Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea

OBJECTIVES

To determine whether a single polysomnographic night was a valid measure of obstructive sleep apnea syndrome (OSAS) in children with symptoms of sleep-disordered breathing.

STUDY DESIGN

The night-to-night variability of respiratory and sleep parameters was measured prospectively in 30 snoring children aged 1.6 to 11.3 years (mean +/- SD, 4.1 +/- 2) by using 2 nocturnal polysomnograms performed 7 to 27 days apart (14 +/- 5 days).

RESULTS

The mean of the respiratory variables including apnea index, apnea/hypopnea index, arterial oxygen saturation, and end-tidal partial pressure of carbon dioxide were not significantly different from night to night. Among the sleep parameters, there was no significant night-to-night difference in sleep efficiency, arousal index, percent rapid eye movement, or percent of slow wave sleep. Only the percentage of stage 2 was significantly different between the nights. The polysomnographic clinical diagnosis remained the same on both nights for all children, although the disease severity differed slightly in 2 patients.

CONCLUSIONS

There is little clinically significant night-to-night variability in pediatric polysomnography, and no first-night effect. These data suggest that a single polysomnographic night is an adequate measure of the OSAS in children with symptoms of sleep-disordered breathing.

APOE genotype and survival in men and women with Alzheimer's disease

BACKGROUND

The epsilon 4 allele of the APOE gene (APOE) is more frequent in patients with AD than in the general population, but studies are inconclusive as to whether it affects rate of progression or survival. Because survival in AD is generally longer in women than in men, the authors investigated whether APOE affects 10-year survival equally in men and women.

METHODS

APOE testing was performed on 125 patients with probable AD enrolled in the Johns Hopkins AD Research Center between November 1984 and March 1987. The 39 men and 86 women were followed at 6-month intervals until censoring (by death or withdrawal from the study) or March 1997. Patients were dichotomized into those with and those without at least one epsilon 4 allele. For each sex, a Cox proportional hazards regression, allowing for delayed entry and covarying for age at onset, was used to examine the effect of epsilon 4 on survival.

RESULTS

All patients who died during the study period and had autopsy (n = 92) were found to have definite AD. Average survival from disease onset did not differ by sex (12.1 years in men; 12.3 years in women). In neither sex were differences found between epsilon 4-positive and epsilon 4-negative subgroups in education, duration of AD at entry, or severity of dementia. However, in both sexes the epsilon 4-positive subgroup was approximately 3 years older at onset of AD and at entry to the study than the epsilon 4-negative subgroup. Adjusting for age at onset, the presence of an epsilon 4 allele significantly increased the relative risk of death only for men (RR = 2.69; 95% CI = 1.23 to 5.87).

CONCLUSIONS

In this sample of mostly white, well-educated research participants with AD, the APOE epsilon 4 allele was associated with shorter survival in men but not in women.

Olfactory mucosa ultrastructure in the short-tailed shrews, Blarina brevicauda and Blarina carolinensis

The olfactory mucosae of the northern short-tailed shrew, Blarina brevicauda, and the southern short-tailed shrew, Blarina carolinensis, were examined by light and electron microscopy. A well-developed olfactory epithelium was observed that included all of the cells necessary to provide for a sensitive olfactory system, suggesting that olfaction plays a major role in the behavior of these animals. There were no significant differences between the olfactory mucosae of these two species. The general features of the olfactory epithelium in these shrews were similar to those reported for several other macrosmatic mammals. A new type of supporting cell, called the light supporting cell, was observed in these shrews. The light supporting cell cytoplasm exhibited very little staining by light microscopy and had low electron density by transmission electron microscopy compared to that of the more common dark supporting cell. The light supporting cell had a convex apical surface with microvilli and lacked the large amounts of smooth endoplasmic reticulum (SER) typical of the apical cytoplasm of the dark supporting cell. In the lamina propria of the mucosa, the Bowman's glands consisted of two cell types, one with electron-lucent, alcian blue-positive granules, and the other with electron-dense PAS-positive granules. The cell with electron-lucent granules contained large amounts of SER and small clumps of rough ER. The cells with electron-dense granules had large amounts of RER and little SER.

Lack of relation between race and cognitive test performance in Alzheimer's disease

This study evaluated cognitive test performance in African-American and European-American Alzheimer's disease patients with equivalent years of education. Group differences were negligible on a variety of memory, language, and attentional measures, including several widely used neuropsychological tests. Differences between racial groups observed in earlier studies may have stemmed, in part, from differences in education, which may itself serve as a proxy for other potentially important sociologic and health variables.

Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon

Fine structural changes in the Achilles tendons of patients with long-term diabetes mellitus were investigated. All patients had clinical and electrophysiological evidence of diabetic neuropathy and had ulceration and/or Charcot neuroarthropathy. Several differences between tendons of diabetic (n = 12) and nondiabetic (n = 5) individuals were observed by electron microscopy. In diabetics, these differences included increased packing density of collagen fibrils, decreases in fibrillar diameter, and abnormal fibril morphology. In one diabetic patient, individual collagen fibrils were tightly apposed so that many areas of tendon appeared as a single mass of closely adhering fibrillae. In addition, foci in which collagen fibrils appeared twisted, curved, overlapping and otherwise highly disorganized were common in specimens from most patients (11 of 12). These morphologic abnormalities in the Achilles tendons of diabetics appear to reflect a poorly known process of structural reorganization that may be the result of nonenzymatic glycation expressed over many years. Such structural changes could contribute to the tightening of the Achilles tendor a phenomenon consistent with clinical observations of extreme shortening of the Achilles tendon-gastrocnemius-soleus complex common in advanced diabetic neuropaths. In patients with diabetic neuropathy, tendon shortening causes severe equinus that may precipitate serious ulceration, stress fractures, and Charcot collapse of the foot. However, in nondiabetics, the fine structure of the Achilles tendon appears normal, consistent with the finding that the ultrastructural changes result from diabetes rather than neuropathy.

Predicting rate of cognitive decline in probable Alzheimer's disease

Recent attempts to identify predictors of rate of decline in Alzheimer's disease (AD) have been extremely variable in choice of outcome variables, predictor variables tested, timing of assessments, and statistical approaches. In this study, a random effects regression model was applied to seek predictors of decline on the Mini-Mental State Exam in 132 patients with probable AD reassessed every 6 months for up to 7.5 years. Potential predictor variables at baseline were of three types: patients characteristics, clinical variables, and cognitive performances. The final multivariate analysis indicated that the following characteristics predicted more rapid cognitive decline: more education, history of dementia in a first degree relative, non-right handedness, better performances of Boston Naming Test, Gollin Incomplete Figures Test, and Benton Visual Retention Test-Delay, and worse performances on Responsive Naming Test, WAIS-R Block Design, and Benton Visual Retention Test-Copy.

Apolipoprotein E genotype and rate of decline in probable Alzheimer's disease

BACKGROUND

The risk of Alzheimer's disease (AD) appears to increase, and the age at onset to decrease, with the number of epsilon 4 alleles. If this relationship is due to increased rate of pathophysiological change, the presence of epsilon 4 would be expected to influence progression of disease, predicting a more rapid decline with increasing number of epsilon 4 alleles.

OBJECTIVE

To determine if the frequency of the epsilon 4 allele of the apolipoprotein E (ApoE) gene affects the rate of clinical progression in AD.

SETTING

Alzheimer's Disease Research Center.

SUBJECTS

One hundred one subjects meeting criteria of the National Institute of Neurological Disorders and Stroke for probable AD or of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) for definite AD; 78 of these subjects met the additional criterion of having a Mini-Mental State Examination score of at least 10 for analysis of rate of decline.

MEASUREMENTS

The subjects' characteristics and neuropsychological battery, including the Mini-Mental state Examination, Spatial Delayed Recognition Span, Boston Naming Test, Category Fluency Test, and the Physical Capacity Subscale of the Psychogeriatric Dependency Rating Scale.

DESIGN

The subjects were followed up longitudinally for approximately one decade. Medical histories were taken and physical and neurologic examinations and neuropsychological testing were performed every 6 months. Three and a half years of data were available for most tests and 5.5 for the Psychogeriatric Dependency Rating Scale; thereafter, patients were no longer testable. A general linear model analysis of variance was used to assess the influence of ApoE on demographic characteristics and baseline performances on neuropsychological measures. A random-effects regression model was used to predict change over time associated with presence of epsilon 4 on clinical and cognitive measures.

RESULTS

The age at onset was greatest for the epsilon 4-heterozygous subjects and least for the epsilon 4-negative subjects. The heterozygous subjects declined more rapidly on the Mini-Mental State Examination and the Category Fluency Test than the subjects without the epsilon 4 allele or with epsilon homozygosity. The homozygous subjects declined faster on only one subscale: the Physical Capacity subscale of the Psychogeriatric Dependency Rating Scale. Covarying for age at onset did not affect the results.

CONCLUSIONS

The ApoE genotype does not strongly influence the rate of decline in AD, implying that epsilon 4 might predispose to the development of the disease without accelerating its pathogenesis or progression. The effects of epsilon 4 on both age at onset and rate of decline need to be further investigated.

Nonsteroidal anti-inflammatory drugs in Alzheimer's disease

We reviewed the records of 210 patients in the Johns Hopkins Alzheimer's Disease Research Center to evaluate the role of nonsteroidal anti-inflammatory drugs (NSAIDs) on clinical features and progression of the disease. We compared patients taking NSAIDs or aspirin on a daily basis (N = 32) to non-NSAID patients (N = 177) on clinical, cognitive, and psychiatric measures. The NSAID group had a significantly shorter duration of illness at study entry. Even after controlling for this difference, the NSAID group performed better on the Mini-Mental State Examination, Boston Naming Test, and the delayed condition of the Benton Visual Retention Test. Furthermore, analysis of longitudinal changes over 1 year revealed less decline among NSAID patients than among non-NSAID patients on measures of verbal fluency, spatial recognition, and orientation. These findings support other recent studies suggesting that NSAIDs may serve a protective role in Alzheimer's disease.

Fine structure of the submandibular salivary gland of the venomous short-tailed shrew, Blarina brevicauda Say (Insectivora: Soricidae)

Adult male short-tailed shrews, Blarina brevicauda, (Insectivora: Soricidae) were trapped in Virginia and Pennsylvania, anesthetized, and perfused via the left ventricle of the heart with fixative. The submandibular glands were dissected free and prepared for transmission electron microscopy. The lobular, compound tubuloacinar glands had secretory endpieces consisting of seromucous acini and serous tubules connected to intercalated ducts, granular ducts, striated ducts, and excretory ducts. The general cytology of the submandibular gland of Blarina shared morphological characters with individuals in several other mammalian orders and yet differed in many ways from another Insectivore, the European hedgehog, Erinaceus europaeus.

Electron microscopic localization of cholinesterase activity in Alzheimer brain tissue

Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity was localized by electron microscopic enzyme cytochemistry in cortex from Alzheimer brains and brains from non-demented cases. In the tangle-rich medial temporal cortex of the Alzheimer brain, most of the neuronal AChE was associated with neurofibrillary tangles. These structures also contained BChE activity. In normal neurons AChE activity was found in the rough endoplasmic reticulum, nuclear envelope and Golgi apparatus. Little BChE activity was noted in normal cortex. In neuritic plaques, AChE and BChE activity was associated mostly with the amyloid, but also with the neuritic component.

Reinnervation of peripheral nerve grafts by spinal cord fibres tested by transcranial brain stimulation

A scheme for surgery in patients with avulsed roots is represented by a rat model whose left sciatic nerve was grafted upon the right sciatic nerve, the proximal end of the graft being introduced into the spinal cord white matter. Transcranial stimulation, EMG recording, HRP and histological studies proved that the communication between the brain and the denervated muscles may be reestablished via the motoneurons, through the graft, bypassing the motor roots. Behavioral techniques were developed and will be tested in the future. The possibility of using neurotrophic drugs will be considered.

Ultrastructural localization of acetylcholinesterase in the synganglion of the tick, Dermacentor variabilis (Say)

Light- and electron-microscopic enzyme cytochemistry was used to localize acetylcholinesterase (AChE) activity in the synganglion (brain) of the tick Dermacentor variabilis. High AChE activity was observed throughout the neuropil as well as adjacent to most neuronal perikarya. Intracellular activity was not observed by light microscopy. By electron microscopy, reaction product was localized at the plasma membrane of glia and neurons. Enzyme activity was not associated with the olfactory globuli neurons. In other types of neurons, small amounts of reaction product were observed in the Golgi apparatus and nuclear envelope. Large neurosecretory neurons contained activity that appeared to be associated with deep invaginations of the plasma membrane as well as intracellular membranes. AChE activity was also associated with processes of both neurons and glia. In most peripheral nerves AChE activity was associated with virtually all axons. Clearly then, AChE is associated with glia and non-cholinergic neurons as well as with presumed cholinergic neurons. The widespread localization and large amounts of AChE in the tick brain exceeds that reported for other invertebrates and vertebrates. As has been suggested for other animals, AChE in the tick brain may have functions in addition to its known role in cholinergic neurotransmission.

Carbonic anhydrase histochemistry. A potential diagnostic method for peripheral nerve repair

Many large-diameter myelinated axons in spinal dorsal roots contain carbonic anhydrase activity, whereas few small-diameter ventral root axons stain for this enzyme. This differential localization of carbonic anhydrase in sensory and motor nerve fibers is indicative of the potential of carbonic anhydrase histochemistry to provide a convenient method for identifying predominantly motor or sensory fascicles in cut ends of peripheral nerves, thereby facilitating coaptation of fascicles in peripheral nerve repair.

Localization of acetylcholinesterase-positive neurons projecting to the mouse main olfactory bulb

In this study a technique for staining brain tissue for both acetylcholinesterase (AChE) and axonally transported horseradish peroxidase conjugated to wheat germ agglutinin (HRP-WGA) has been used to identify and quantitate the AChE-synthesizing neurons that project to the main olfactory bulb (MOB) of the mouse. The primary sites of double stained neurons included the nucleus of the horizontal limb of the diagonal band (including the nucleus basalis and the magnocellular preoptic nucleus), locus coeruleus and the lateral hypothalamic area. The AChE activity in the neurons of the locus coeruleus and lateral hypothalamic area is suggested to be related to possible cholinoceptive function or some other role, but not to cholinergic projections to the MOB. Therefore, the cholinergic projection to the mouse MOB is suggested to originate in the nucleus of the horizontal limb of the diagonal band, an area that, for the purposes of this study, includes the mouse equivalent of the nucleus basalis of Meynert and what has previously been known as the magnocellular preoptic nucleus.

Quantitative localization of neurons projecting to the mouse main olfactory bulb

Horseradish peroxidase conjugated to wheat germ agglutinin was used as the tracer to demonstrate the cells of origin of the main olfactory bulb (MOB) afferent fibers in the mouse. The neurons projecting to the olfactory bulb were counted by area to show the contribution of each brain area to the system of MOB afferents. The majority of neurons projecting to the MOB were found in the nucleus olfactorius anterior and the cortex cerebri, area pyriformis, being respectively 53.8% and 35.7% of the total number of labeled neurons counted. The average total number of neurons per mouse brain projecting to the MOB was about 146,600.

Electron microscopic demonstration of neural connections using horseradish peroxidase: a comparison of the tetramethylbenzidine procedure with seven other histochemical methods

Eight methods for the electron microscopic demonstration of horseradish peroxidase (HRP) labeling have been compared in adjacent series of vibratome sections of mouse lumbar spinal cord. The tracer, a HRP-wheat germ agglutinin (WGA) conjugate, was injected into the gastrocnemius muscle complex. Following retrograde axonal transport to the lumbar motor neurons and transganglionic anterograde transport of the tracer to the dorsal horn, the HRP activity was demonstrated in eight series of adjacent sections of lumbar spinal cord using eight methods. These included procedures using tetramethylbenzidine (TMB), benzidine dihydrochloride (BDHC), o-tolidine, paraphenylenediamine-pyrocatechol (PPD-PC), and 4 methods using 3,3'-diaminobenzidine (DAB). All eight methods were able to demonstrate both retrograde labeling of motor neurons and transganglionic anterograde transport into the dorsal horn. However, there were differences in the appearance of the various reaction products under the electron microscope. In addition, differences in the distribution of the reaction products were observed by both light and electron microscopy. The largest distribution of reaction product was observed with TMB. BDHC and o-tolidine were next, followed by the DAB procedures and PPD-PC. The TMB, BDHC, and o-tolidine reaction products were all found to be suitable for electron microscopy. The TMB reaction product was electron dense and had a very distinctive crystalloid appearance that made identification of HRP-labeled neuronal profiles easy and unequivocal.

Ultrastructural evidence in mice that transganglionically transported horseradish peroxidase-wheat germ agglutinin conjugate reaches the intraspinal terminations of sensory neurons

Horseradish peroxidase conjugated to wheat germ agglutinin (HRP-WGA) has been localized by electron microscopy in the central projections of primary sensory neurons following injection of the tracer into the gastrocnemius muscle of mice. The tracer was taken up by nerve terminals in the muscle and transported transganglionically into the central spinal cord terminations of the primary sensory neurons. The HRP-WGA was localized using a new tetramethylbenzidine ultracytochemical method and the diaminobenzidine-glucose oxidase technique. The results demonstrate that the HRP-WGA is transported into the axon terminals after passing through the sensory ganglion. These data provide an experimental basis for the use of the conjugate to map the central projections of sensory neurons.

The adrenal medulla of the diabetic mouse (C57BL/KsJ, db/db): biochemical and morphological changes

1. Anatomic and biochemical indices of adrenal medullary function were studied in mice (Mus musculus) with hereditary mellitus (C57BL/KsJ, db/db). 2. In the diabetic mice increases in medullary catecholamine content and in the activities of tyrosine hydroxylase, dopamine-beta-hydroxylase, and phenylethanolamine-N-methyltransferase were accompanied by increases in adrenal weight and size. 3. Morphometric study of adrenals from diabetic mice showed that the medulla was increased in size but had a lower cell density indicating that medullary hypertrophy as well as hyperplasia were probably responsible for this size increase. 4. These observations are consistent with the occurrence of chronic adrenal medullary stimulation in the diabetic syndrome of these mice.

Immunocytochemical demonstration of nerve growth factor and histofluorescence of catecholaminergic nerves in the salivary glands of diabetic mice

Nerve growth factor (NGF) was localized in the submandibular, sublingual, and parotid salivary glands of male and female diabetic mice and their normal littermates by immunoperoxidase staining using p-phenylenediamine-pyrocatechol as a chromogen for the cytochemical demonstration of peroxidase activity. In the normal male submandibular gland, immunoreactive NGF was localized in the apical regions of granular, intercalated and collecting duct cells, while in the normal female submandibular gland, NGF was present throughout the cytoplasm of granular duct cells. The localization of NGF in the diabetic male and female submandibular glands was similar and resembled that of the normal female. NGF immunoreactivity was also observed in the striated duct cells in the sublingual and parotid glands of all four types of mice. The sympathetic innervation of the submandibular glands of normal and diabetic mice was demonstrated using glyoxylic acid-induced histofluorescence. The pattern of sympathetic innervation and the intensity of catecholamine fluorescence was consistently different in the four types of mice. In the normal male submandibular gland the fluorescence was very intense, particularly in nerves adjacent to the granular ducts. In the normal female submandibular gland, the fluorescence was weak, while in the diabetic male and female the fluorescence was moderate. The correlation between the intensity of the immunocytochemical staining for NGF and the catecholamine fluorescence adjacent to the granular ducts suggests a trophic influence of the NGF-containing granular ducts on their sympathetic innervation.

Additional factors influencing sensitivity in the tetramethyl benzidine method for horseradish peroxidase neurohistochemistry

In experiments that use horseradish peroxidase (HRP) and tetramethyl benzidine (TMB) for tracing neural connections, the activity of tissue-bound enzyme as well as the stability of the resultant reaction product are influenced by the duration of storage, the composition of the storage medium, the type of counterstaining and even the details of histological dehydration. Furthermore, the conditions for preserving HRP activity are very different from those necessary for preserving the stability of the tetramethyl benzidine (TMB) reaction product. Thus, tissue-bound HRP activity is stable at a neutral pH, while a much lower pH, around 3.3, is required for preserving the stability of the TMB reaction product. Recent evidence indicates that the stabilization bath in sodium nitroferricyanide that was previously recommended is not necessary. However, gradual dehydration of mounted sections is essential for long-term stability. Excessive counterstaining and excessive dehydration interfere with the detection of reaction product. These considerations are pertinent to experiments using free HRP as well as to those where the enzyme has been conjugated to wheat germ agglutinin.

Stability of bovine adrenal medulla cells in culture

The functional stability of primary cultures of adrenal medulla cells was investigated. Isolated cells were prepared by treatment of bovine adrenal glands with collagenase followed by purification on Percoll density gradients and were maintained in Dulbecco's medium containing 10% fetal calf serum. Within 12 h after plating on plastic culture dishes, the cells became firmly attached and exhibited good survival for periods of time up to 3 weeks, as indicated by their morphology using light and electron microscopy, by maintenance of their content of catecholamines, tyrosine hydroxylase, dopamine-beta-hydroxylase, and phenylethanolamine N-methyltransferase, and their ability to respond to secretagogues. During the first 10 days to 2 weeks in culture there was little or no change in any of these parameters. During the 3rd week there were progressive losses of catecholamine and enzyme activities and increased vacuolization of medullary cells. The cells synthesized protein and RNA with no apparent loss in activities over the period studied, but did not incorporate [3H]thymidine into PCA-precipitable material. The cells responded to secretagogues and secretory antagonists similarly to isolated perfused adrenal glands. The studies described here demonstrate that primary cultures of adrenal medulla cells provide an excellent experimental system for obtaining more detailed information on stimulus-secretion coupling and other functional aspects of the adrenal medulla.