Patent Foramen Ovale Closure in Obstructive Sleep Apnea Improves Blood Pressure and Cardiovascular Function.

UNLABELLED Obstructive sleep apnea (OSA) is a frequent syndrome characterized by intermittent hypoxemia and increased prevalence of arterial hypertension and cardiovascular morbidity. In OSA, the presence of patent foramen ovale (PFO) is associated with increased number of apneas and more severe oxygen desaturation. We hypothesized that PFO closure improves sleep-disordered breathing and, in turn, has favorable effects on vascular function and arterial blood pressure. In 40 consecutive patients with newly diagnosed OSA, we searched for PFO. After initial cardiovascular assessment, the 14 patients with PFO underwent initial device closure and the 26 without PFO served as control group. Conventional treatment for OSA was postponed for 3 months in both groups, and polysomnographic and cardiovascular examinations were repeated at the end of the follow-up period. PFO closure significantly improved the apnea-hypopnea index (ΔAHI -7.9±10.4 versus +4.7±13.1 events/h, P=0.0009, PFO closure versus control), the oxygen desaturation index (ΔODI -7.6±16.6 versus +7.6±17.0 events/h, P=0.01), and the number of patients with severe OSA decreased significantly after PFO closure (79% versus 21%, P=0.007). The following cardiovascular parameters improved significantly in the PFO closure group, although remained unchanged in controls: brachial artery flow-mediated vasodilation, carotid artery stiffness, nocturnal systolic and diastolic blood pressure (-7 mm Hg, P=0.009 and -3 mm Hg, P=0.04, respectively), blood pressure dipping, and left ventricular diastolic function. In conclusion, PFO closure in OSA patients improves sleep-disordered breathing and nocturnal oxygenation. This translates into an improvement of endothelial function and vascular stiffening, a decrease of nighttime blood pressure, restoration of the dipping pattern, and improvement of left ventricular diastolic function. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01780207.

Sleep disordered breathing and vascular function in patients with chronic mountain sickness and healthy high-altitude dwellers.

Background Chronic mountain sickness (CMS) is often associated with vascular dysfunction, but the underlying mechanism is unknown. Sleep disordered breathing (SDB) frequently occurs at high altitude. At low altitude SDB causes vascular dysfunction. Moreover, in SDB, transient elevations of right-sided cardiac pressure may cause right-to-left shunting in the presence of a patent foramen ovale (PFO) and, in turn, further aggravate hypoxemia and pulmonary hypertension. We speculated that compared to healthy high-altitude dwellers, in patients with CMS, SDB and nocturnal hypoxemia are more pronounced and related to vascular dysfunction. Methods We performed overnight sleep recordings, and measured systemic and pulmonary-artery pressure in 23 patients with CMS (mean±SD age 52.8±9.8 y) and 12 healthy controls (47.8±7.8 y) at 3600 m. In a subgroup of 15 subjects with SDB, we searched for PFO with transesophagal echocardiography. Results The major new findings were that in CMS patients, a) SDB and nocturnal hypoxemia was more severe (P<0.01) than in controls (apnea/hypopnea index, AHI, 38.9±25.5 vs. 14.3±7.8[nb/h]; SaO2, 80.2±3.6 vs. 86.8±1.7[%], CMS vs. controls), and b) AHI was directly correlated with systemic blood pressure (r=0.5216, P=0.001) and pulmonary-artery pressure (r=0.4497, P=0.024). PFO was associated with more severe SDB (AHI 48.8±24.7 vs. 14.8±7.3[nb/h], P=0.013, PFO vs. no PFO) and hypoxemia. Conclusion SDB and nocturnal hypoxemia are more severe in CMS patients than in controls and are associated with systemic and pulmonary vascular dysfunction. The presence of a PFO appeared to further aggravate SDB. Closure of PFO may improve SDB, hypoxemia and vascular dysfunction in CMS patients. Clinical Trials Gov Registration NCT01182792.

Home parenteral nutrition is beneficial in systemic sclerosis patients with gastrointestinal dysfunction

OBJECTIVES To assess 12-month changes in nutritional status and quality of life (QoL) in systemic sclerosis (SSc) patients requiring home parenteral nutrition (HPN). METHOD We conducted a retrospective, single-centre database analysis of SSc patients regarding a 12-month period of HPN at an interdisciplinary University Unit/team for nutrition and rheumatic diseases. Nutritional status was analysed by nutritional risk screening (NRS) and body mass index (BMI). QoL was evaluated using Short-Form Health Survey (SF-36) questionnaires. RESULTS Between 2008 and 2013, daily nocturnal HPN was initiated in five consecutive SSc patients (four females and one male, mean age 62.2 years) suffering severe malnutrition due to gastrointestinal tract (GIT) involvement. After 12 months of HPN, the mean NRS score decreased from 4.4 (range 4-5) to 1.4 (range 1-2), the mean BMI increased from 19.1 (range 17.4-20.3) to 21.0 kg/m(2) (range 18.3-23.4). QoL improved in all patients, reflected by the summary of physical components with 33.92 points before vs. 67.72 points after 12 months of HPN, and the summary of mental components with 49.66 points before vs. 89.27 points after 12 months of HPN. Two patients suffered one catheter-related infection each with subsequent surgical removal and reinsertion. CONCLUSIONS HPN is a feasible method for improving anthropometric parameters and QoL in SSc patients severely affected by GIT dysfunction. We recommend HPN in malnourished, catabolic SSc patients unable to otherwise maintain or improve their nutritional status.

Alternative nighttime nutrition regimens in glycogen storage disease type I: a controlled crossover study

BACKGROUND Traditional approaches for nighttime glycemic control in glycogen storage disease type I (GSDI) include continuous tube feeding, or ingestion of uncooked corn starch (CS) at bedtime. A modified corn starch (MCS) has been shown to prolong euglycemia in some patients. The aim of this study was to evaluate whether stable nighttime glucose control can be achieved with other types of slowly digested carbohydrates in adult GSDI patients. METHODS In this cross-over study, nocturnal glucose control and fasting times were assessed with three different nocturnal nutrition regimens in five patients, using continuous glucose monitoring (CGMS) in an outpatient everyday life setting. For each patient, continuous glucose profiles were measured after ingestion of (1) CS, (2) MCS or (3) a pasta meal at bedtime, during 5 to 6 consecutive nights for each regimen. RESULTS Stable nocturnal glucose control was achieved for all patients with a pasta meal, with a mean duration of glycemia >3.5 mmol/l of 7.6 h (range 5.7-10.8), and >4 mmol/l of 7 h (5.2-9.2), similar to CS and MCS. Fasting glucose before breakfast on workdays (after 7.1 ± 0.8 h) was not significantly different between the three interventions (CS 4.1 ± 0.5 mmol/l, MCS 4.6 ± 0.7 mmol/l, pasta 4.3 ± 0.9 mmol/l). During prolonged fasting on weekends, longer duration of normoglycemia was achieved with CS or MCS than with pasta. CONCLUSION Consumption of cooked pasta is a suitable and more palatable alternative to uncooked corn starch to achieve nighttime glucose control in adult patients with GSDI.

ALTERATIONS IN HYPOTHALAMIC CONTENT OF LUTEINIZING HORMONE RELEASING HORMONE AND PITUITARY RESPONSIVENESS ASSOCIATED WITH TESTICULAR REGRESSION INDUCED BY PINEAL RELATED TREATMENTS IN THE GOLDEN HAMSTER

The adult male golden hamster, when exposed to blinding (BL), short photoperiod (SP), or daily melatonin injections (MEL) demonstrates dramatic reproductive collapse. This collapse can be blocked by removal of the pineal gland prior to treatment. Reproductive collapse is characterized by a dramatic decrease in both testicular weight and serum gonadotropin titers. The present study was designed to examine the interactions of the hypothalamus and pituitary gland during testicular regression, and to specifically compare and contrast changes caused by the three commonly employed methods of inducing testicular regression (BL,SP,MEL). Hypothalamic LHRH content was altered by all three treatments. There was an initial increase in content of LHRH that occurred concomitantly with the decreased serum gonadotropin titers, followed by a precipitous decline in LHRH content which reflected the rapid increases in both serum LH and FSH which occur during spontaneous testicular recrudescence. In vitro pituitary responsiveness was altered by all three treatments: there was a decline in basal and maximally stimulatable release of both LH and FSH which paralleled the fall of serum gonadotropins. During recrudescence both basal and maximal release dramatically increased in a manner comparable to serum hormone levels. While all three treatments were equally effective in their ability to induce changes at all levels of the endocrine system, there were important temporal differences in the effects of the various treatments. Melatonin injections induced the most rapid changes in endocrine parameters, followed by exposure to short photoperiod. Blinding required the most time to induce the same changes. This study has demonstrated that pineal-mediated testicular regression is a process which involves dynamic changes in multiply-dependent endocrine relationships, and proper evaluation of these changes must be performed with specific temporal events in mind. ^

Function of histaminergic retinopetal axons in rat and primate retinas

Mammalian retinas receive input from histaminergic neurons in the posterior hypothalamus. These neurons are most active during the waking state of the animal, but their role in retinal information processing is not known. To determine the function of these retinopetal axons, their targets in the rat and monkey retina were identified. Using antibodies to three histamine receptors, HR1, HR2, and HR3, the immunolabeling was analyzed by confocal and electron microscopy. These experiments showed that mammalian retinas possess histamine receptors. In macaques and baboons, diurnal species, HR3 receptors were found at the apex of ON-bipolar cell dendrites in cone pedicles and rod spherules, sclerad to the other neurotransmitter receptors that have been localized there. In addition, HR1 histamine receptors were localized to large puncta in the inner plexiform layer, a subset of ganglion cells and retinal blood vessels. In rats, a nocturnal species, the localization of histamine receptors in the retina was markedly different. Most HR1 receptors were localized to dopaminergic amacrine cells and on elements in the rod spherule. To determine how histaminergic retinopetal axons contribute to retinal information processing, responses of retinal ganglion cells to histamine were analyzed. The effects of histamine on the maintained and light-evoked activity of retinal ganglion cells were analyzed. In monkeys, histamine and the HR3 agonist, methylhistamine, increased or decreased the maintained activity of most ganglion cells, but a few did not respond. The responses of a subset of ganglion cells to light stimuli were decreased by histamine, a finding suggesting that histaminergic retinopetal axons contribute to light adaptation during the day. In rats, histamine nearly always increased the maintained activity and produced both increases and decreases in the light responses. The effects of histamine on maintained activity of ganglion cells in the rat can be partially attributed to HR1-mediated changes in the activity of dopaminergic amacrine cells, at night. Together, these experiments provide the first indication of the function of retinopetal axons in mammalian retinas. ^

An evaluation of sleep hypnotic and stimulant effect on human performance using a computerized psychological test battery

This study evaluated the administration-time-dependent effects of a stimulant (Dexedrine 5-mg), a sleep-inducer (Halcion 0.25-mg) and placebo (control) on human performance. The investigation was conducted on 12 diurnally active (0700-2300) male adults (23-38 yrs) using a double-blind, randomized sixway-crossover three-treatment, two-timepoint (0830 vs 2030) design. Performance tests were conducted hourly during sleepless 13-hour studies using a computer generated, controlled and scored multi-task cognitive performance assessment battery (PAB) developed at the Walter Reed Army Institute of Research. Specific tests were Simple and Choice Reaction Time, Serial Addition/Subtraction, Spatial Orientation, Logical Reasoning, Time Estimation, Response Timing and the Stanford Sleepiness Scale. The major index of performance was "Throughput", a combined measure of speed and accuracy.^ For the Placebo condition, Single and Group Cosinor Analysis documented circadian rhythms in cognitive performance for the majority of tests, both for individuals and for the group. Performance was best around 1830-2030 and most variable around 0530-0700 when sleepiness was greatest (0300).^ Morning Dexedrine dosing marginally enhanced performance an average of 3% with reference to the corresponding in time control level. Dexedrine AM also increased alertness by 10% over the AM control. Dexedrine PM failed to improve performance with reference to the corresponding PM control baseline. With regard to AM and PM Dexedrine administrations, AM performance was 6% better with subjects 25% more alert.^ Morning Halcion administration caused a 7% performance decrement and 16% increase in sleepiness and a 13% decrement and 10% increase in sleepiness when administered in the evening compared to corresponding in time control data. Performance was 9% worse and sleepiness 24% greater after evening versus morning Halcion administration.^ These results suggest that for evening Halcion dosing, the overnight sleep deprivation occurring in coincidence with the nadir in performance due to circadian rhythmicity together with the CNS depressant effects combine to produce performance degradation. For Dexedrine, morning administration resulted in only marginal performance enhancement; Dexedrine in the evening was less effective, suggesting the 5-mg dose level may be too low to counteract the partial sleep deprivation and nocturnal nadir in performance. ^

Algunas conclusiones acerca de la diversión de jóvenes y adolescentes en la provincia de Mendoza

La temática que se aborda en el presente artículo se refiere a algunas conclusiones que surgen del trabajo de investigación «La diversión nocturna de jóvenes y adolescentes». Pretende aportar algunos elementos para conocer a los/las adolescentes y jóvenes, sus percepciones y significaciones, particularmente respecto de las actividades de diversión como forma de expresión particular. Interesa que se tengan en cuenta sus resultados como contribuciones para el diseño, implementación y reformulación de actuales o futuras políticas públicas. Las expresiones de los/las adolescentes y jóvenes permiten descubrir nuevos posicionamientos y legitimar su voz procurando instalar sus intereses en la agenda del Estado, como aporte a la construcción de la ciudadanía.

Competencia y conflicto. Hesíodo y los consejos de administración familiar : Una lectura política del tópico

El proyecto del presente trabajo consiste en reflexionar sobre la constitución del sujeto ético-político en los Erga de Hesíodo. Trabajaremos desde una propuesta de matriz antropológica, en torno a los consejos de administración familiar que el poeta propone, recurriendo a Jenofonte cuando la comparación sea oportuna. Siguiendo el horizonte semántico del término chresis, indagaremos dos cuestiones fundamentales, la gestión del hogar, a partir de la problematización del matrimonio como cuestión afín, y la gestión de los vínculos personales, que van más allá del oikos, para convocar a otros actores, el hermano, el huésped, el amigo. En ambos niveles, el estrictamente familiar con la presencia del marido y la esposa en el centro de la escena, y el familiar, en sentido más amplio, los tópicos devuelven ciertas preocupaciones y reflexiones en torno a cuestiones que se repiten, el trabajo, la riqueza, la productividad, la prudencia, el honor, la convivencia, la tolerancia. Se plasma un universo antropológico que nos permite relevar, desde los topoi recortados, la pequeña familia intramuros y la gran familia extramuros, la preocupación habitual de la constitución de un sujeto temperante que en Hesíodo cobra distintas aristas. El modelo discursivo obedece a las reglas de formación que reconocemos en los Erga como matriz de discurso: recomendaciones, consejos, exhortaciones, que delinean dos topoi reconocibles, dos categorías de sujetos, dos registros de conductas, dos modelos de instalación en la vida. Hesíodo nos tiene acostumbrados a esos sistemas binarios que, a nuestro juicio, se inscriben en la lógica del linaje. Hombres, valores, conductas de matriz diurna o nocturna, positiva o negativa, luminosa o tenebrosa. La vida familiar y la comunitaria no parece escapar a esta lógica binaria y el corpus de consejos no hace otra cosa que vigorizar con su logos el aspecto diurno de la tensión

Feeding parameters of copepods from upwelling areas

Feeding patterns of mass herbivorous copepods in upwelling areas are investigated. Daily rations and aspects of their formation are examined in Calanoides carinatus (Benguela upwelling), Calanus pacificus (off the California coast), and Calanus australis (Peru upwelling). Rations were calculated based on gut plant pigment contents obtained at daily stations using laser spectrofluorometry, experimental data on the rate of gut evacuation and data on the carbon/chlorophyll ratio in phytoplankton and particulate matter at the respective stations. When phytoplankton was abundant, diel feeding rhythms were not pronounced and gut pigment level was high during the entire 24-h period. When phytoplankton biomass was low, distinct feeding rhythms were pronounced with a nocturnal maximum. During active upwelling intensive feeding on phytoplankton supports energy (respiration) and plastic (growth, development, reproduction, accumulation of reserves) metabolism of copepods. When upwelling was inactive, the surface part of the population feeds less actively and is able only partially to cover its energy expenditures. The actively growing and reproducing populations of C. pacificus and C. carinatus may consume close to 20% of primary production, whereas the inactive population of C. australis consumed only 0.2% of primary production when upwelling weakened.

Competencia y conflicto. Hesíodo y los consejos de administración familiar : Una lectura política del tópico

El proyecto del presente trabajo consiste en reflexionar sobre la constitución del sujeto ético-político en los Erga de Hesíodo. Trabajaremos desde una propuesta de matriz antropológica, en torno a los consejos de administración familiar que el poeta propone, recurriendo a Jenofonte cuando la comparación sea oportuna. Siguiendo el horizonte semántico del término chresis, indagaremos dos cuestiones fundamentales, la gestión del hogar, a partir de la problematización del matrimonio como cuestión afín, y la gestión de los vínculos personales, que van más allá del oikos, para convocar a otros actores, el hermano, el huésped, el amigo. En ambos niveles, el estrictamente familiar con la presencia del marido y la esposa en el centro de la escena, y el familiar, en sentido más amplio, los tópicos devuelven ciertas preocupaciones y reflexiones en torno a cuestiones que se repiten, el trabajo, la riqueza, la productividad, la prudencia, el honor, la convivencia, la tolerancia. Se plasma un universo antropológico que nos permite relevar, desde los topoi recortados, la pequeña familia intramuros y la gran familia extramuros, la preocupación habitual de la constitución de un sujeto temperante que en Hesíodo cobra distintas aristas. El modelo discursivo obedece a las reglas de formación que reconocemos en los Erga como matriz de discurso: recomendaciones, consejos, exhortaciones, que delinean dos topoi reconocibles, dos categorías de sujetos, dos registros de conductas, dos modelos de instalación en la vida. Hesíodo nos tiene acostumbrados a esos sistemas binarios que, a nuestro juicio, se inscriben en la lógica del linaje. Hombres, valores, conductas de matriz diurna o nocturna, positiva o negativa, luminosa o tenebrosa. La vida familiar y la comunitaria no parece escapar a esta lógica binaria y el corpus de consejos no hace otra cosa que vigorizar con su logos el aspecto diurno de la tensión

Competencia y conflicto. Hesíodo y los consejos de administración familiar : Una lectura política del tópico

El proyecto del presente trabajo consiste en reflexionar sobre la constitución del sujeto ético-político en los Erga de Hesíodo. Trabajaremos desde una propuesta de matriz antropológica, en torno a los consejos de administración familiar que el poeta propone, recurriendo a Jenofonte cuando la comparación sea oportuna. Siguiendo el horizonte semántico del término chresis, indagaremos dos cuestiones fundamentales, la gestión del hogar, a partir de la problematización del matrimonio como cuestión afín, y la gestión de los vínculos personales, que van más allá del oikos, para convocar a otros actores, el hermano, el huésped, el amigo. En ambos niveles, el estrictamente familiar con la presencia del marido y la esposa en el centro de la escena, y el familiar, en sentido más amplio, los tópicos devuelven ciertas preocupaciones y reflexiones en torno a cuestiones que se repiten, el trabajo, la riqueza, la productividad, la prudencia, el honor, la convivencia, la tolerancia. Se plasma un universo antropológico que nos permite relevar, desde los topoi recortados, la pequeña familia intramuros y la gran familia extramuros, la preocupación habitual de la constitución de un sujeto temperante que en Hesíodo cobra distintas aristas. El modelo discursivo obedece a las reglas de formación que reconocemos en los Erga como matriz de discurso: recomendaciones, consejos, exhortaciones, que delinean dos topoi reconocibles, dos categorías de sujetos, dos registros de conductas, dos modelos de instalación en la vida. Hesíodo nos tiene acostumbrados a esos sistemas binarios que, a nuestro juicio, se inscriben en la lógica del linaje. Hombres, valores, conductas de matriz diurna o nocturna, positiva o negativa, luminosa o tenebrosa. La vida familiar y la comunitaria no parece escapar a esta lógica binaria y el corpus de consejos no hace otra cosa que vigorizar con su logos el aspecto diurno de la tensión

Atmospheric nitrate concentrations and isotope composition for samples collected in the marine boundary layer in 2006 and 2007

The comprehensive isotopic composition of atmospheric nitrate (i.e., the simultaneous measurement of all its stable isotope ratios: 15N/14N, 17O/16O and 18O/16O) has been determined for aerosol samples collected in the marine boundary layer (MBL) over the Atlantic Ocean from 65°S (Weddell Sea) to 79°N (Svalbard), along a ship-borne latitudinal transect. In nonpolar areas, the d15N of nitrate mostly deriving from anthropogenically emitted NOx is found to be significantly different (from 0 to 6 per mil) from nitrate sampled in locations influenced by natural NOx sources (-4 ± 2) per mil. The effects on d15N(NO3-) of different NOx sources and nitrate removal processes associated with its atmospheric transport are discussed. Measurements of the oxygen isotope anomaly (D17O = d17O - 0.52 × d18O) of nitrate suggest that nocturnal processes involving the nitrate radical play a major role in terms of NOx sinks. Different D17O between aerosol size fractions indicate different proportions between nitrate formation pathways as a function of the size and composition of the particles. Extremely low d15N values (down to -40 per mil) are found in air masses exposed to snow-covered areas, showing that snowpack emissions of NOx from upwind regions can have a significant impact on the local surface budget of reactive nitrogen, in conjunction with interactions with active halogen chemistry. The implications of the results are discussed in light of the potential use of the stable isotopic composition of nitrate to infer atmospherically relevant information from nitrate preserved in ice cores.

Calcareous green alga Halimeda tolerates ocean acidification conditions at tropical carbon dioxide seeps

We investigated ecological, physiological, and skeletal characteristics of the calcifying green alga Halimeda grown at CO2 seeps (pHtotal ? 7.8) and compared them to those at control reefs with ambient CO2 conditions (pHtotal ? 8.1). Six species of Halimeda were recorded at both the high CO2 and control sites. For the two most abundant species Halimeda digitata and Halimeda opuntia we determined in situ light and dark oxygen fluxes and calcification rates, carbon contents and stable isotope signatures. In both species, rates of calcification in the light increased at the high CO2 site compared to controls (131% and 41%, respectively). In the dark, calcification was not affected by elevated CO2 in H. digitata, whereas it was reduced by 167% in H. opuntia, suggesting nocturnal decalcification. Calculated net calcification of both species was similar between seep and control sites, i.e., the observed increased calcification in light compensated for reduced dark calcification. However, inorganic carbon content increased (22%) in H. digitata and decreased (-8%) in H. opuntia at the seep site compared to controls. Significantly, lighter carbon isotope signatures of H. digitata and H. opuntia phylloids at high CO2 (1.01 per mil [parts per thousand] and 1.94 per mil, respectively) indicate increased photosynthetic uptake of CO2 over HCO3- potentially reducing dissolved inorganic carbon limitation at the seep site. Moreover, H. digitata and H. opuntia specimens transplanted for 14 d from the control to the seep site exhibited similar delta13C signatures as specimens grown there. These results suggest that the Halimeda spp. investigated can acclimatize and will likely still be capable to grow and calcify in inline image conditions exceeding most pessimistic future CO2 projections.

Seawater carbonate chemistry and net dissolution rate for experiment of Shiraho reef

Acidification of the oceans by increasing anthropogenic CO2 emissions will cause a decrease in biogenic calcification and an increase in carbonate dissolution. Previous studies have suggested that carbonate dissolution will occur in polar regions and in the deep sea where saturation state with respect to carbonate minerals (Omega) will be <1 by 2100. Recent reports demonstrate nocturnal carbonate dissolution of reefs, despite a Omega a (aragonite saturation state) value of >1. This is probably related to the dissolution of reef carbonate (Mg-calcite), which is more soluble than aragonite. However, the threshold of Omega for the dissolution of natural sediments has not been clearly determined. We designed an experimental dissolution system with conditions mimicking those of a natural coral reef, and measured the dissolution rates of aragonite in corals, and of Mg-calcite excreted by other marine organisms, under conditions of Omega a > 1, with controlled seawater pCO2. The experimental data show that dissolution of bulk carbonate sediments sampled from a coral reef occurs at Omega a values of 3.7 to 3.8. Mg-calcite derived from foraminifera and coralline algae dissolves at Omega a values between 3.0 and 3.2, and coralline aragonite starts to dissolve when Omega a = 1.0. We show that nocturnal carbonate dissolution of coral reefs occurs mainly by the dissolution of foraminiferans and coralline algae in reef sediments.