rats were anesthetized by inhalation of isoflurane. The tail vessels were carefully dissected from the ventral side near the radix. Randomly, normal saline, prilocaine 0.5%, prilocaine 0.5% with epinephrine 1:200,000, ropivacaine 0.2%, ropivacaine 0.5%, or ropivacaine 0.75% was applied directly to the artery. Blood flow in the tail was continuously measured by use of laser Doppler flowmetry distal to the surgical site. Changes in temperature in the tail were detected by use of infrared thermography. RESULTS: Blood flow decreased after the application of ropivacaine at all concentrations in comparison with normal saline (P < .01 at t = 10 minutes, P < .001 at t = 20, 30, and 40 minutes). This effect was most pronounced at t = 30 minutes for ropivacaine 0.5% (with a 64.5% decrease in blood flow). Prilocaine 0.5% with epinephrine 1:200,000 reduced blood flow by up to 44.7% (t = 20 minutes, P < .001). In comparison with the placebo, the application of ropivacaine 0.5% and 0.75%, as well as prilocaine 0.5% with epinephrine 1:200,000, caused a significant reduction in tail temperature (P < .001 at t = 20, 30, and 40 minutes). No alteration in blood flow or temperature was seen after application of prilocaine 0.5%. CONCLUSIONS: The application of ropivacaine directly to a rat's tail artery diminished blood flow and lowered regional skin temperature. These effects were dose related. The use of ropivacaine at higher concentrations can, therefore, not be recommended if tissues supplied by end arteries might be affected.     

The boston qualitative scoring system for the rey-osterrieth complex figure: A study of children with attention deficit hyperactivity disorder

Abstract

The Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure (ROCF) was utilized to examine the qualitative features of ROCF performance of children with Attention Deficit Hyperactivity Disorder (ADHD). Thirty-nine children with ADHD were compared to age-matched controls (n = 39) on their reproduction of the ROCF. ADHD children performed more poorly than did control children on measures of attention to detail, expansion, accuracy, and neatness. Sensitivity and specificity of individual BQSS measures for discriminating ADHD from control subjects were determined, and a logistic regression model was derived, yielding an overall sensitivity of 64% and specificity of 97% for the classification of ADHD. Eighty-one percent of all children were correctly classified. Cross-validation of this model on an independent sample of ADHD and control subjects revealed good predictive accuracy. These findings suggest that the BQSS may be a useful measure in the neuropsychological evaluation of children with suspected ADHD.     

Preliminary data on oxytocin modulation of neural reactivity in women to emotional stimuli of children depending on childhood emotional neglect

Sensitivity for rewarding cues and distress signals from children is fundamental to human caregiving and modulated by the neuropeptide oxytocin. In a functional magnetic resonance imaging study, we investigated whether oxytocin regulates neural responses to reward or distress cues form children. In a placebo-controlled, within-subject design, we measured neural responses to positive, negative, and neutral cues from children in 22 healthy female subjects who received oxytocin (24 IU) versus placebo. Further, based on current literature, we hypothesized that oxytocin effects are modulated by experiences of childhood trauma. The task elicited valence-specific effects—positive images activated the ventromedial prefrontal cortex, left anterior cingulate cortex, and right putamen, and images of children in distress activated the bilateral amygdala, hippocampus, and right medial superior frontal cortex. The effects of oxytocin depended on subjective reports of childhood emotional neglect. Self-reported neglect interacted with oxytocin administration in the amygdala, hippocampus, and prefrontal areas. In individuals with higher scores of emotional neglect, oxytocin increased neural reactivity of limbic structures to positive and neutral images. Our findings need replication in larger samples and can therefore be considered preliminary but are in line with the recent literature on the modulating effect of childhood adversity on the sensitivity to oxytocin administration.     

Psycho-neurogene Faktoren bei der Genese lebensbedrohlicher Arrhythmien

Tachyarrhythmien treten h?ufig w?hrend erh?hter psychischer Erregung auf. Bei Patienten, bei denen ein Kardioverter Defibrillator (ICD) implantiert wurde, lassen sich arrhythmische Episoden und deren Onset-Zeitpunkt exakt aufzeichnen und erlauben so einerseits die Differenzierung der aufgetretenen Rhythmusst?rung und andererseits eine detailliertere Analyse der situativen Umst?nde und m?glicher an der Ausl?sung beteiligter psychischer Komponenten. In der vorliegenden einzelfallbezogenen Studie wurden bei 3 m?nnlichen Patienten im Alter zwischen 60 und 68 Jahren, bei denen der ICD erfolgreich eine ventrikul?re Tachykardie terminiert hatte, die ICD-Protokolle und die damit korrespondierenden Patientenaussagen analysiert. Die Analyse der akuten Onset-Bedingungen konnte ausgepr?gte Zusammenh?nge zwischen lebensbedrohlichen Herzrhythmusst?rungen in natürlicher Umgebung und emotionalen Stressoren aufdecken. Als Stressoren wurden unterschieden eine vulnerable Situation, die eine psychogene Triggerung maligner Arrhythmien bewirkte (Fall 1); eine Panikepisoden-?hnliche Erwartungsspannung (Fall 2) sowie eine aversive ?rgerreaktion, die auf dem Boden eines andauernden Zustandes von Hilf- und Ausweglosigkeit (Fall 3) einen besonders potenten sympathiko-exzitatorischen Stimulus darstellt. Dieses Ergebnis deckt sich mit einer Reihe von laborexperimentellen und epidemiologischen Studien, die einen Zusammenhang zwischen psychischer Erregung und der Entstehung von Tachyarrhythmien belegen. Die Berücksichtigung emotional-kognitiver Faktoren bei der Arrhythmogenese k?nnte ein Beitrag bei der Therapie zur Pr?vention des pl?tzlichen Herztodes werden.     

Postprandial Lipid Metabolism in Normolipidemic Subjects and Patients with Mild to Moderate Hypertriglyceridemia: Effects of Test Meals Containing Saturated Fatty Acids,Mono-Unsaturated Fatty Acids,or Medium-Chain Fatty Acids

Fasting and postprandial hypertriglyceridemia are causal risk factors for atherosclerosis. The prevalence of hypertriglyceridemia is approximately 25–30% and most hypertriglyceridemic patients suffer from mild to moderate hypertriglyceridemia. Data regarding dietary interventions on postprandial triglyceride metabolism of mildly to moderately hypertriglyceridemic patients is, however, sparse. In a randomized controlled trial, eight mildly hypertriglyceridemic patients and five healthy, normolipidemic controls received three separate standardized fat-meals containing either saturated fatty acids (SFA), mono-unsaturated fatty acids (MUFA), or medium-chain fatty acids (MCFA) in a randomized order. Fasting and postprandial lipid parameters were determined over a 10 h period and the (incremental) area under the curve (AUC/iAUC) for plasma triglycerides and other parameters were determined. MCFA do not lead to a significant elevation of postprandial total plasma triglycerides and other triglyceride parameters, while both SFA (patients: p = 0.003, controls: p = 0.03 compared to MCFA) and MUFA (patients: p = 0.001; controls: p = 0.14 compared to MCFA) do lead to such an increase. Patients experienced a significantly more pronounced increase of plasma triglycerides than controls (SFA: patients iAUC = 1006 mg*h/dL, controls iAUC = 247 mg*h/dL, p = 0.02; MUFA: patients iAUC = 962 mg*h/dL, controls iAUC = 248 mg*h/dL, p = 0.05). Replacing SFA with MCFA may be a treatment option for mildly to moderately hypertriglyceridemic patients as it prevents postprandial hypertriglyceridemia.