Evaluation of cutoff scores for the Parkinson's disease sleep scale-2

BACKGROUND

The Parkinson's Disease Sleep Scale (PDSS)-2 is a recently developed tool for evaluating disease-related nocturnal disturbances in patients with Parkinson's disease (PD). However, its cutoff score has not been clinically assessed. We determined the optimal cutoff score of the Japanese version of the PDSS-2.

METHODS

Patients with PD (n = 146) and controls (n = 100) completed the PDSS-2 and the Pittsburgh Sleep Quality Index (PSQI). Poor sleepers were defined as having global PSQI scores >5. Optimal cutoff scores for determining poor sleepers were assessed using the receiver operating characteristic curve.

RESULTS

A PDSS-2 total score ≥ 14 exhibited 82.0% sensitivity and 70.6% specificity, whereas a PDSS-2 total score ≥ 15 provided 72.1% sensitivity and 72.9% specificity in distinguishing poor sleepers (PSQI score >5) from good sleepers (PSQI ≤ 5). Nocturnal disturbances were more frequently observed in patients with PD than in controls (PDSS-2 total score ≥ 14 or ≥ 15; 51.4% vs 20%; 45.9% vs 19%). Nocturnal disturbances were associated with higher Hoehn and Yahr stages and Unified Parkinson's Disease Rating Scale motor scores, impaired quality of life, daytime sleepiness, and depressive symptoms.

CONCLUSION

We suggest that PDSS-2 total scores ≥ 15 are useful for detecting poor sleepers among patients with PD.

Time differences in the formation of meteorites as determined from the ratio of lead-207 to lead-206

Measurements of the lead isotopic composition and the uranium, thorium, and lead concentrations in meteorites were made in order to obtain more precise radiometric ages of these members of the solar system. The newly determined value of the lead isotopic composition of Canyon Diablo troilite is as follows: (206)Pb/(204)Pb = 9.307, (207)Pb/(2O4)Pb = 10.294, and (208)Pb/(204)Pb = 29.476. The leads of Angra dos Reis, Sioux County, and Nuevo Laredo achondrites are very radiogenic, the (206)Pb/(204)Pb values are about 200, and the uranium-thorium-lead systems are nearly concordant. The ages of the meteorites as calculated from a single-stage (207)Pb/(206)Pb isochron based on the newly determined primordial lead value and the newly reported (235)U and (838)U decay constants, are 4.528 x 10(9) years for Sioux County and Nuevo Laredo and 4.555 x 10(9) years for Angra dos Reis. When calculated with the uranium decay constants used by Patterson, these ages are 4.593 x 10(9) years and 4.620 x 10(9) years, respectively, and are therefore 40 to 70 x 10(6) years older than the 4.55 x 10(9) years age Patterson reported. The age difference of 27 x 10(6) years between Angra dos Reis and the other two meteorites is compatible with the difference between the initial (87)Sr/(86)Sr ratio of Angra dos Reis and that of seven basaltic achondrites observed by Papanastassiou and Wasserburg. The time difference is also comparable to that determined by (129)1-(129)Xe chronology. The ages of ordinary chondrites (H5 and L6) range from 4.52 to 4.57 x 10(9) years, and, here too, time differences in the formation of the parent bodies or later metamorphic events are indicated. Carbonaceous chondrites(C2 and C3) appear to contain younger lead components.

Spectrum of neurological diseases associated with antibodies to minor gangliosides GM1b and GalNAc-GD1a

The authors reported the neurological disease spectrum associated with autoantibodies against minor gangliosides GM1b and GalNAc-GD1a. IgG and IgM antibody reactivity against gangliosides GM1, GM2, GM1b, GD1a, GalNAc-GD1a and GQ1b was investigated in sera from 7000 consecutive patients who had various neurological conditions. The clinical diagnoses for 456 anti-GM1b-positive patients were Guillain-Barré syndrome (GBS, 71%), atypical GBS with preserved deep tendon reflexes (12%), Fisher syndrome (10%), Bickerstaff's brainstem encephalitis (2%), ataxic GBS (2%) and acute ophthalmoparesis (1%). For 193 anti-GalNAc-GD1a-positive patients, the diagnoses were GBS (70%), atypical GBS (16%), Fisher syndrome (10%) and Bickerstaff's brainstem encephalitis (3%). Of the patients with GBS or atypical GBS, 28% of 381 anti-GM1b-positive and 31% of 166 anti-GalNAc-GD1a-positive patients had neither anti-GM1 nor anti-GD1a antibodies. Of those patients with Fisher syndrome, Bickerstaff's brainstem encephalitis, ataxic GBS or acute ophthalmoparesis, 33% of 67 anti-GM1b-positive, and 52% of 25 anti-GalNAc-GD1a-positive patients had no anti-GQ1b antibodies. Autoantibodies against GM1b and GalNAc-GD1a are associated with GBS, Fisher syndrome and related conditions. These antibodies should provide useful serological markers for identifying patients who have atypical GBS with preserved deep tendon reflexes, ataxic GBS, Bickerstaff's brainstem encephalitis or acute ophthalmoparesis, especially for those who have no antibodies to GM1, GD1a or GQ1b. A method to prepare GM1b was developed.

Intractable chronic inflammatory demyelinating polyneuropathy treated successfully with ciclosporin

BACKGROUND

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous disorder and both clinical course and response to treatment vary widely. Because of the propensity for relapse, CIDP requires maintenance therapy after the initial response to treatment. There is no consensus regarding this in the published literature.

PRESENT REPORT

A patient with CIDP was treated with oral prednisolone and cyclophosphamide pulse therapy but required repeated plasma exchange and intravenous immunoglobulin (IVIg). Treatment with ciclosporin freed the patient from repeated IVIg administration. Therapeutic responses in 14 subsequent cases including three patients who showed improvement with ciclosporin are also presented along with an algorithm of the authors' suggested protocol for treatment.

CONCLUSION

Ciclosporin should be considered for patients with intractable CIDP who require repeated IVIg.

Side Effects of Combined Therapy of Methylprednisolone and Intravenous Immunoglobulin in Guillain-Barré Syndrome

Side effects were compared in 9 patients with Guillain-Barré syndrome treated with standard intravenous immunoglobulin (IVIg) only and in 9 treated with combined methylprednisolone and IVIg therapy. Headache occurred in 2 in both groups, indicative that pre-infusion with steroids does not prevent headache. Transient liver function disturbances were present in 2 patients of the former group and in 6 of the latter.

Range of cross reactivity of anti-GM1 IgG antibody in Guillain-Barré syndrome

The cross reactivity of anti-GM1 IgG antibody with various gangliosides and asialo-GM1 in serum samples from 27 patients with Guillain-Barré syndrome was investigated. An enzyme linked immunosorbent assay (ELISA) absorption study showed that anti-GM1 IgG antibody cross reacted with asialo-GM1 in 52% of the patients, GM1b in 41%, GD1b in 22%, and GalNAc-GD1a in 19%, and that it did not cross react with GM2, GT1b, or GQ1b. The antibody that cross reacted with GD1b was associated with a high frequency of cranial nerve involvement and negative Campylobacter jejuni serology. Anti-GM1 IgG antibody has a broad range of cross reactivity which may contribute to various clinical variations of Guillain-Barré syndrome.

[Usefulness of rapid examination method by test tape for cerebrospinal fluid]

We evaluated the usefulness of the test tape for cerebrospinal fluid (CSF), with which glucose and protein were examined, in aid of rapid diagnosis of various neurological diseases. Twenty-eight patients were examined to estimate the level of CSF glucose and protein using test tape. The data accuracy was confirmed with the data from standard measurements because the data from test tape correlated significantly with the data measured by standard method (glucose, p < 0.05; protein, p < 0.01). The test tape is useful for the rapid examination of CSF. We hope that more accurate test tape method will be developed for CSF glucose and protein determination.

Origin of the Sudbury Complex by Meteoritic Impact: Neodymium Isotopic Evidence

Samarium-neodymium isotopic data on whole rocks and minerals of the Sudbury Complex in Canada gave an igneous crystallization age of 1840 +/- 21 x 10(6) years. The initial epsilon neodymium values for 15 whole rocks are similar to those for average upper continental crust, falling on the crustal trend of neodymium isotopic evolution as defined by shales. The rare earth element concentration patterns of Sudbury rocks are also similar to upper crustal averages. These data suggest that the Sudbury Complex formed from melts generated in the upper crust and are consistent with a meteoritic impact.

Samarium-Neodymium Systematics in Kimberlites and in the Minerals of Garnet Lherzolite Inclusions

The initial ratios of neodymium-143 to neodymium-144 in kimberlites ranging in age between 90 x 10(6) to 1300 x 10(6) years from South Africa, India, and the United States are different from the corresponding ratios in the minerals of peridotite inclusions in the kimberlites but are identical to the ratios in the basaltic achondrite Juvinas at the times of emplacement of the respective kimberlite pipes. This correlation between the kimberlites and Juvinas, which represents the bulk chondritic earth in rare-earth elements, strongly indicates that the kimberlite's source in the mantle is chondritic in rare-earth elements and relatively primeval in composition.

Excess Lead in "Rusty Rock" 66095 and Implications for an Early Lunar Differentiation

Apollo 16 breccia 66095 contains a remarkably high amount of lead (15 parts per million), 85 percent of which is not supported by uranium and thorium in the rock. An acid leach experiment coupled with separate analyses of the whole rock and mineral fractions for uranium, thorium, and lead indicate that the excess lead has a lunar source and was apparently introduced about 4.0 x 10(9) years ago. The data also suggest that a major lunar crustal differentiation occurred about 4.47 x 10(9) years ago.

Age of the Moon: An Isotopic Study of Uranium-Thorium-Lead Systematics of Lunar Samples

Concentrations of U, Th, and Pb in Apollo 11 samples studied are low (U. 0.16 to 0.87; Th, 0.53 to 3.4; Pb, 0.29 to 1.7, in ppm) but the extremely radiogenic lead in samples allows radiometric dating. The fine dust and the breccia have a concordant age of 4.66 billion years on the basis of (207)Pb/(206)Pb, (206)Pb/(238)U, (207)Pb/(235U), and(208)Pb/(232)Th ratios. This age is comparable with the age of meteorites and with the age generally accepted for the earth. Six crystalline and vesicular samples are distinctly younger than the dust and breccia. The (238)U/(235)U ratio is the same as that in earth rocks, and (234)U is in radioactive equilibrium with parent (238)U.

Genetic Relations of Oceanic Basalts as Indicated by Lead Isotopes

The isotopic compositions of lead and the concentrations lead, uranium, and thorium in samples of oceanic tholeiite and alkali suites are determined, and the genetic relations of the oceanic basalts are discussed. Lead of the oceanic tholeiites has a varying lead-206: lead-204 ratio between 17.8 and 18.8, while leads of the alkali basalt suites from Easter Island and Guadalupe Island are very radiogenic with lead-206: lead-204 ratios between 19.3 and 20.4 It is concluded that (i) the isotopic composition of lead in oceanic tholeiite suggests that the upper mantle source region of the tholeiite was differentiated from and original mantle material more than 1 billion years ago and that the upper mantle is not homogeneous at the present time, (ii) less than 20 million years was required for the crystal differentiation within the alkali suite from Easter Island, (iii) no crustal contamination was involved in the course of differentiation of rocks from Easter Island; however, some crustal contamination may have affected Guadalupe Island rocks, and (iv) alkali basalt may be produced from the tholeiite in the oceanic region by crystal differentiation. Alternatively the difference in the isotopic composition of lead in oceanic basalts may be produced by partial melting at different depths of a differentiated upper mantle.

Potassium, Rubidium, Strontium, Thorium, Uranium, and the Ratio of Strontium-87 to Strontium-86 in Oceanic Tholeiitic Basalt

The average concentrations of potassium, rubidium, strontium, thorium, and uranium in oceanic tholeiitic basalt are (in parts per million) K, 1400; Rb, 1.2; Sr, 120; Th, 0.2; and U, 0.1. The ratio Sr(87) to Sr(86) is about 0.702, that of K to U is 1.4 x 10(4), and of Th to U is 1.8. These amounts of K, Th, U, and radiogenic Sr(87) are less than in other common igneous rocks. The ratios of Th to U and Sr(87) to Sr(86) suggest that the source region of the oceanic tholeiites was differentiated from the original mantle material some time in the geologic past.