Sleep-Disordered Breathing and Periodic Limb Movements in Narcolepsy with Cataplexy: A Systematic Analysis of 35 Consecutive Patients

Background: Disturbed sleep is a core feature of narcolepsy with cataplexy (NC). Few studies have independently assessed sleep-disordered breathing (SDB) and periodic limb movements (PLMs) in non-homogeneous series of patients with and without cataplexy. We systematically assessed both SDB and PLMs in well-defined NC patients. Methods: We analyzed the clinical and polysomnographic features of 35 consecutive NC patients (mean age 40 ± 16 years, 51% males, 23/23 hypocretin-deficient) to assess the prevalence of SDB (apnea-hypopnea index >5) and PLMs (periodic leg movements in sleep (PLMI) >15) together with their impact on nocturnal sleep and daytime sleepiness using the multiple sleep latency test. Results: 11 (31%) and 14 (40%) patients had SDB and PLMs, respectively. SDB was associated with older age (49 ± 16 vs. 35 ± 13 years, p = 0.02), higher BMI (30 ± 5 vs. 27 ± 6, p = 0.05), and a trend towards higher PLMI (25 ± 20 vs. 12 ± 23, p = 0.052), whereas PLMs with older age (50 ± 16 vs. 33 ± 11 years, p = 0.002) and reduced and fragmented sleep (e.g. sleep efficiency of 82 ± 12% vs. 91 ± 6%, p = 0.015; sleep time of 353 ± 66 vs. 395 ± 28, p = 0.010). SDB and PLMs were also mutually associated (p = 0.007), but not correlated to daytime sleepiness. Conclusions: SDB and PLMs are highly prevalent and associated in NC. Nevertheless, SDB and PLMs are rarely severe, suggesting an overall limited effect on clinical manifestations.

Gender differences in disordered eating and weight dissatisfaction in Swiss adults: Which factors matter?

Background Research results from large, national population-based studies investigating gender differences in weight dissatisfaction and disordered eating across the adult life span are still limited. Gender is a significant factor in relation to weight dissatisfaction and disordered eating. However, the reasons for gender differences in these conditions are still poorly understood. The aim of this study was to examine gender differences in weight dissatisfaction and disordered eating in the general Swiss adult population and to identify gender-specific risk factors. Methods The study population consisted of 18156 Swiss adults who completed the population-based Swiss Health Survey 2007. Self-reported weight dissatisfaction, disordered eating and associated risk factors were assessed. In order to examine whether determinants of weight dissatisfaction and disordered eating (dieting to lose weight, binge eating, and irregular eating) differ in men and women, multivariate logistic regressions were applied separately for women and men. Results Although more men than women were overweight, more women than men reported weight dissatisfaction. Weight category, smoking status, education, and physical activity were significantly associated with weight dissatisfaction in men and women. In women, nationality and age were also significant factors. Gender-specific risk factors such as physical activity or weight category were identified for specific disordered eating behaviours. Conclusions The results suggest that gender specific associations between predictors and disordered eating behaviour should be considered in the development of effective prevention programs against disordered eating.

Numerical study of Anderson localization of terahertz waves in disordered waveguides

We present a numerical study of electromagnetic wave transport in disordered quasi-one-dimensional waveguides at terahertz frequencies. Finite element method calculations of terahertz wave propagation within LiNbO3 waveguides with randomly arranged air-filled circular scatterers exhibit an onset of Anderson localization at experimentally accessible length scales. Results for the average transmission as a function of waveguide length and scatterer density demonstrate a clear crossover from diffusive to localized transport regime. In addition, we find that transmission fluctuations grow dramatically when crossing into the localized regime. Our numerical results are in good quantitative agreement with theory over a wide range of experimentally accessible parameters both in the diffusive and localized regime opening the path towards experimental observation of terahertz wave localization.

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.

Particle and energy transport in quantum disordered and quasi-periodic chains connected to mesoscopic Fermi reservoirs

We study a model of nonequilibrium quantum transport of particles and energy in a many-body system connected to mesoscopic Fermi reservoirs (the so-called meso-reservoirs). We discuss the conservation laws of particles and energy within our setup as well as the transport properties of quasi-periodic and disordered chains.

Optical in situ calibration of Sb to grow disordered GaInP by MOVPE

Reflectance anisotropy spectroscopy (RAS) was employed to determine the optimal specific molar flow of Sb needed to grow GaInP with a given order parameter by MOVPE. The RAS signature of GaInP surfaces exposed to different Sb/P molar flow ratios were recorded, and the RAS peak at 3.02 eV provided a feature that was sensitive to the amount of Sb on the surface. The range of Sb/P ratios over which Sb acts as a surfactant was determined using the RA intensity of this peak, and different GaInP layers were grown using different Sb/P ratios. The order parameter of the resulting layers was measured by PL at 20 K. This procedure may be extensible to the calibration of surfactant-mediated growth of other materials exhibiting characteristic RAS signatures.

Protein folding from a highly disordered denatured state: The folding pathway of chymotrypsin inhibitor 2 at atomic resolution

Previous experimental and theoretical studies have produced high-resolution descriptions of the native and folding transition states of chymotrypsin inhibitor 2 (CI2). In similar fashion, here we use a combination of NMR experiments and molecular dynamics simulations to examine the conformations populated by CI2 in the denatured state. The denatured state is highly unfolded, but there is some residual native helical structure along with hydrophobic clustering in the center of the chain. The lack of persistent nonnative structure in the denatured state reduces barriers that must be overcome, leading to fast folding through a nucleation–condensation mechanism. With the characterization of the denatured state, we have now completed our description of the folding/unfolding pathway of CI2 at atomic resolution.

Forced expression of the tumor suppressor adenomatosis polyposis coli protein induces disordered cell migration in the intestinal epithelium.

Mutations of the human adenomatosis polyposis coli (APC) gene are associated with the development of familial as well as sporadic intestinal neoplasia. To examine the in vivo function of APC, 129/Sv embryonic stem (ES) cells were transfected with DNA encoding the wild-type human protein under the control of a promoter that is active in all four of the small intestine's principal epithelial lineages during their migration-associated differentiation. ES-APC cells were then introduced into C57BL/6-ROSA26 blastocysts. Analyses of adult B6-ROSA26<-->129/Sv-APC chimeric mice revealed that forced expression of APC results in markedly disordered cell migration. When compared with the effects of forced expression of E-cadherin, the data suggest that APC-catenin and E-cadherin-catenin complexes have opposing effects on intestinal epithelial cell movement/adhesiveness; augmentation of E-cadherin-beta-catenin complexes produces a highly ordered, "adhesive" migration, whereas augmentation of APC-beta-catenin complexes produces a disordered, nonadhesive migratory phenotype. We propose that APC mutations may promote tumorigenesis by increasing the relative activity of cadherin-catenin complexes, resulting in enhanced adhesiveness and functional anchorage of initiated cells within the intestinal crypt. Our studies also indicate that chimeric mice generated from B6-ROSA26 blastocysts and genetically manipulated ES cells should be useful for auditing gene function in the gastrointestinal tract and in other tissues.

Direct observation of disordered regions in the major histocompatibility complex class II-associated invariant chain.

Invariant chain (Ii) is a trimeric membrane protein which binds and stabilizes major histocompatibility complex class II heterodimers in the endoplasmic reticulum and lysosomal compartments of antigen-presenting cells. In concert with an intracellular class II-like molecule, HLA-DM, Ii seems to facilitate loading of conventional class II molecules with peptides before transport of the class II-peptide complex to the cell surface for recognition by T cells. The interaction of Ii with class II molecules is thought to be mediated in large part through a region of 24 amino acids (the class II-associated Ii peptide, CLIP) which binds as a cleaved moiety in the antigenic peptide-binding groove of class II molecules in HLA-DM-deficient cell lines. Here we use nuclear magnetic resonance techniques to demonstrate that a soluble recombinant Ii ectodomain contains significant disordered regions which probably include CLIP.

Critical behavior of three-dimensional disordered Potts models with many states

We study the 3D Disordered Potts Model with p = 5 and p = 6. Our numerical simulations (that severely slow down for increasing p) detect a very clear spin glass phase transition. We evaluate the critical exponents and the critical value of the temperature, and we use known results at lower p values to discuss how they evolve for increasing p. We do not find any sign of the presence of a transition to a ferromagnetic regime.

First-order transition in a three-dimensional disordered system

We present the first detailed numerical study in three dimensions of a first-order phase transition that remains first order in the presence of quenched disorder (specifically, the ferromagnetic-paramagnetic transition of the site-diluted four states Potts model). A tricritical point, which lies surprisingly near the pure-system limit and is studied by means of finite-size scaling, separates the first-order and second-order parts of the critical line. This investigation has been made possible by a new definition of the disorder average that avoids the diverging-variance probability distributions that plague the standard approach. Entropy, rather than free energy, is the basic object in this approach that exploits a recently introduced microcanonical Monte Carlo method.

First Order Phase Transition in a 3D disordered system

We present a detailed numerical study on the effects of adding quenched impurities to a three dimensional system which in the pure case undergoes a strong first order phase transition (specifically, the ferromagnetic/paramagnetic transition of the site-diluted four states Potts model). We can state that the transition remains first-order in the presence of quenched disorder (a small amount of it) but it turns out to be second order as more impurities are added. A tricritical point, which is studied by means of Finite-Size Scaling, separates the first-order and second-order parts of the critical line. The results were made possible by a new definition of the disorder average that avoids the diverging-variance probability distributions that arise using the standard methodology. We also made use of a recently proposed microcanonical Monte Carlo method in which entropy, instead of free energy, is the basic quantity.

Phase Transitions in Disordered Systems: The Example of the Random-Field Ising Model in Four Dimensions

By performing a high-statistics simulation of the D = 4 random-field Ising model at zero temperature for different shapes of the random-field distribution, we show that the model is ruled by a single universality class. We compute to a high accuracy the complete set of critical exponents for this class, including the correction-to-scaling exponent. Our results indicate that in four dimensions (i) dimensional reduction as predicted by the perturbative renormalization group does not hold and (ii) three independent critical exponents are needed to describe the transition.

Sleep-disordered breathing among acute ischemic stroke patients in Brazil.

OBJECTIVES Sleep-disordered breathing (SDB) is very common in acute stroke patients and has been related to poor outcome. However, there is a lack of data about the association between SDB and stroke in developing countries. The study aims to characterize the frequency and severity of SDB in Brazilian patients during the acute phase of ischemic stroke; to identify clinical and laboratorial data related to SDB in those patients; and to assess the relationship between sleep apnea and functional outcome after six months of stroke. METHODS Clinical data and laboratorial tests were collected at hospital admission. The polysomnography was performed on the first night after stroke symptoms onset. Functional outcome was assessed by the modified Rankin Scale (mRS). RESULTS We prospectively evaluated 69 patients with their first-ever acute ischemic stroke. The mean apnea-hypopnea index (AHI) was 37.7 ± 30.2. Fifty-three patients (76.8%) exhibited an AHI ≥ 10 with predominantly obstructive respiratory events (90.6%), and thirty-three (47.8%) had severe sleep apnea. Age (OR: 1.09; 95% CI: 1.03-1.15; p= 0.004) and hematocrit (OR: 1.18; 95% CI: 1.03-1.34; p= 0.01) were independent predictors of sleep apnea. Age (OR: 1.13; 95% CI: 1.03-1.24; p= 0.01), body mass index (OR: 1.54; 95% CI: 1.54-2.18; p= 0.01), and hematocrit (OR: 1.19; 95% CI: 1.01-1.40; p= 0.04) were independent predictors of severe sleep apnea. The National Institutes of Health Stroke Scale (NIHSS; OR: 1.30; 95% CI: 1.1-1.5; p= 0.001) and severe sleep apnea (OR: 9.7; 95% CI: 1.3-73.8; p= 0.03) were independently associated to mRS >2 at six months, after adjusting for confounders. CONCLUSION Patients with acute ischemic stroke in Brazil have a high frequency of SDB. Severe sleep apnea is associated with a poor long-term functional outcome following stroke in that population.

A practical treatise on the remmitent fever of infants, with remarks on hydrocephalus internus ... and cases and observations, designed to illustrate the influence exerted by a certain disordered state of the chylopöietic viscera, upon local and constitutional diseases ... in two parts /

Mode of access: Internet.