Resa diagnostica di anamnesi, EEG intercritico ed home-made video negli episodi parossistici notturni: confronto con la VEPSG

Poiché la diagnosi differenziale degli episodi parossistici notturni è affidata alla VEPSG, tenendo conto dei limiti di tale metodica, il progetto attuale ha lo scopo di definire la resa diagnostica di strumenti alternativi alla VEPSG: anamnesi, home-made video ed EEG intercritico. Sono stati reclutati consecutivamente 13 pazienti, afferiti al nostro Dipartimento per episodi parossistici notturni. Ciascun paziente è stato sottoposto ad un protocollo diagnostico standardizzato. A 5 Medici Esperti in Epilessia e Medicina del Sonno è stato chiesto di formulare un orientamento diagnostico sulla base di anamnesi, EEG intercritico, home-made video e VEPSG. Attraverso l’elaborazione degli orientamenti diagnostici è stata calcolata la resa diagnostica delle procedure esaminate, a confronto con la VEPSG, attraverso il concetto di “accuratezza diagnostica”. Per 6 pazienti è stato possibile porre una diagnosi di Epilessia Frontale Notturna, per 2 di parasonnia, in 5 la diagnosi è rimasta dubbia. L’accuratezza diagnostica di ciascuna procedura è risultata moderata, con lievi differenze tra le diverse procedure (61.5% anamnesi; 66% home-made video; 69,2 % EEG intercritico). E’ essenziale migliorare ulteriormente l’accuratezza diagnostica di anamnesi, EEG intercritico ed home-made video, che possono risultare cruciali nei casi in cui la diagnosi non è certa o quando la VEPSG non è disponibile.

Early steps in ventral nerve cord development in chelicerates and myriapods and formation of brain compartments in spiders

The central point of this work is the investigation of neurogenesis in chelicerates and myriapods. By comparing decisive mechanisms in neurogenesis in the four arthropod groups (Chelicerata, Crustacea, Insecta, Myriapoda) I was able to show which of these mechanisms are conserved and which developmental modules have diverged. Thereby two processes of embryonic development of the central nervous system were brought into focus. On the one hand I studied early neurogenesis in the ventral nerve cord of the spiders Cupiennius salei and Achaearanea tepidariorum and the millipede Glomeris marginata and on the other hand the development of the brain in Cupiennius salei.rnWhile the nervous system of insects and crustaceans is formed by the progeny of single neural stem cells (neuroblasts), in chelicerates and myriapods whole groups of cells adopt the neural cell fate and give rise to the ventral nerve cord after their invagination. The detailed comparison of the positions and the number of the neural precursor groups within the neuromeres in chelicerates and myriapods showed that the pattern is almost identical which suggests that the neural precursors groups in these arthropod groups are homologous. This pattern is also very similar to the neuroblast pattern in insects. This raises the question if the mechanisms that confer regional identity to the neural precursors is conserved in arthropods although the mode of neural precursor formation is different. The analysis of the functions and expression patterns of genes which are known to be involved in this mechanism in Drosophila melanogaster showed that neural patterning is highly conserved in arthropods. But I also discovered differences in early neurogenesis which reflect modifications and adaptations in the development of the nervous systems in the different arthropod groups.rnThe embryonic development of the brain in chelicerates which was investigated for the first time in this work shows similarities but also some modifications to insects. In vertebrates and arthropods the adult brain is composed of distinct centres with different functions. Investigating how these centres, which are organised in smaller compartments, develop during embryogenesis was part of this work. By tracing the morphogenetic movements and analysing marker gene expressions I could show the formation of the visual brain centres from the single-layered precheliceral neuroectoderm. The optic ganglia, the mushroom bodies and the arcuate body (central body) are formed by large invaginations in the peripheral precheliceral neuroectoderm. This epithelium itself contains neural precursor groups which are assigned to the respective centres and thereby build the three-dimensional optical centres. The single neural precursor groups are distinguishable during this process leading to the assumption that they carry positional information which might subdivide the individual brain centres into smaller functional compartments.rn

Genetische Mechanismen der dorsoventralen Musterbildung im embryonalen Gehirn von Drosophila

In Vertebraten und Insekten ist während der frühen Entwicklung des zentralen Nervensystems (ZNS), welches sich aus dem Gehirn und dem ventralen Nervensystem (VNS) zusammensetzt, die Unterteilung des Neuroektoderms (NE) in diskrete Genexpressions-Domänen entscheidend für die korrekte Spezifizierung neuraler Stammzellen. In Drosophila wird die Identität dieser Stammzellen (Neuroblasten, NB) festgelegt durch die positionellen Informationen, welche von den Produkten früher Musterbildungsgene bereitgestellt werden und das Neuroektoderm in anteroposteriorer (AP) und dorsoventraler (DV) Achse unterteilen. Die molekulargenetischen Mechanismen, welche der DV-Regionalisierung zugrunde liegen, wurden ausführlich im embryonalen VNS untersucht, sind für das Gehirn jedoch weitestgehend unverstanden. rnIm Rahmen dieser Arbeit wurden neue Erkenntnisse bezüglich der genetischen Mechanismen gewonnen, welche die frühembryonale Anlage des Gehirns in DV-Achse unterteilen. So konnte gezeigt werden, dass das cephale Lückengen empty spiracles (ems), das Segmentpolaritätsgen engrailed (en), sowie der „Epidermal growth factor receptor“ (EGFR) und das Gen Nk6 homeobox (Nkx6) für Faktoren codieren, die als zentrale Regulatoren die DV Musterbildung in der Gehirnanlage kontrollieren. Diese Faktoren interagieren zusammen mit den ebenso evolutionär konservierten Homöobox-Genen ventral nervous system defective (vnd), intermediate neuroblasts defective (ind) und muscle segment homeobox (msh) in einem komplexen, regulatorischen DV-Netzwerk. Die im Trito (TC)- und Deutocerebrum (DC) entschlüsselten genetischen Interaktionen basieren überwiegend auf wechselseitiger Repression. Dementsprechend sorgen 1) Vnd und Ems durch gegenseitige Repression für eine frühe DV-Unterteilung des NE, und 2) wechselseitige Repression zwischen Nkx6 und Msh, als auch zwischen Ind und Msh für die Aufrechterhaltung der Grenze zwischen intermediärem und dorsalem NE. 3) Sowohl Ind als auch Msh sind in der Lage, die Expression von vnd zu inhibieren. Ferner konnte gezeigt werden, dass Vnd durch Repression von Msh als positiver Regulator von Nkx6 fungiert. Überdies beeinflusst Vnd die Expression von ind in segment-spezifischer Art und Weise: Vnd reprimiert ind-Expression im TC, sorgt jedoch für eine positive Regulation von ind im DC durch Repression von Msh. Auch der EGFR-Signalweg ist an der frühen DV-Regionalisierung des Gehirns beteiligt, indem er durch positive Regulation der msh-Repressoren Vnd, Ind und Nkx6 dazu beiträgt, dass die Expression von msh auf dorsales NE beschränkt bleibt. Ferner stellte sich heraus, dass das AP-Musterbildungsgen ems die Expression der DV-Gene kontrolliert und umgekehrt: Ems ist für die Aktivierung von Nkx6, ind und msh in TC und DC erforderlich ist, während Nkx6 und Ind zu einem späteren Zeitpunkt benötigt werden, um ems im intermediären DC gemeinsam zu reprimieren. Überdies konnte gezeigt werden, dass das Segmentpolaritätsgen en Aspekte der Expression von vnd, ind und msh in segment-spezifischer Art und Weise reguliert. En reprimiert ind und msh, hält jedoch vnd-Expression im DC aufrecht; im TC wird En benötigt, um die Expression von Msh herunter zu regulieren und somit die Aktivierung von ind dort zu ermöglichen.rnrnZusammengenommen zeigen diese Ergebnisse, dass AP Musterbildungsfaktoren in umfangreichen Maß die Expression der DV Gene im Gehirn (und VNS) kontrollieren. Ferner deuten diese Daten darauf hin, dass sich das „Konzept der ventralen Dominanz“, welches für die DV-Musterbildung im VNS postuliert wurde, nicht auf das genregulatorische Netzwerk im Gehirn übertragen lässt, da Interaktionen zwischen den beteiligten Faktoren hauptsächlich auf wechselseitiger (und nicht einseitiger) Repression basieren. Zudem scheint das Konzept der ventralen Dominanz auch für das VNS nicht uneingeschränkt zu gelten, da in dieser Arbeit u.a. gezeigt werden konnte, dass dorsal exprimiertes Msh in der Lage ist, intermediäres ind zu reprimieren. Interessanterweise ist gegenseitige Repression von Homöodomänen-Proteinen im sich entwickelnden Neuralrohr von Vertebraten weit verbreitet und darüberhinaus essenziell für den Aufbau diskreter DV-Vorläuferdomänen, und weist insofern eine große Ähnlichkeit zu den in dieser Arbeit beschriebenen DV-Musterbildungsvorgängen im frühembryonalen Fliegengehirn auf.rn

Atomistic simulations of liquid crystals in the bulk and at their interfaces

In this thesis, we have dealt with several problems concerning liquid crystals (LC) phases, either in the bulk or at their interfaces, by the use of atomistic molecular dynamics (MD) simulations. We first focused our attention on simulating and characterizing the bulk smectic phase of 4-n-octyl-4'-cyanobiphenyl (8CB), allowing us to investigate the antiparallel molecular arrangement typical of SmAd smectic phases. A second topic of study was the characterization of the 8CB interface with vacuum by simulating freely suspended thin films, which allowed us to determine the influence of the interface on the orientational and positional order. Then we investigated the LC-water and LC-electrolyte water solution interface. This interface has recently found application in the development of sensors for several compounds, including biological molecules, and here we tried to understand the re-orientation mechanism of LC molecules at the interface which is behind the functioning of these sensors. The characterization of this peculiar interface has incidentally led us to develop a polarizable force field for the pentyl-cyanobiphenyl mesogen, whose process of parametrization and validation is reported here in detail. We have shown that this force field is a significant improvement over its previous, static charge non polarizable version in terms of density, orientational order parameter and translational diffusion.

Lokalisation und Quantifizierung von 4-Hydroxynonenal in der Kochlea des Meerschweinchens nach Applikation von Gentamicin

Einleitung und Literaturdiskussion: Gentamicin ist ein aus Bakterien gewonnenes Aminoglykosid-Antibiotikum, das seit vielen Jahren im klinischen Alltag zur Therapie von bakteriellen Infektionen und zur Behandlung des Morbus Ménière eingesetzt wird. Ein bedeutender, jedoch noch nicht vollständig verstandener, Pathomechanismus ist dabei die Entstehung von 4-HNE durch Lipid Peroxidation und die konsekutive Schädigung durch das gebildete Aldehyd. Ziel dieser Arbeit war es, die Beeinflussung der Expression von 4-HNE in sieben verschiedenen Regionen der Kochlea (SV, SL, CO, NF, LF, IDZ und SGZ) durch Gentamicin zu beschreiben und quantitativ zu ermitteln.rnMaterial und Methoden: Die Meerschweinchen wurden in vier Gruppen unterteilt: eine unbehandelte Kontrollgruppe und je eine Gruppe 1, 2 und 7 Tage nach Gentamicin-Applikation. Nach Ablauf der Inkubationszeit wurden die Kochleae den Tieren entnommen, das Gewebe fixiert, geschnitten und auf Objektträgern aufgebracht. Die Schnitte wurden mit 4-HNE-Antikörpern behandelt und die Immunreaktion mikroskopisch lokalisiert und zelluläre quantitative Unterschiede am Computer berechnet.rnErgebnisse: Die Auswertung der Daten ergab signifikante Anstiege der Immunreaktion auf 4-HNE von der Kontrollgruppe zu allen drei Behandlungsgruppen in vier der sieben untersuchten Regionen (Stria vascularis, Spirales Ligament, Cortisches Organ und Nervenfasern). In zwei Bereichen (Fibrozyten im Limbus und Interdentalzellen) kam es zwischen Kontrollgruppe und nur einer Behandlungsgruppe D (7d) zu einer signifikanten Erhöhung. Lediglich die Spiralganglionzellen erbrachten keine signifikanten Differenzen. Der Vergleich der Einzelwindungen erbrachte für die Stria vascularis, das Spirale Ligament, das Cortische Organ und die Nervenfasern signifikante Anstiege innerhalb der drei Windungen von der Kontrollgruppe zu den drei Behandlungsgruppen. Bei der Stria vascularis zeigte sich als einzige Region eine signifikant erhöhte Immunfärbung in allen drei Einzelwindungen von der Kontrollgruppe zu allen Behandlungsgruppen. Beim Vergleich der Gesamtwindungen ließ sich ausschließlich für die Region der Stria vascularis von der ersten zur dritten Windung ein Anstieg der Braunfärbung feststellen. Zudem konnten Korrelationen der Färbeintensitäten einerseits zwischen den beiden Regionen der Lateralen Wand und andererseits zwischen zwei Zelltypen im Limbus aufgezeigt werden.rnDiskussion: Die durch Gentamicin-gesteigerte 4-HNE-Expression kann durch genomische und nicht-genomische Prozesse hervorgerufen werden.

Investigations into the effect of nucleoside modifications on the physicochemical properties and biological function of DNA and RNA

This thesis explores the effect of chemical nucleoside modification on the physicochemical and biological properties of nucleic acids. Positional alteration on the Watson-Crick edge of purines and pyrimidines, the “C-H” edge of pyrimidines, as well as both the Hoogsteen and sugar edges of purines were attempted by means of copper catalyzed azide-alkyne cycloaddition. For this purpose, nucleic acid building blocks carrying terminal alkynes were synthesized and introduced into oligonucleotides by solid-phase oligonucleotide chemistry. rnOf particular interest was the effect of nucleoside modification on hydrogen bond formation with complementary nucleosides. The attachment of propargyl functionalities onto the N2 of guanosine and the N4 of 5-methylcytosine, respectively, followed by incorporation of the modified analogs into oligonucleotides, was successfully achieved. Temperature dependent UV-absorption melting measurements with duplexes formed between modified oligonucleotides and a variety of complementary strands resulted in melting temperatures for the respective duplexes. As a result, the effect that both the nature and the site of nucleoside modification have on base pairing properties could thus be assisted. rnTo further explore the enzymatic recognition of chemically modified nucleosides, the oligonucleotide containing the N2-modified guanosine derivative on the 5’-end, which was clicked to a fluorescent dye, was subjected to knockdown analyses of the eGFP reporter gene in the presence of increasing concentrations of siRNA duplexes. From these dose-dependent experiments, a clear effect of 5’-labeling on the knockdown efficiency could be seen. In contrast, 3’-labeling was found to be relatively insignificant.rn

Topological mass of magnetic Skyrmions probed by ultrafast dynamic imaging

In dieser Arbeit untersuchen wir mittels zeitaufgelöster Abbildungen die Gigahertz-Dynamik von magnetischen Skyrmionen, um die Bewegungsgleichungen für diese Quasiteilchen zu bestimmen. Um dieses Ziel zu erreichen haben wir zunächst ein CoB/Pt Schichtsystem entwickelt, das starke senkrechte magnetische Anisotropie mit einer besonders geringen Rauigkeit der Energielandschaft verbindet. Diese Eigenschaften sind für das repetitive dynamische Abbildungsverfahren unerlässlich. In einem zweiten Schritt haben wir das Probendesign optimiert und so weiterentwickelt, dass eine Beobachtung der Skyrmionenbewegung mit einer Auflösung von besser als 3 nm möglich wurde. Aufgrund dieser Verbesserungen ist es uns gelungen, die Trajektorie eines Skyrmionen aufzuzeichnen. Diese Bewegung ist eine Superposition von zwei Drehbewegungen, einer im Uhrzeigersinn und einer gegen läufigen. Aus der Existenz dieser zwei Moden lässt sich schließen, dass Skyrmionen träge Quasiteilchen sind, und aus den Frequenzen können wir einen Wert für die träge Masse ableiten. Es stellt sich heraus, dass die Masse von Skyrmion fünfmal größer ist als von existierenden Theorien vorhergesagt. Die Masse wird folglich durch einen neuartigen Mechanismus bestimmt, der sich aus der räumlichen Beschränkung der Skyrmionen ergibt, welche sich direkt aus der Topologie bleitenrnlässt.

Molekulare Analyse des Kolumnar-Gens beim Apfel (Malus x domestica)

Das Kolumnarwachstum beim Apfel (Malus x domestica) geht auf eine in den frühen 1960er Jahren entdeckte Zufallsmutation zurück. Die daraus resultierende Sprossmutante ist von großem wirtschaftlichem Interesse, da diese sehr kompakte Wuchsform unter anderem zu einer enormen Ertragssteigerung durch eine hohe Pflanzdichte der Bäume führt. Das Ziel der Arbeit ist die Entschlüsselung der molekularen Ursache dieser Mutation, die bisher weitgehend ungeklärt ist. Die Analyse wurde durch die Erstellung einer Referenzsequenz der Co-Zielregion einer kolumnaren Apfelsorte sowie durch die Konstruktion eng gekoppelter molekularer Marker realisiert. Durch die Konstruktion von genomischen Apfel-BAC-Bibliotheken mit mehrfacher Genomabdeckung und die Erstellung geeigneter Sonden wurde die Co-Region kloniert und deren Sequenz bestimmt. In Kombination zu dieser klassischen positionellen Klonierungsstrategie wurden genomische Illumina „mate pair“-Bibliotheken erstellt, sequenziert und bioinformatisch analysiert, um die genomische Region vollständig zu annotieren. Somit wurde eine vollständige genomische Referenz der Co-Region einer kolumnaren Apfelsorte erstellt, die die Grundlage für weitere Analysen bildet. Auf Basis dieser Referenz konnte die Co-Mutation in Form der Integration des LTR-Retrotransposons Gypsy-44 im kolumnaren Chromosom an Position 18,79 Mbp auf Chromosom 10 lokalisiert werden. Darüber hinaus konnten Transposon-basierende molekulare Marker erstellt werden, die eine verlässliche Genotypisierung von Apfelbäumen in Bezug auf das Kolumnarwachstum ermöglichen und dies unabhängig von der verwendeten Apfelsorte. Der genaue Wirkmechanismus von Gypsy-44, der zur Ausprägung dieses extremen Phänotyps führt, ist bislang unklar. Zusammenfassend lässt sich sagen, dass die molekulare Ursache für das kolumnare Wachstum aufgeklärt werden konnte und zudem die ersten molekularen Marker erstellt wurden, die eine sortenunabhängige Differenzierung zwischen kolumnaren und nicht kolumnaren Apfelbäumen ermöglichen.

'Alternate-goal bias' in antisaccades and the influence of expectation

Saccadic performance depends on the requirements of the current trial, but also may be influenced by other trials in the same experiment. This effect of trial context has been investigated most for saccadic error rate and reaction time but seldom for the positional accuracy of saccadic landing points. We investigated whether the direction of saccades towards one goal is affected by the location of a second goal used in other trials in the same experimental block. In our first experiment, landing points ('endpoints') of antisaccades but not prosaccades were shifted towards the location of the alternate goal. This spatial bias decreased with increasing angular separation between the current and alternative goals. In a second experiment, we explored whether expectancy about the goal location was responsible for the biasing of the saccadic endpoint. For this, we used a condition where the saccadic goal randomly changed from one trial to the next between locations on, above or below the horizontal meridian. We modulated the prior probability of the alternate-goal location by showing cues prior to stimulus onset. The results showed that expectation about the possible positions of the saccadic goal is sufficient to bias saccadic endpoints and can account for at least part of this phenomenon of 'alternate-goal bias'.

Basilar artery occlusion

The clinical presentation of basilar artery occlusion (BAO) ranges from mild transient symptoms to devastating strokes with high fatality and morbidity. Often, non-specific prodromal symptoms such as vertigo or headaches are indicative of BAO, and are followed by the hallmarks of BAO, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and dysphagia. When clinical findings suggest an acute brainstem disorder, BAO has to be confirmed or ruled out as a matter of urgency. If BAO is recognised early and confirmed with multimodal CT or MRI, intravenous thrombolysis or endovascular treatment can be undertaken. The goal of thrombolysis is to restore blood flow in the occluded artery and salvage brain tissue; however, the best treatment approach to improve clinical outcome still needs to be ascertained.

In Vitro Evaluation of Ventricular Cannulation for Rotodynamic Cardiac Assist Devices

The influence of positioning and geometry of ventricular cannulas for contemporary continuous flow Left Ventricular Assist Devices (LVADs) was evaluated in a non-beating isolated heart preparation with borescopic visualization. Preload and LVAD flow were varied to evaluate degrees of ventricular decompression up to the point of ventricular collapse. The performance of a flanged cannula was compared to a conventional bevel-tipped cannula: quantitatively by the maximal flow attainable, and qualitatively by visualization of fluid tracer particles within the ventricular chamber. Three forms of ventricular suck-down occurred: concentric collapse, gradual entrainment and instantaneous entrainment. In some circumstances, unstable oscillations of the ventricle were observed prior to complete collapse. Under conditions of low preload, the flanged cannula demonstrated less positional sensitivity, provided greater flow, and exhibited fewer areas of stagnation than the beveled cannula. These observations warrant further consideration of a flanged ventricular cannula to mitigate complications encountered with conventional cannulae.

Can imagined whole-body rotations improve vestibular compensation?

Unilateral damage to the labyrinth and the vestibular nerve cause rotational vertigo, postural imbalance, oculomotor disorders and spatial disorientation. Electrophysiological investigations in animals revealed that such deficits are partly due to imbalanced spontaneous activity and sensitivity to motion in neurons located in the ipsilesional and contralesional vestibular nuclei. Neurophysiological reorganizations taking place in the vestibular nuclei are the basis of the decline of the symptoms over time, a phenomenon known as vestibular compensation. Vestibular compensation is facilitated by motor activity and sensory experience, and current rehabilitation programs favor physical activity during the acute stage of a unilateral vestibular loss. Unfortunately, vestibular-defective patients tend to develop strategies in order to avoid movements causing imbalance and nausea (in particular body movements towards the lesioned side), which impedes vestibular compensation. Neuroanatomical evidence suggests a cortical control of postural and oculomotor reflexes based on corticofugal projections to the vestibular nuclei and, therefore, the possibility to manipulate vestibular functions through top-down mechanisms. Based on evidence from neuroimaging studies showing that imagined whole-body movements can activate part of the vestibular cortex, we propose that mental imagery of whole-body rotations to the lesioned and to the healthy side will help rebalancing the activity in the ipsilesional and contralesional vestibular nuclei. Whether imagined whole-body rotations can improve vestibular compensation could be tested in a randomized controlled study in such patients beneficiating, or not, from a mental imagery training. If validated, this hypothesis will help developing a method contributing to reduce postural instability and falls in vestibular-defective patients. Imagined whole-body rotations thus could provide a simple, safe, home-based and self-administered therapeutic method with the potential to overcome the inconvenience related to physical movements.

Gender differences of atrial and ventricular remodeling and autonomic tone in nonelite athletes

Veteran endurance athletes have an increased risk of developing atrial fibrillation (AF), with a striking male predominance. We hypothesized that male athletes were more prone to atrial and ventricular remodeling and investigated the signal-averaged P wave and factors that promote the occurrence of AF. Nonelite athletes scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race, were invited. Of the 873 marathon and nonmarathon runners who were willing to participate, 68 female and 70 male athletes were randomly selected. The runners with cardiovascular disease or elevated blood pressure (>140/90 mm Hg) were excluded. Thus, 121 athletes were entered into the final analysis. Their mean age was 42 ± 7 years. No gender differences were found for age, lifetime training hours, or race time. The male athletes had a significantly longer signal-averaged P-wave duration (136 ± 12 vs 122 ± 10 ms; p <0.001). The left atrial volume was larger in the male athletes (56 ± 13 vs 49 ± 10 ml; p = 0.001), while left atrial volume index showed no differences (29 ± 7 vs 30 ± 6 ml/m²; p = 0.332). In male athletes, the left ventricular mass index (107 ± 17 vs 86 ± 16 g/m²; p <0.001) and relative wall thickness (0.44 ± 0.06 vs 0.41 ± 0.07; p = 0.004) were greater. No differences were found in the left ventricular ejection fraction (63 ± 4% vs 66 ± 6%; p = 0.112) and mitral annular tissue Doppler e' velocity (10.9 ± 1.5 vs 10.6 ± 1.5 cm/s; p = 0.187). However, the tissue Doppler a' velocity was higher (8.7 ± 1.2 vs 7.6 ± 1.3 cm/s; p < 0.001) in the male athletes. Male athletes had a higher systolic blood pressure at rest (123 ± 9 vs 110 ± 11 mm Hg; p < 0.001) and at peak exercise (180 ± 15 vs 169 ± 19 mm Hg; p = 0.001). In the frequency domain analysis of heart rate variability, the sympatho-vagal balance, represented by the low/high-frequency power ratio, was significantly greater in male athletes (5.8 ± 2.8 vs 3.9 ± 1.9; p < 0.001). Four athletes (3.3%) had at least one documented episode of paroxysmal AF, all were men (p = 0.042). In conclusion, for a comparable amount of training and performance, male athletes showed a more pronounced atrial remodeling, a concentric type of ventricular remodeling, and an altered diastolic function. A higher blood pressure at rest and during exercise and a higher sympathetic tone might be causal. The altered left atrial substrate might facilitate the occurrence of AF.

Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes

Endurance athletes have an increased risk of developing atrial fibrillation (AF) at 40 to 50 years of age. Signal-averaged P-wave analysis has been used for identifying patients at risk for AF. We evaluated the impact of lifetime training hours on signal-averaged P-wave duration and modifying factors. Nonelite men athletes scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race, were invited. Four hundred ninety-two marathon and nonmarathon runners applied for participation, 70 were randomly selected, and 60 entered the final analysis. Subjects were stratified according to their lifetime training hours (average endurance and strength training hours per week × 52 × training years) in low (<1,500 hours), medium (1,500 to 4,500 hours), and high (>4,500 hours) training groups. Mean age was 42 ± 7 years. From low to high training groups signal-averaged P-wave duration increased from 131 ± 6 to 142 ± 13 ms (p = 0.026), and left atrial volume increased from 24.8 ± 4.6 to 33.1 ± 6.2 ml/m(2) (p = 0.001). Parasympathetic tone expressed as root of the mean squared differences of successive normal-to-normal intervals increased from 34 ± 13 to 47 ± 16 ms (p = 0.002), and premature atrial contractions increased from 6.1 ± 7.4 to 10.8 ± 7.7 per 24 hours (p = 0.026). Left ventricular mass increased from 100.7 ± 9.0 to 117.1 ± 18.2 g/m(2) (p = 0.002). Left ventricular systolic and diastolic function and blood pressure at rest were normal in all athletes and showed no differences among training groups. Four athletes (6.7%) had a history of paroxysmal AF, as did 1 athlete in the medium training group and 3 athletes in the high training group (p = 0.252). In conclusion, in nonelite men athletes lifetime training hours are associated with prolongation of signal-averaged P-wave duration and an increase in left atrial volume. The altered left atrial substrate may facilitate occurrence of AF. Increased vagal tone and atrial ectopy may serve as modifying and triggering factors.

Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review

Objective: To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Data sources: Eligible studies were systematically searched on 16 databases from inception to December 2010. Review methods: The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. Results: A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Conclusion: Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.