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Bergmann M, Stefani A, Ibrahim A, Anselmi V, Brandauer E, Högl B, Cesari M. A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients. J Sleep Res 2024; 33:e14074. [PMID: 37922734 DOI: 10.1111/jsr.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Excessive fragmentary myoclonus (EFM) is a frequent finding during routine video-polysomnography (VPSG). We aimed to automatically measure the prevalence of EFM according to current American Academy of Sleep Medicine (AASM) criteria, and the fragmentary myoclonus index (FMI) in sleep stage N1, N2, N3, rapid eye movement (REM) sleep and wake in a large patient population. A total of 500 VPSG recordings of patients admitted to the Sleep Laboratory, Department of Neurology, Medical University of Innsbruck, Austria, between May 1, 2022 and February 28, 2023, were included. EFM according to AASM criteria and FMI were computed by applying a previously validated algorithm. EFM was automatically detected in 121 of the 500 Sleep Laboratory patients (24.2%, 95% confidence interval 20.1%-28.9%). FMI increased with age, male gender, apnea-hypopnea-index (AHI), oxygen desaturation index (ODI), and periodic leg movements of sleep (PLMS) index. FMI was highest in REM sleep behaviour disorder (RBD), followed by neurodegenerative and internal medicine diseases, but the increase in the FMI was not explained by the disease itself but rather by the age and sex of the patients. Almost a quarter of our patient population had EFM. However, the prevalence of EFM does not allow the drawing of any conclusions about the pathophysiology of EFM or even the determination of a pathological FMI cut-off value. Associations of the FMI with age, sex, AHI, ODI and PLMS are in line with previous studies, but the FMI needs to be evaluated in different disease entities to learn more about its pathophysiology.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Anselmi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Zhang Y, Kang S, Luo X, Shukla T, Gao T, Allen D, Allen S, Bergmann M. Microplastics and nanoplastics pose risks on the Tibetan Plateau environment. Sci Bull (Beijing) 2024; 69:589-592. [PMID: 38158291 DOI: 10.1016/j.scib.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Yulan Zhang
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Shichang Kang
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Xi Luo
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tanuj Shukla
- State Key Laboratory of Cryospheric Science, Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Tanguang Gao
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China
| | - Deonie Allen
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham 200003, UK
| | - Steve Allen
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham 200003, UK; Ocean Frontiers Institute, Dalhousie University, Halifax B3H 4R2, Canada
| | - Melanie Bergmann
- Alfred-Wegener-Institut Helmholtz-Zentrum für Polar-und Meeresforschung, Bremerhaven D-27515, Germany
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3
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Rynek R, Tekman MB, Rummel C, Bergmann M, Wagner S, Jahnke A, Reemtsma T. Hotspots of Floating Plastic Particles across the North Pacific Ocean. Environ Sci Technol 2024; 58:4302-4313. [PMID: 38394333 PMCID: PMC10919090 DOI: 10.1021/acs.est.3c05039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
The pollution of the marine environment with plastic debris is expected to increase, where ocean currents and winds cause their accumulation in convergence zones like the North Pacific Subtropical Gyre (NPSG). Surface-floating plastic (>330 μm) was collected in the North Pacific Ocean between Vancouver (Canada) and Singapore using a neuston catamaran and identified by Fourier-transform infrared spectroscopy (FT-IR). Baseline concentrations of 41,600-102,700 items km-2 were found, dominated by polyethylene and polypropylene. Higher concentrations (factors 4-10) of plastic items occurred not only in the NPSG (452,800 items km-2) but also in a second area, the Papaha̅naumokua̅kea Marine National Monument (PMNM, 285,200 items km-2). This second maximum was neither reported previously nor predicted by the applied ocean current model. Visual observations of floating debris (>5 cm; 8-2565 items km-2 and 34-4941 items km-2 including smaller "white bits") yielded similar patterns of baseline pollution (34-3265 items km-2) and elevated concentrations of plastic debris in the NPSG (67-4941 items km-2) and the PMNM (295-3748 items km-2). These findings suggest that ocean currents are not the only factor provoking plastic debris accumulation in the ocean. Visual observations may be useful to increase our knowledge of large-scale (micro)plastic pollution in the global oceans.
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Affiliation(s)
- Robby Rynek
- Department
of Analytical Chemistry, Helmholtz Centre
for Environmental Research − UFZ, 04318 Leipzig, Germany
| | - Mine B. Tekman
- Alfred-Wegener-Institut,
Helmholtz-Zentrum für Polar- und Meeresforschung, 27570 Bremerhaven, Germany
- Department
of Natural and Mathematical Sciences, Faculty of Engineering, Ozyegin University, 34794 Istanbul, Turkey
| | - Christoph Rummel
- Department
of Bioanalytical Ecotoxicology, Helmholtz-Centre
for Environmental Research − UFZ, 04318 Leipzig, Germany
| | - Melanie Bergmann
- Alfred-Wegener-Institut,
Helmholtz-Zentrum für Polar- und Meeresforschung, 27570 Bremerhaven, Germany
| | - Stephan Wagner
- Department
of Analytical Chemistry, Helmholtz Centre
for Environmental Research − UFZ, 04318 Leipzig, Germany
| | - Annika Jahnke
- Department
of Exposure Science, Helmholtz-Centre for
Environmental Research − UFZ, 04318 Leipzig, Germany
- Institute
for Environmental Research, RWTH Aachen
University, 52047 Aachen, Germany
| | - Thorsten Reemtsma
- Department
of Analytical Chemistry, Helmholtz Centre
for Environmental Research − UFZ, 04318 Leipzig, Germany
- Institute
of Analytical Chemistry, University of Leipzig, Linnéstrasse 3, 04103 Leipzig, Germany
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Bergmann M, Högl B, Stefani A. Clinical neurophysiology of REM parasomnias: Diagnostic aspects and insights into pathophysiology. Clin Neurophysiol Pract 2024; 9:53-62. [PMID: 38328386 PMCID: PMC10847011 DOI: 10.1016/j.cnp.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/17/2023] [Accepted: 10/22/2023] [Indexed: 02/09/2024] Open
Abstract
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity. Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology. RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation. Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
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Bergmann M, Högl B, Ibrahim A, Brandauer E, Heidbreder A, Stefani A, Cesari M. A reliable automatic algorithm to score fragmentary myoclonus. J Sleep Res 2023; 32:e13921. [PMID: 37132127 DOI: 10.1111/jsr.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
Excessive fragmentary myoclonus (EFM) is an incidental polysomnographic finding requiring documentation of ≥20 minutes of NREM sleep with ≥5 fragmentary myoclonus (FM) potentials per minute. Manual FM scoring is time-consuming and prone to inter-rater variability. This work aimed to validate an automatic algorithm to score FM in whole-night recordings. One expert scorer manually scored FM in the anterior tibialis muscles in 10 polysomnographies of as many subjects. The algorithm consisted of two steps. First, parameters of the automatic leg movement identification algorithm of the BrainRT software (OSG, Belgium) were modified to identify FM-like activity. Second, a post-processing algorithm was implemented to remove FM activity not meeting sufficient amplitude criteria. The parameter choice and the post-processing were optimised with leave-one-out cross-validation. Agreement with the human scorer was measured with Cohen's kappa (k) and correlation between manual and automatic FM indices in different sleep stages was evaluated. Agreement in identifying patients with EFM was computed. The algorithm showed substantial agreement (average k > 0.62) for all sleep stages, except for W, where a moderate agreement was observed (average k = 0.58). Nonetheless, the agreement between human scorer and the algorithm was similar to previously reported values of inter-rater variability for FM scoring. Correlation coefficients were over 0.96 for all sleep stages. Furthermore, the presence/absence of EFM was correctly identified in 80% of the subjects. In conclusion, this work presents a reliable algorithm for automatic scoring of FM and EFM. Future studies will apply it to objectively and consistently evaluate FM indices and the presence of EFM in large populations.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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6
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Berger-Sieczkowski E, Endmayr V, Haider C, Ricken G, Jauk P, Macher S, Pirker W, Högl B, Heidbreder A, Schnider P, Bradley-Zechmeister E, Mariotto S, Koneczny I, Reinecke R, Kasprian G, Weber C, Bergmann M, Milenkovic I, Berger T, Gaig C, Sabater L, Graus F, Gelpi E, Höftberger R. Analysis of inflammatory markers and tau deposits in an autopsy series of nine patients with anti-IgLON5 disease. Acta Neuropathol 2023; 146:631-645. [PMID: 37646790 PMCID: PMC10499680 DOI: 10.1007/s00401-023-02625-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
Anti-IgLON5 disease is a rare neurological, probably autoimmune, disorder associated in many cases with a specific tauopathy. Only a few post-mortem neuropathological studies have been reported so far. Little is known about the pathogenic mechanisms that result in neurodegeneration. We investigated the neuropathology of anti-IgLON5 disease and characterized cellular and humoral inflammation. We included nine cases (six of them previously published). Median age of patients was 71 years (53-82 years), the median disease duration was 6 years (0.5-13 years), and the female to male ratio was 5:4. Six cases with a median disease duration of 9 years presented a prominent tauopathy. Five of them had a classical anti-IgLON5-related brainstem tauopathy and another presented a prominent neuronal and glial 4-repeat tauopathy, consistent with progressive supranuclear palsy (PSP). Three cases with short disease duration (median 1.25 years) only showed a primary age-related neurofibrillary pathology. Inflammatory infiltrates of T and B cells were mild to moderate and did not significantly differ between anti-IgLON5 disease cases with or without tauopathy. In contrast, we found an extensive neuropil deposition of IgG4 in the tegmentum of the brainstem, olivary nucleus, and cerebellar cortex that was most prominent in two patients with short disease duration without the typical IgLON5-related tauopathy. The IgG4 deposits were particularly prominent in the cerebellar cortex and in these regions accompanied by mild IgG1 deposits. Activated complement deposition (C9neo) was absent. Our study indicates that IgLON5-related tau pathology occurs in later disease stages and may also present a PSP-phenotype with exclusively 4-repeat neuronal and glial tau pathology. The prominent deposition of anti-IgLON5 IgG4 at predilection sites for tau pathology suggests that anti-IgLON5 antibodies precede the tau pathology. Early start of immunotherapy might prevent irreversible neuronal damage and progression of the disease, at least in a subgroup of patients.
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Affiliation(s)
- Evelyn Berger-Sieczkowski
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Verena Endmayr
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carmen Haider
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerda Ricken
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp Jauk
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Klinik Ottakring, Vienna, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schnider
- Department of Neurology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | | | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Inga Koneczny
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Raphael Reinecke
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Kasprian
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Corinna Weber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Milenkovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Neuroimmunology Laboratory-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lidia Sabater
- Neuroimmunology Laboratory-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Laboratory-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ellen Gelpi
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Neurological Tissue Bank of the Biobanc-Hospital Clinic-IDIBAPS, Barcelona, Spain.
| | - Romana Höftberger
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Joza S, Iranzo A, Stefani A, Pelletier A, Serradell M, Muñoz‐Lopetegi A, Ibrahim A, Holzknecht E, Montplaisir JY, Mayà G, Santamaria J, Gaig C, Bergmann M, Brandauer E, Högl B, Gagnon J, Postuma RB. Is REM Sleep Behavior Disorder Changing? Secular Changes Versus Referral Patterns. Mov Disord Clin Pract 2023; 10:1519-1524. [PMID: 37868932 PMCID: PMC10585963 DOI: 10.1002/mdc3.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. Objective To assess if, over time, milder iRBD cases are presenting earlier. Methods Disease-free survival was compared in two iRBD recruitment epochs: 2004 to 2013 ("earlier") versus 2014to 2022 ("later") and by referral type ("self-referral" vs. "conventional-referral") in three large centers. Results In Montreal, among 209 subjects followed prospectively, shorter time to phenoconversion was observed in the earlier epoch (5-year phenoconversion = 42% earlier vs. 23% later); diagnosis before 2014 had a 1.8-fold phenoconversion hazard. However, no difference was observed in 248 subjects from Barcelona and 166 from Innsbruck. Analysis of Montreal data found that increased survival in the later epoch was driven by an increasing number of self-referrals, who phenoconverted at 1/3 the rate of physician-referred subjects. Conclusions Increased patient awareness of iRBD results in earlier presentation to clinical attention, with a longer time to phenoconversion.
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Affiliation(s)
- Stephen Joza
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
| | - Alex Iranzo
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Ambra Stefani
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Amelie Pelletier
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
| | - Monica Serradell
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Amaia Muñoz‐Lopetegi
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Abubaker Ibrahim
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jacques Y. Montplaisir
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Gerard Mayà
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Joan Santamaria
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Carles Gaig
- Neurology Service, Sleep Disorders CenterHospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERNEDBarcelonaSpain
| | - Melanie Bergmann
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Birgit Högl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | - Jean‐François Gagnon
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
- Department of PsychologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Ronald B. Postuma
- Montreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Centre d'Études Avancées en Médecine du SommeilHôpital du Sacré‐Cœur de MontréalMontrealQuebecCanada
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Ibrahim A, Ferri R, Cesari M, Frauscher B, Heidbreder A, Bergmann M, Högl B, Stefani A. Large muscle group movements during sleep in healthy people: normative values and correlation to sleep features. Sleep 2023; 46:zsad129. [PMID: 37129552 PMCID: PMC10424171 DOI: 10.1093/sleep/zsad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
STUDY OBJECTIVES To investigate the frequency and characteristics of large muscle group movements (LMMs) during sleep in healthy adults. METHODS LMMs were scored following the International Restless Legs Syndrome Study Group criteria in 100 healthy participants aged 19-77 years. A LMM was defined as a temporally overlapping increase in EMG activity and/or the occurrence of movement artifacts in at least two channels. LMM indices and durations in total sleep time (TST), NREM and REM sleep, and association with arousals, awakenings, and/or respiratory events were calculated. Correlations of LMMs indices and durations with sleep architecture, respiratory and motor events, and subjective sleep quality were investigated. RESULTS Median LMMs index in TST was 6.8/h (interquartile range (IQR), 4.5-10.8/h), median mean duration 12.4 s (IQR 10.7-14.4 s). Mean LMMs duration was longer in NREM (median 12.7 s, IQR 11.1-15.2 s) versus REM sleep (median 10.3 s, IQR 8.0-13.5s), p < 0.001. LMMs associated with awakening increased with age (p = 0.029). LMMs indices in TST were higher in men than women (p = 0.018). LMMs indices correlated positively with N1 sleep percentage (ρ = 0.49, p < 0.001), arousal index (ρ = 0.40, p = 0.002), sleep stages shift index (ρ = 0.43, p < 0.001, apnea index (ρ = 0.36, p = 0.017), and video-visible movements indices (ρ = 0.45, p < 0.001), and negatively with N3 sleep (ρ = -0.38, p= 0.004) percentage. CONCLUSIONS This is the first study providing normative data on LMMs frequency in healthy adults. LMMs are a ubiquitous phenomenon often associated with other events. Correlation with arousals and respiratory events suggests a potential clinical significance of LMMs in adults that awaits further investigation.
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Affiliation(s)
- Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Cesari M, Ruzicka L, Högl B, Ibrahim A, Holzknecht E, Heidbreder A, Bergmann M, Brandauer E, Garn H, Kohn B, Stefani A. Improved automatic identification of isolated rapid eye movement sleep behavior disorder with a 3D time-of-flight camera. Eur J Neurol 2023; 30:2206-2214. [PMID: 37151137 PMCID: PMC10947372 DOI: 10.1111/ene.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Automatic 3D video analysis of the lower body during rapid eye movement (REM) sleep has been recently proposed as a novel tool for identifying people with isolated REM sleep behavior disorder (iRBD), but, so far, it has not been validated on unseen subjects. This study aims at validating this technology in a large cohort and at improving its performances by also including an analysis of movements in the head, hands and upper body. METHODS Fifty-three people with iRBD and 128 people without RBD (of whom 89 had sleep disorders considered RBD differential diagnoses) were included in the study. An automatic algorithm identified movements from 3D videos during REM sleep in four regions of interest (ROIs): head, hands, upper body and lower body. The movements were divided into categories according to duration: short (0.1-2 s), medium (2-15 s) and long (15-300 s). For each ROI and duration range, features were obtained from the identified movements. Logistic regression models using as predictors the features from one single ROI or a combination of ROIs were trained and tested in a 10-runs 10-fold cross-validation scheme on the task of differentiating people with iRBD from people without RBD. RESULTS The best differentiation was achieved using short movements in all four ROIs (test accuracy 0.866 ± 0.007, test F1 score = 0.783 ± 0.010). Single group analyses showed that people with iRBD were distinguished successfully from subjects with RBD differential diagnoses. CONCLUSIONS Automatic 3D video analysis might be implemented in clinical routine as a supportive screening tool for identifying people with RBD.
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Affiliation(s)
- Matteo Cesari
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Laurenz Ruzicka
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Birgit Högl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Abubaker Ibrahim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Melanie Bergmann
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Heinrich Garn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Bernhard Kohn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Ambra Stefani
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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10
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Stefani A, Serradell M, Holzknecht E, Gaig C, Ibrahim A, Marrero P, Cesari M, Pérez-Carbonell L, Brandauer E, Fernández-Arcos A, Bergmann M, Matos N, Santamaria J, Högl B, Iranzo A. Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods. Mov Disord 2023; 38:1000-1007. [PMID: 37147274 DOI: 10.1002/mds.29407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. OBJECTIVE The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. METHODS In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. RESULTS Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. CONCLUSIONS RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monica Serradell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Evi Holzknecht
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paula Marrero
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Matteo Cesari
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Pérez-Carbonell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Elisabeth Brandauer
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Fernández-Arcos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Melanie Bergmann
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuria Matos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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11
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Alava JJ, Jahnke A, Bergmann M, Aguirre-Martínez GV, Bendell L, Calle P, Domínguez GA, Faustman EM, Falman J, Kazmiruk TN, Klasios N, Maldonado MT, McMullen K, Moreno-Báez M, Öberg G, Ota Y, Price D, Shim WJ, Tirapé A, Vandenberg JM, Zoveidadianpour Z, Weis J. A Call to Include Plastics in the Global Environment in the Class of Persistent, Bioaccumulative, and Toxic (PBT) Pollutants. Environ Sci Technol 2023. [PMID: 37216429 DOI: 10.1021/acs.est.3c02476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Juan José Alava
- Ocean Pollution Research Unit & Nippon Foundation-Ocean Litter Project, Institute for the Oceans and Fisheries, University of British Columbia, AERL 2202 Main Mall, Vancouver V6T 1Z4, BC, Canada
- School of Resource and Environmental Management, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Annika Jahnke
- Department of Ecological Chemistry, Helmholtz Centre for Environmental Research-UFZ, Permoserstr. 15, Leipzig DE-04318, Germany
- Institute for Environmental Research, RWTH Aachen University, Aachen DE-52074, Germany
| | - Melanie Bergmann
- Alfred-Wegener-Institute Helmholtz-Zentrum für Polar- und Meeresforschung, Bremerhaven DE-16227570, Germany
| | - Gabriela V Aguirre-Martínez
- Química y Farmacia. Facultad de Ciencias de la Salud, Universidad Arturo Prat, Avenida Arturo Prat Chacón, Iquique 2120, Chile
| | - Leah Bendell
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Paola Calle
- Facultad de Ciencias de la Vida, ESPOL Polytechnic University, Escuela Superior Politécnica del Litoral, ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 00000, Ecuador
| | - Gustavo A Domínguez
- Facultad de Ciencias de la Vida, ESPOL Polytechnic University, Escuela Superior Politécnica del Litoral, ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 00000, Ecuador
| | - Elaine M Faustman
- Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite #100, Seattle 98105, Washington, United States
| | - Jill Falman
- Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite #100, Seattle 98105, Washington, United States
| | - Tamara N Kazmiruk
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Natasha Klasios
- Department of Zoology, University of British Columbia, Vancouver V6T 1Z4, BC, Canada
| | - Maria T Maldonado
- Earth, Ocean & Atmospheric Sciences, University of British Columbia, 2207 Main Mall, Vancouver BC V6T 1Z4, Canada
| | - Karly McMullen
- Ocean Pollution Research Unit & Nippon Foundation-Ocean Litter Project, Institute for the Oceans and Fisheries, University of British Columbia, AERL 2202 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Marcia Moreno-Báez
- The Fletcher School/Tufts Technology Services, Tufts University, 35 Lower Campus Rd, Medford 02155, Massachusetts, United States
| | - Gunilla Öberg
- Institute for Resources, Environment and Sustainability, University of British Columbia, AERL 2202 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Yoshitaka Ota
- Nippon Foundation Ocean Nexus Center, School of Marine and Environmental Affairs EarthLab, University of Washington, Box 355674, Seattle 98195-5674, Washington, United States
| | - Dana Price
- Ocean Pollution Research Unit & Nippon Foundation-Ocean Litter Project, Institute for the Oceans and Fisheries, University of British Columbia, AERL 2202 Main Mall, Vancouver V6T 1Z4, BC, Canada
| | - Won Joon Shim
- Korea Institute of Ocean Science and Technology (KIOST), Geoje 53201, Republic of Korea
- University of Science and Technology, Daejeon, 34113, South Korea
| | - Ana Tirapé
- Facultad de Ciencias de la Vida, ESPOL Polytechnic University, Escuela Superior Politécnica del Litoral, ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 00000, Ecuador
| | - Jessica M Vandenberg
- Nippon Foundation Ocean Nexus Center, School of Marine and Environmental Affairs EarthLab, University of Washington, Box 355674, Seattle 98195-5674, Washington, United States
| | - Zeinab Zoveidadianpour
- Ocean Pollution Research Unit & Nippon Foundation-Ocean Litter Project, Institute for the Oceans and Fisheries, University of British Columbia, AERL 2202 Main Mall, Vancouver V6T 1Z4, BC, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, BC, Canada
| | - Judith Weis
- Department of Biological Sciences, Rutgers University, Newark 07102, New Jersey, United States
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12
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Bergmann M, Allen S, Krumpen T, Allen D. High Levels of Microplastics in the Arctic Sea Ice Alga Melosira arctica, a Vector to Ice-Associated and Benthic Food Webs. Environ Sci Technol 2023; 57:6799-6807. [PMID: 37083047 PMCID: PMC10157888 DOI: 10.1021/acs.est.2c08010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Plastic pollution has become ubiquitous with very high quantities detected even in ecosystems as remote as Arctic sea ice and deep-sea sediments. Ice algae growing underneath sea ice are released upon melting and can form fast-sinking aggregates. In this pilot study, we sampled and analyzed the ice algaeMelosira arcticaand ambient sea water from three locations in the Fram Strait to assess their microplastic content and potential as a temporary sink and pathway to the deep seafloor. Analysis by μ-Raman and fluorescence microscopy detected microplastics (≥2.2 μm) in all samples at concentrations ranging from 1.3 to 5.7 × 104 microplastics (MP) m-3 in ice algae and from 1.4 to 4.5 × 103 MP m-3 in sea water, indicating magnitude higher concentrations in algae. On average, 94% of the total microplastic particles were identified as 10 μm or smaller in size and comprised 16 polymer types without a clear dominance. The high concentrations of microplastics found in our pilot study suggest thatM. arctica could trap microplastics from melting ice and ambient sea water. The algae appear to be a temporary sink and could act as a key vector to food webs near the sea surface and on the deep seafloor, to which its fast-sinking aggregates could facilitate an important mechanism of transport.
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Affiliation(s)
- Melanie Bergmann
- HGF-MPG Group for Deep Sea Ecology and Technology, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar- und Meeresforschung, 27570 Bremerhaven, Germany
| | - Steve Allen
- Ocean Frontiers Institute, Dalhousie University, B3H 4R2 Nova Scotia, Canada
| | - Thomas Krumpen
- Sea Ice Physics, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar- und Meeresforschung, 27570 Bremerhaven, Germany
| | - Deonie Allen
- School of Geography, Earth and Environmental Science, University of Birmingham, B15 2TT Birmingham, U. K
- School of Physical and Chemical Sciences, University of Canterbury, 8041 Christchurch, New Zealand
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13
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Bergmann M, Wanschitz J, Stefani A, Heidbreder A, Brandauer E, Cesari M, Löscher WN, Högl B. A prospective case-control study of excessive fragmentary myoclonus in the upper and lower extremities: Clinical characteristics and electrophysiological correlates. Sleep Med 2023; 106:84-89. [PMID: 37075530 DOI: 10.1016/j.sleep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Excessive fragmentary myoclonus (EFM) is an incidental finding in video-polysomnography (VPSG) and listed among "Sleep Related Movement Disorders - Isolated symptoms and normal variants" in the ICSD-3. We aimed to prospectively evaluate EFM in the upper and lower extremities in a large sleep laboratory cohort and to investigate clinical characteristics and peripheral nerve pathology in patients with and without EFM. METHODS Two-hundred consecutive sleep laboratory patients with EFM according to ICSD-3 criteria were included and matched to 100 patients without EFM for age, sex and presence or absence of sleep-related breathing disorder. Patients additionally underwent peripheral neurophysiological work-up. RESULTS In 31/200 (15.5%) patients EFM was present not only in the lower extremities, but also in the upper extremities. Patients with EFM had less REM sleep (%/SPT; median (IQR); 13.8 (9.1-18.2) vs. 17.1 (10.1-20.5); p = 0.008) and the PLMS-Index was higher in patients with EFM than in those without (16.2 vs. 8.8/h; p = 0.009). Polyneuropathy (PNP) and nerve root lesions L5 and S1 were more frequent in patients with than in those without EFM (31.5% vs. 21% and 5% vs. 0%; p = 0.003). CONCLUSIONS In this large cohort we systematically investigated upper and lower extremities with surface electromyography during sleep and show that EFM is much more frequent in the lower extremities than in the upper extremities and corroborate the association of EFM with peripheral nerve pathology and PLMS.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Austria.
| | - Julia Wanschitz
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Austria
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14
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Green DS, Almroth BC, Altman R, Bergmann M, Gündoğdu S, Warrier AK, Boots B, Walker TR, Krieger A, Syberg K. Time to kick the butt of the most common litter item in the world: Ban cigarette filters. Sci Total Environ 2023; 865:161256. [PMID: 36587695 DOI: 10.1016/j.scitotenv.2022.161256] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Cigarette filters offer no public health benefits, are single-use plastics (cellulose acetate) and are routinely littered. Filters account for a significant proportion of plastic litter worldwide, requiring considerable public funds to remove, and are a source of microplastics. Used cigarette filters can leech toxic chemicals and pose an ecological risk to both terrestrial and aquatic ecosystems. Bottom-up measures, such as focusing on consumer behaviour, are ineffective and we need to impose top-down solutions (i.e., bans) if we are to reduce the prevalence of this number one litter item. Banning filters offers numerous ecological, socioeconomic, and public health benefits.
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Affiliation(s)
- Dannielle S Green
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom
| | - Bethanie Carney Almroth
- Dept. of Biological and Environmental Sciences, University of Gothenburg, Box 463, 405 30 Göteborg, Sweden
| | - Rebecca Altman
- Independent Scholar, Providence, RI, United States of America
| | - Melanie Bergmann
- HGF-MPG Group for Deep-Sea Ecology and Technology, Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, 27568 Bremerhaven, Germany
| | - Sedat Gündoğdu
- Faculty of Fisheries, Cukurova University, 01330 Adana, Turkey
| | - Anish Kumar Warrier
- Centre for Climate Studies, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Bas Boots
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom
| | - Tony R Walker
- School for Resource and Environmental Studies, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kristian Syberg
- Dept. of Science and Environment, Roskilde University, 4000 Roskilde, Denmark.
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Cesari M, Heidbreder A, Gaig C, Bergmann M, Brandauer E, Iranzo A, Holzknecht E, Santamaria J, Högl B, Stefani A. Automatic analysis of muscular activity in the flexor digitorum superficialis muscles: a fast screening method for rapid eye movement sleep without atonia. Sleep 2023; 46:zsab299. [PMID: 34984464 PMCID: PMC9995778 DOI: 10.1093/sleep/zsab299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To identify a fast and reliable method for rapid eye movement (REM) sleep without atonia (RWA) quantification. METHODS We analyzed 36 video-polysomnographies (v-PSGs) of isolated REM sleep behavior disorder (iRBD) patients and 35 controls' v-PSGs. Patients diagnosed with RBD had: i) RWA, quantified with a reference method, i.e. automatic and artifact-corrected 3-s Sleep Innsbruck Barcelona (SINBAR) index in REM sleep periods (RSPs, i.e. manually selected portions of REM sleep); and ii) v-PSG-documented RBD behaviors. We quantified RWA with other (semi)-automated methods requiring less human intervention than the reference one: the indices proposed by the SINBAR group (the 3-s and 30-s phasic flexor digitorum superficialis (FDS), phasic/"any"/tonic mentalis), and the REM atonia, short and long muscle activity indices (in mentalis/submentalis/FDS muscles). They were calculated in whole REM sleep (i.e. REM sleep scored following international guidelines), in RSPs, with and without manual artifact correction. Area under curves (AUC) discriminating iRBD from controls were computed. Using published cut-offs, the indices' sensitivity and specificity for iRBD identification were calculated. Apnea-hypopnea index in REM sleep (AHIREM) was considered in the analyses. RESULTS RWA indices from FDS muscles alone had the highest AUCs and all of them had 100% sensitivity. Without manual RSP selection and artifact correction, the "30-s phasic FDS" and the "FDS long muscle activity" had the highest specificity (85%) with AHIREM < 15/h. RWA indices were less reliable when AHIREM≥15/h. CONCLUSIONS If AHIREM<15/h, FDS muscular activity in whole REM sleep and without artifact correction is fast and reliable to rule out RWA.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Cesari M, Egger K, Stefani A, Bergmann M, Ibrahim A, Brandauer E, Högl B, Heidbreder A. Differentiation of central disorders of hypersomnolence with manual and artificial-intelligence-derived polysomnographic measures. Sleep 2023; 46:6862127. [PMID: 36455881 DOI: 10.1093/sleep/zsac288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Differentiation of central disorders of hypersomnolence (DOH) is challenging but important for patient care. This study aimed to investigate whether biomarkers derived from sleep structure evaluated both by manual scoring as well as with artificial intelligence (AI) algorithms allow distinction of patients with different DOH. We included video-polysomnography data of 40 narcolepsy type 1 (NT1), 26 narcolepsy type 2 (NT2), 23 patients with idiopathic hypersomnia (IH) and 54 participants with subjective excessive daytime sleepiness (sEDS). Sleep experts manually scored sleep stages. A previously validated AI algorithm was employed to obtain automatic hypnograms and hypnodensity graphs (where each epoch is represented as a mixture of sleep stage probabilities). One-thousand-three features describing sleep architecture and instability were extracted from manual/automatic hypnogram and hypnodensity graphs. After feature selection, random forest classifiers were trained and tested in a 5-fold-cross-validation scheme to distinguish groups pairwise (NT1-vs-NT2, NT1-vs-IH, …) and single groups from the pooled remaining ones (NT1-vs-rest, NT2-vs-rest,…). The accuracy/F1-score values obtained in the test sets were: 0.74 ± 0.04/0.79 ± 0.05 (NT1-vs-NT2), 0.89 ± 0.09/0.91 ± 0.08 (NT1-vs-IH), 0.93 ± 0.06/0.91 ± 0.07 (NT1-vs-sEDS), 0.88 ± 0.04/0.80 ± 0.07 (NT1-vs-rest), 0.65 ± 0.10/0.70 ± 0.09 (NT2-vs-IH), 0.72 ± 0.12/0.60 ± 0.10 (NT2-vs-sEDS), 0.54 ± 0.19/0.38 ± 0.13 (NT2-vs-rest), 0.57 ± 0.11/0.35 ± 0.18 (IH-vs-sEDS), 0.71 ± 0.08/0.35 ± 0.10 (IH-vs-rest) and 0.76 ± 0.08/0.71 ± 0.13 (sEDS-vs-rest). The results confirm previous findings on sleep instability in patients with NT1 and show that combining manual and automatic AI-based sleep analysis could be useful for better distinction of NT2 from IH, but no precise sleep biomarker of NT2 or IH could be identified. Validation in a larger and multi-centric cohort is needed to confirm these findings.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kristin Egger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Dey T, Trasande L, Altman R, Wang Z, Krieger A, Bergmann M, Allen D, Allen S, Walker TR, Wagner M, Syberg K, Brander SM, Almroth BC. Global plastic treaty should address chemicals. Science 2022; 378:841-842. [DOI: 10.1126/science.adf5410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tridibesh Dey
- Department of Global Studies, Aarhus University, 8000 Aarhus C, Denmark
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | | | - Zhanyun Wang
- Swiss Federal Laboratories for Materials Science and Technology (EMPA), Technology and Society Laboratory, 9014 St. Gallen, Switzerland
| | | | - Melanie Bergmann
- Deep-Sea Ecology and Technology, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar-und Meeresforschung, 27570 Bremerhaven, Germany
| | - Deonie Allen
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch 8041, New Zealand
- School of Geography, Earth, and Environmental Sciences, University of Birmingham Edgbaston, Birmingham B15 2TT, UK
| | - Steve Allen
- Ocean Frontier Institute, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Tony R. Walker
- School for Resource and Environmental Studies, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Martin Wagner
- Department of Biology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kristian Syberg
- Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Susanne M. Brander
- Department of Fisheries, Wildlife, and Conservation Sciences, Coastal Oregon Marine Experiment Station, Oregon State University, OR 97333, USA
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Science, University of Gothenburg, 40530 Gothenburg, Sweden
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18
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Lauder L, Bergmann M, Paitazoglou C, Ozdemir R, Iliadis C, Bartunek J, Lauten A, Keller T, Weber S, Sievert H, Anker SD, Mahfoud F. Impact of atrial flow regulator implantation on survival in patients with heart failure with reduced and preserved ejection fraction: a post-hoc analysis of the PRELIEVE study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
This analysis aims to assess the theoretical impact of atrial flow regulator implantation on mortality by comparing the observed survival rate with the median predicted probability for one-year survival.
Methods
The prospective, multicentre, open-label, non-randomised PRELIEVE study assessed the safety and efficacy of the atrial flow regulator in patients with symptomatic HFrEF (left ventricular ejection fraction (LVEF) ≥15% and <40%) or HFpEF (LVEF ≥40% and <70%) and elevated PCWP (≥15mmHg at rest or ≥25mmHg during exercise). In this analysis, after the first 60 patients completed twelve months of follow-up, the theoretical impact of atrial flow regulator implantation on survival was assessed by comparing the observed mortality rate with the median predicted probability for one-year mortality. Each subject's risk of mortality was predicted from individual baseline data using the Meta-Analysis Global Group in Chronic HF (MAGGIC) prognostic model.
Results
A total of 87 patients had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete twelve-month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202–370). A total of six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (−9.3 deaths per 100 patient-years; 95% CI −11.1 to −8.4), there was no difference in patients with HFrEF (−3.6 deaths per 100 patient-years; 95% CI −9.5 to 3.0) (Figure 1). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup).
Conclusion
In patients with HFpEF, the mortality rate following atrial flow regulator implantation was lower than the predicted mortality rate. These findings need to be confirmed by larger randomised, controlled trials.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Occlutech International AB
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Affiliation(s)
- L Lauder
- University hospital of Saarland (UKS) , Homburg , Germany
| | - M Bergmann
- Cardiologicum Hamburg , Hamburg , Germany
| | - C Paitazoglou
- Schleswig-Holstein University Clinic, Lubeck Campus, University Heart Center Lübeck , Luebeck , Germany
| | - R Ozdemir
- Bezmialem University, Department of Cardiology , Istanbul , Turkey
| | - C Iliadis
- Heart Center at the University of Cologne, Department of Cardiology, Pulmonology, Angiology and Intensive Care Medicine , Cologne , Germany
| | - J Bartunek
- Olv Hospital Aalst, Cardiovascular Center , Aalst , Belgium
| | - A Lauten
- HELIOS Clinic Erfurt, Department of General and Interventional Cardiology , Erfurt , Germany
| | - T Keller
- ACOMED statistik , Leipzig , Germany
| | - S Weber
- ACOMED statistik , Leipzig , Germany
| | - H Sievert
- CardioVascular Center Frankfurt , Frankfurt , Germany
| | - S D Anker
- Berlin Institute of Health Center for Regenerative Therapies , Berlin , Germany
| | - F Mahfoud
- University hospital of Saarland (UKS) , Homburg , Germany
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19
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Botterell ZLR, Bergmann M, Hildebrandt N, Krumpen T, Steinke M, Thompson RC, Lindeque PK. Microplastic ingestion in zooplankton from the Fram Strait in the Arctic. Sci Total Environ 2022; 831:154886. [PMID: 35364160 DOI: 10.1016/j.scitotenv.2022.154886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Some of the highest microplastic concentrations in marine environments have been reported from the Fram Strait in the Arctic. This region supports a diverse ecosystem dependent on high concentrations of zooplankton at the base of the food web. Zooplankton samples were collected during research cruises using Bongo and MOCNESS nets in the boreal summers of 2018 and 2019. Using FTIR scanning spectroscopy in combination with an automated polymer identification approach, we show that all five species of Arctic zooplankton investigated had ingested microplastics. Amphipod species, found in surface waters or closely associated with sea ice, had ingested significantly more microplastic per individual (Themisto libellula: 1.8, Themisto abyssorrum: 1, Apherusa glacialis: 1) than copepod species (Calanus hyperboreus: 0.21, Calanus glacialis/finmarchicus: 0.01). The majority of microplastics ingested were below 50 μm in size, all were fragments and several different polymer types were present. We quantified microplastics in water samples collected at six of the same stations as the Calanus using an underway sampling system (inlet at 6.5 m water depth). Fragments of several polymer types and anthropogenic cellulosic fibres were present, with an average concentration of 7 microplastic particles (MP) L-1 (0-18.5 MP L-1). In comparison to the water samples, those microplastics found ingested by zooplankton were significantly smaller, highlighting that the smaller-sized microplastics were being selected for by the zooplankton. High levels of microplastic ingestion in zooplankton have been associated with negative effects on growth, development, and fecundity. As Arctic zooplankton only have a short window of biological productivity, any negative effect could have broad consequences. As global plastic consumption continues to increase and climate change continues to reduce sea ice cover, releasing ice-bound microplastics and leaving ice free areas open to exploitation, the Arctic could be exposed to further plastic pollution which could place additional strain on this fragile ecosystem.
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Affiliation(s)
- Zara L R Botterell
- Marine Ecology and Biodiversity, Plymouth Marine Laboratory, Prospect Place, West Hoe, Plymouth PL1 3DH, UK; School of Life Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Melanie Bergmann
- HGF-MPG Joint Research Group for Deep-Sea Ecology and Technology, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar - und Meeresforschung, Am Handelshafen 12, 27570 Bremerhaven, Germany
| | - Nicole Hildebrandt
- HGF-MPG Joint Research Group for Deep-Sea Ecology and Technology, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar - und Meeresforschung, Am Handelshafen 12, 27570 Bremerhaven, Germany
| | - Thomas Krumpen
- Climate Sciences, Sea Ice Physics, Alfred-Wegener-Institut Helmholtz-Zentrum für Polar - und Meeresforschung, Bussestraße 24, 27570 Bremerhaven, Germany
| | - Michael Steinke
- School of Life Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Richard C Thompson
- Marine Biology and Ecology Research Centre (MBERC), School of Biological and Marine Sciences, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Penelope K Lindeque
- Marine Ecology and Biodiversity, Plymouth Marine Laboratory, Prospect Place, West Hoe, Plymouth PL1 3DH, UK.
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20
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Kohn B, Ruzicka L, Hogl B, Ibrahim A, Garn H, Heidbreder A, Bergmann M, Brandauer E, Holzknecht E, Stefani A, Cesari M. TeaSpam: A Novel Method of TEmporal And SPAtial Movement Encoding during Sleep. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:4222-4225. [PMID: 36085969 DOI: 10.1109/embc48229.2022.9871521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Movements during sleep characterize sleep disorders, which can disturb sleep or its onset, impacting sleep quantity and quality. Video-polysomnography is the current gold standard to assess movements during sleep, but its availability is limited. Using data recorded with a 3D time of flight sensor, we developed a novel method of encoding temporal and spatial information of automatically identified movements during sleep. In a cohort of 20 insomnia patients and 18 controls, we showed that this novel method holds important information able to discriminate the groups. Future studies will explore the methodology in the context of other sleep disorders.
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21
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Paulsen N, Ewertz M, Bergmann T, Holm H, Feddersen S, Fruekilde P, Vojdeman F, Nielsen H, Qvortrup C, Plomgaard P, Bertelsen B, Rossing C, Andersen S, Greibe E, Hoffmann-Lücke E, Ramlov A, Nielsen C, Lolas I, Bøttger P, Bergmann M, Pfeiffer P, Damkier P. SO-29 Dihydropyrimidine dehydrogenase (DPD) genotype and phenotype among Danish cancer patients: Prevalence and correlation between DPYD-genotype mutations and P-uracil concentrations. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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22
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Betts TR, Grygier M, Nielsen-Kudsk JE, Schmitz T, Sandri M, Casu G, Bergmann M, Hildick-Smith D, Christen T, Allocco DJ. One-year results from the FLXibility post-approval study: final real-world clinical outcomes with a next-generation left atrial appendage closure device. Europace 2022. [DOI: 10.1093/europace/euac053.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific Corporation, Marlborough, MA, USA
Background
The WATCHMAN FLX left atrial appendage (LAA) closure device received CE-mark and FDA approval based on the results of the PINNACLE FLX IDE study, but evidence of outcomes with this next-generation device in everyday clinical practise is limited.
Purpose
The FLXibility Post-Approval Study collected real-world data on patients implanted with a WATCHMAN FLX in a routine clinical practise.
Methods
Patients were implanted with a WATCHMAN FLX per local standard of care, with a subsequent first follow-up visit from 45-120 days post-implant and a final follow-up at 1 year post procedure. A Clinical Event Committee adjudicated all major adverse events and TEE/CT imaging results were adjudicated by a core laboratory.
Results
Among 300 patients enrolled at 17 centres in Europe, the mean age was 74.6±8.0 years, mean CHA2DS2-VASc score was 4.3±1.6, mean HAS-BLED score was 2.6±1.0, and 62.1% were male. The device was successfully implanted in 99.0% (297/300) of patients; 97.0% (289/298) required only 1 device for an implantation attempt and no patient required >2 devices. TEE was used for 78% of procedures and ICE for 22%. The post-implant medication regimen was DAPT for 87.3% (262/300). At first follow-up, among 170 patients with evaluable imaging, 87.6% (149/170) had no leak, 12.4% (21/170) had leak >0mm to ≤5mm with 16 (9.4%) of these <3mm, and no patient had leak >5mm, per core lab adjudication. At 1 year, 93.3% (280/300) patients had final follow-up or death. At final follow-up, 61% of patients were on a single antiplatelet medication, 21% were on DAPT, 6% were on a direct oral anticoagulation medication, and 12% were not taking any antiplatelet/anticoagulation medication. One-year all-cause mortality was 10.8% (32/295), among which 5.1% (15/295) were cardiovascular or unexplained. Disabling stroke occurred in 1.0% (3/295) of patients and nondisabling stroke also in 1.0% (3/295) of patients; all were nonfatal. No patient experienced a systemic embolism. Device-related thrombus was detected in 2.4% (7/295) patients. Pericardial effusion requiring surgery or pericardiocentesis occurred in 1.0% (3/295), with all of these events occurring in the first 7 days post-procedure. Cumulative BARC-3 or -5 bleeding occurred in 3.7% (11/300) of patients from 0 to 7 days, in 7.3% (22/300) at 6 months, and in 8.1% (24/295) patients at 1 year. One patient (0.3%) had a peri-procedural device embolisation, with no subsequent device embolisations or any device migration reported for any patient through 1 year.
Conclusions
The WATCHMAN FLX device had excellent procedural success rates, with high effective LAA closure rates and low serious adverse event rates in everyday clinical practise.
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Affiliation(s)
- TR Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Grygier
- University Hospital of Lords Transfiguration, Poznan, Poland
| | | | - T Schmitz
- Elisabeth Krankenhaus Essen, Essen, Germany
| | - M Sandri
- Herzzentrum Universitat Leipzig, Leipzig, Germany
| | - G Casu
- Sassari University Hospital, Sassari, Italy
| | | | - D Hildick-Smith
- Royal Sussex County Hospital, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - T Christen
- Boston Scientific Corporation, Marlborough, United States of America
| | - DJ Allocco
- Boston Scientific Corporation, Marlborough, United States of America
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23
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Bergmann M, Almroth BC, Brander SM, Dey T, Green DS, Gundogdu S, Krieger A, Wagner M, Walker TR. A global plastic treaty must cap production. Science 2022; 376:469-470. [PMID: 35482877 DOI: 10.1126/science.abq0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Melanie Bergmann
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, D-27570 Bremerhaven, Germany
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Susanne M Brander
- Department of Fisheries, Wildlife, and Conservation Sciences, Coastal Oregon Marine Experiment Station, Oregon State University, Corvallis, OR 97331, USA
| | - Tridibesh Dey
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, Exeter EX4 4PY, UK
| | - Dannielle S Green
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Sedat Gundogdu
- Faculty of Fisheries, Cukurova University, 01330 Adana, Turkey
| | | | - Martin Wagner
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tony R Walker
- School for Resource and Environmental Studies, Dalhousie University, Halifax, NS B3H 4R2, Canada
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24
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Högl B, Arnulf I, Bergmann M, Cesari M, Gan-Or Z, Heidbreder A, Iranzo A, Krohn L, Luppi PH, Mollenhauer B, Provini F, Santamaria J, Trenkwalder C, Videnovic A, Stefani A. Rapid eye movement sleep behaviour disorder: Past, present, and future. J Sleep Res 2022; 31:e13612. [PMID: 35470494 PMCID: PMC9541438 DOI: 10.1111/jsr.13612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
This manuscript presents an overview of REM sleep behaviour disorder (RBD) with a special focus on European contributions. After an introduction examining the history of the disorder, we address the pathophysiological and clinical aspects, as well as the diagnostic issues. Further, implications of RBD diagnosis and biomarkers are discussed. Contributions of European researchers to this field are highlighted.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - Melanie Bergmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Anna Heidbreder
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Lynne Krohn
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Pierre-Hervé Luppi
- Centre of Neuroscience of Lyon, UMR 5292 CNRS/U1028 INSERM, Lyon, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Federica Provini
- IRCCS Institute of Neurological Sciences, UOC NeuroMet, Bellaria Hospital, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Claudia Trenkwalder
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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25
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Bergmann M, Brandauer E, Stefani A, Heidbreder A, Unterberger I, Högl B. The additional diagnostic benefits of performing both video-polysomnography and prolonged video-EEG-monitoring: when and why. Clin Neurophysiol Pract 2022; 7:98-102. [PMID: 35330982 PMCID: PMC8938868 DOI: 10.1016/j.cnp.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022] Open
Abstract
Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are indicated for different suspected diagnoses. Here, we report on 109 patients who underwent both, VPSG and pVEEG-M, within a 10 year period. Both examinations were performed in case of comorbidities, to achieve a final diagnosis or to refute differential diagnoses.
Objective Video-polysomnography (VPSG) and prolonged video-EEG-monitoring (pVEEG-M) are neurophysiological investigation modalities. Depending on indication either is performed, but occasionally patients undergo both (during the same or separate stays). We sought to assess the reasons and potential benefits of dual diagnostic assessments with both modalities. Methods A retrospective chart-review was performed to identify patients who underwent both VPSG and pVEEG-M during the 10 year period between 2007 and 2017. One-hundred-nine patients were identified who had undergone both studies. Patients were grouped according to indication and outcome. Results One-hundred-nine patients had both, a VPSG and pVEEG-M, in 62 (56.9%) the studies were performed because of separate diagnoses independent from each other. In 47 patients (43.1%) investigation with both modalities was needed to clarify the suspected diagnosis or to refute differential diagnoses. Out of these 47, 11 (10.1% of the whole group) arrived a new final diagnosis whereas in 36 (33%) the primary diagnosis was corroborated with the second modality. Conclusions In the majority of cases VPSG plus pVEEG-M were indicated to diagnose or monitor different comorbid diseases (e.g. sleep-related breathing disorder and epilepsy). In the other cases, performing both modalities was useful to achieve a higher diagnostic accuracy or to refute differential diagnoses. Significance VPSG and pVEEG-M are neurophysiological investigations which complement each other, especially in case of two different comorbid diseases in a single patient, to rule out differential diagnosis or when a higher diagnostic certainty is seeked.
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26
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Warmbier J, Lüdecke DK, Flitsch J, Buchfelder M, Fahlbusch R, Knappe UJ, Kreutzer J, Buslei R, Bergmann M, Heppner F, Glatzel M, Saeger W. Typing of inflammatory lesions of the pituitary. Pituitary 2022; 25:131-142. [PMID: 34463941 PMCID: PMC8821060 DOI: 10.1007/s11102-021-01180-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distinguished, with secondary types occurring more frequently (75.1%) than idiopathic inflammatory lesions (15.4%). In primary inflammation, the lymphocytic type is more common (88.5%) than the granulomatous type of hypophysitis (11.5%). The most common causes of secondary inflammation are Rathke's cleft cysts (48.6%), followed by tumors (17.4%) such as the craniopharyngioma (9.1%), adenoma (5.5%) or germinoma (2.0%). More causes are tumor-like lesions (7.1%) such as xanthogranuloma (3.5%) or Langerhans histiocytosis (3.5%), abscesses (5.5%), generalized infections (5.1%), spreaded inflammations (4.7%) and previous surgeries (4.0%). In 1.6% of all specimens the reason for the inflammation remains unclear. The described classification of hypophysitis is important for specific treatment planning after surgery.
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Affiliation(s)
- J. Warmbier
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - D. K. Lüdecke
- grid.13648.380000 0001 2180 3484Clinic of Neurosurgery of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - J. Flitsch
- grid.13648.380000 0001 2180 3484Clinic of Neurosurgery of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - M. Buchfelder
- grid.5330.50000 0001 2107 3311Clinic of Neurosurgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - R. Fahlbusch
- grid.419379.10000 0000 9724 1951International Neuroscience Institute (INI), Rudolf-Pichelmayr-Str. 4, 30625 Hannover, Germany
| | - U. J. Knappe
- grid.5570.70000 0004 0490 981XDepartment of Neurosurgery, Johannes-Wesling-Klinikum Minden, Ruhr-University Bochum (RUB), 32429 Minden, Germany
| | - J. Kreutzer
- Praxis for Neurosurgery, 90941 Nuremberg, Germany
| | - R. Buslei
- grid.419802.60000 0001 0617 3250Institute of Pathology, SozialStiftung Bamberg, 96049 Bamberg, Germany
| | - M. Bergmann
- grid.419807.30000 0004 0636 7065Institute of Neuropathology, Klinikum Bremen-Mitte, 28205 Bremen, Germany
| | - F. Heppner
- grid.6363.00000 0001 2218 4662Institute of Neuropathology of the Humboldt University of Berlin, Charitè, 10117 Berlin, Germany
| | - M. Glatzel
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
| | - W. Saeger
- grid.13648.380000 0001 2180 3484Institute of Neuropathology of the University of Hamburg, UKE, 20246 Hamburg, Germany
- grid.13648.380000 0001 2180 3484Institutes of Pathology and Neuropathology of the University of Hamburg, UKE, Martinistraße 52, 20246 Hamburg, Germany
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Heim B, Ellmerer P, Stefani A, Bergmann M, Brandauer E, Seppi K, Högl B, Djamshidian A. Factors associated with augmentation in patients with restless legs syndrome. Eur J Neurol 2021; 29:1227-1231. [PMID: 34923723 PMCID: PMC9303546 DOI: 10.1111/ene.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Abstract
Background and purpose Augmentation is a paradoxical reaction mainly to dopaminergic medication in patients with restless legs syndrome (RLS), but the exact pathomechanism remains unclear. The aim of this study was to identify factors associated with augmentation in RLS patients. Methods RLS patients with and without current or previous augmentation were recruited. Demographic characteristics, history of smoking, questionnaires for depression, alexithymia, and impulsivity, and RLS severity were obtained. Results We included 122 patients, of whom half had a history of augmentation. Patients with augmentation had a longer disease duration (p = 0.001), had higher RLS severity scores (p = 0.013), had higher levodopa equivalent doses (p < 0.001), had higher scores for alexithymia (p = 0.028), had higher prevalence of impulse control disorders (p < 0.001), more often had a history of smoking (p = 0.039), were more often currently smoking (p = 0.015), and had more average pack‐years (p = 0.016). Conclusions Here, we describe several factors commonly associated with augmentation in RLS. These may help clinicians to screen and treat patients carefully to avoid the challenging side effect of augmentation.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Cesari M, Kohn B, Holzknecht E, Ibrahim A, Heidbreder A, Bergmann M, Brandauer E, Hogl B, Garn H, Stefani A. Automatic 3D Video Analysis of Upper and Lower Body Movements to Identify Isolated REM Sleep Behavior Disorder: A Pilot Study . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:7050-7053. [PMID: 34892726 DOI: 10.1109/embc46164.2021.9630011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment, abnormal jerks and movements during REM sleep. Isolated RBD (iRBD) is recognized as the early stage of alpha-synucleinopathies, i.e. dementia with Lewy bodies, Parkinson's disease and multiple system atrophy. The certain diagnosis of iRBD requires video-polysomnography, evaluated by experts with time-consuming visual analyses. In this study, we propose automatic analysis of movements detected with 3D contactless video as a promising technology to assist sleep experts in the identification of patients with iRBD. By using automatically detected upper and lower body movements occurring during REM sleep with a duration between 4s and 5s, we could discriminate 20 iRBD patients from 24 patients with sleep-disordered breathing with an accuracy of 0.91 and F1-score of 0.90. This pilot study shows that 3D contactless video can be successfully used as a non-invasive technology to assist clinicians in identifying abnormal movements during REM sleep, and therefore to recognize patients with iRBD. Future investigations in larger cohorts are needed to validate the proposed technology and methodology.
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29
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Holzknecht E, Domahs F, Brandauer E, Bergmann M, Zengin T, Delazer M, Hochleitner M, Högl B, Stefani A. Language analysis of spontaneous descriptions of restless legs syndrome: Gender differences? J Sleep Res 2021; 31:e13433. [PMID: 34240501 PMCID: PMC9285969 DOI: 10.1111/jsr.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
Patients with restless legs syndrome (RLS) use various terms when describing their symptoms. Whether gender might influence this has not been investigated so far. The aim of this study was to evaluate possible gender differences in spontaneous descriptions of RLS symptoms. This prospective study, conducted in 100 consecutive German‐speaking RLS patients, used a single standardized question. Answers were digitally recorded and transcribed. A content‐related linguistic analysis of the transcripts was performed by two independent blinded raters. The lengths of the answers and content‐related linguistic features were compared between women and men. Ninety‐eight patients were included in the final analysis, 59 women (60.2%) and 39 men (39.8%), with a median age of 62 (23–94) and 63 (31–82) years, respectively (p = 0.602). Demographic and clinical features, including educational level and RLS treatment class, did not differ between genders (p > 0.05). Total word or sentence count showed no gender differences (p = 0.159 and 0.259, respectively), although men used more words per sentence than women (p = 0.018). More men than women described quiescegenic (i.e., triggered by rest or inactivity) symptoms (p = 0.006) and successful attempts at relief (p = 0.039). There was a non‐significant trend toward a more frequent use of the first‐person perspective in men (median times used = 5 [0–10.5] vs. 3.8 [0–17.5], p = 0.068). The more frequent mention of quiescegenic symptoms and successful attempts at relief in men could indicate differences in phenotypic presentation of RLS between genders, a more precise description of RLS symptoms or a higher experience of self‐efficacy in men compared to women.
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Affiliation(s)
- Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tugba Zengin
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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30
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Bergmann M, Heidbreder A, Stefani A, Raccagni C, Brandauer E, Rudzki D, Fischer MB, Rossmanith E, Pasztorek M, Löscher WN, Högl B, Wanschitz JV. Signs of sympathetic and endothelial cell activation in the skin of patients with restless legs syndrome. Sleep Med 2021; 84:227-236. [PMID: 34174707 DOI: 10.1016/j.sleep.2021.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate skin biopsies of patients with early- and late onset restless legs syndrome (RLS) for concomitant small fiber neuropathy (SFN) and to determine cutaneous sympathetic innervation and microvascularization in comparison to healthy individuals. METHODS Density of intraepidermal nerve fibers (IENFD), adrenergic nerve fibers and dermal capillaries was analyzed by immunofluorescence for PGP9.5, tyrosine hydroxylase and endothelial markers CD31 and CD105 in skin biopsies of 11 individuals with RLS and 8 age- and sex-matched controls. RESULTS IENFD did not differ between RLS and controls, but two RLS patients with comorbid impaired glucose metabolism fulfilled morphometric criteria of SFN according to published normative values. In contrast, dermal nerve bundles of RLS patients showed an increased density of tyrosine hydroxylase+ adrenergic nerve fibers (p < 0.005). Moreover, an increased ratio between immature CD105+ and mature CD31+ endothelial cells within dermal capillaries was observed in RLS (p < 0.02). CONCLUSIONS SFN, as a potential contributing factor for RLS, should be considered in patients with predisposing comorbidities presenting with burning or shooting pain, dysesthesias and impaired sensory and temperature perception. Evidence of an increased adrenergic innervation of the skin in RLS patients is in accordance with sympathetic hyperactivity while signs of endothelial cell activation may reflect an adaptive response to tissue hypoxia.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria; Department of Neurology, Regional General Hospital, Bolzano, 39100, Italy
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Dagmar Rudzki
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Michael B Fischer
- Department for Health Science and Biomedicine, Danube University Krems, Krems, 3500, Austria; Clinic for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, 1090, Austria
| | - Eva Rossmanith
- Department for Health Science and Biomedicine, Danube University Krems, Krems, 3500, Austria
| | - Markus Pasztorek
- Department for Health Science and Biomedicine, Danube University Krems, Krems, 3500, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Julia V Wanschitz
- Department of Neurology, Medical University of Innsbruck, Innsbruck, 6020, Austria.
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Bergmann M, Zablotski Y, Rieger A, Speck S, Truyen U, Hartmann K. Comparison of four commercially available point-of-care tests to detect antibodies against canine distemper virus in dogs. Vet J 2021; 273:105693. [PMID: 34148608 DOI: 10.1016/j.tvjl.2021.105693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Pre-vaccination antibody testing to determine dogs' immunity against canine distemper virus (CDV) is increasingly used. Four point-of-care tests (POC A-D) are available in Europe, but their diagnostic accuracy has not been compared. The study evaluated the diagnostic accuracy and usability of these tests. Sera of client-owned dogs (n = 198; healthy n = 22; unhealthy dogs n = 176) and specific pathogen-free (SPF) dogs (n = 40) were included. Virus neutralisation (VN) was performed as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) were determined. McNemar's test was used to determine significant differences between specificity and sensitivity of the tests and Cohen's kappa was used to assess agreement. The prevalence of anti-CDV antibodies by VN was 80% in client-owned dogs overall, with 100% prevalence in healthy dogs, and 0% in SPF dogs. POC-C and POC-D were considered easiest to perform. Specificity of all tests was high using sera from SPF dogs (88-100%). In healthy dogs, sensitivity was variable (45-98%). Specificity was low in all four POC tests when using sera from acutely ill dogs (6-53%) and clinically healthy dogs with chronic disease (5-77%). In client-owned dogs, including healthy and unhealthy dogs, agreement was poor between tests. All POC tests had a low specificity when investigating sera from ill client-owned dogs and usefullness of these tests especially in dogs that are acutely ill or have chronic disease is not supported by this study.
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Affiliation(s)
- M Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany.
| | - Y Zablotski
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - A Rieger
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - S Speck
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103 Leipzig, Germany
| | - U Truyen
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103 Leipzig, Germany
| | - K Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
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Cesari M, Heidbreder A, Bergmann M, Holzknecht E, Högl B, Stefani A. Flexor digitorum superficialis muscular activity is more reliable than mentalis muscular activity for rapid eye movement sleep without atonia quantification. Sleep 2021; 44:6220466. [PMID: 33842971 DOI: 10.1093/sleep/zsab094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/17/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To evaluate interrater reliability for artefact correction in the context of semi-automated quantification of rapid eye movement (REM) sleep without atonia (RWA) in the mentalis and flexor digitorum superficialis (FDS) muscles. METHODS We included video-polysomnographies of 14 subjects with apnea-hypopnea-index in REM sleep (AHIREM)<15/h and 11 subjects with AHIREM≥15/h. Eight subjects had isolated REM sleep behavior disorder. A validated algorithm (www.osg.be) automatically scored phasic and "any" EMG activity in the mentalis muscle, and phasic EMG activity in the FDS muscles. Four independent expert scorers performed artefact correction according to the SINBAR (Sleep Innsbruck Barcelona) recommendations. Interrater reliability for artefact correction was computed with B-statistics. The variability across scorers of four RWA indices (phasic mentalis, "any" mentalis, phasic FDS and SINBAR - i.e. "any" mentalis and/or phasic FDS - EMG activity indices) was computed. With Friedman tests we compared B-statistics obtained for mentalis and FDS muscles, and the variability of the RWA indices. Influence of AHIREM and RBD diagnosis on the RWA indices variability was evaluated with linear regressions. RESULTS Interrater reliability for artefact correction was higher in the FDS than in the mentalis muscle (p<0.001). Phasic FDS activity was minimally affected by artefacts. Accordingly, the phasic FDS EMG activity index had the lowest variability across scorers (p<0.001). Variability across scorers of the RWA indices including the mentalis muscle increased with AHIREM and was independent from RBD diagnosis. CONCLUSIONS Due to the consistently found low number of artefacts, phasic FDS activity is a reliable measure of RWA.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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33
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Sringean J, Stefani A, Marini K, Bergmann M, Werkmann M, Holzknecht E, De Marzi R, Brandauer E, Hackner H, Djamshidian A, Stockner H, Gaig C, Iranzo A, Santamaria J, Tolosa E, Seppi K, Poewe W, Högl B. REM Sleep Behavior Disorder and REM Sleep Without Atonia are More Frequent in Advanced versus Early Parkinson's Disease. Sleep 2021; 44:6171208. [PMID: 33720377 DOI: 10.1093/sleep/zsab067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/09/2021] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES To evaluate macro sleep architecture and characterize REM sleep without atonia (RWA) by using the SINBAR EMG montage including mentalis and upper extremity muscles in early and advanced Parkinson's disease (PD). METHODS We recruited 30 patients with early- and advanced-stage of PD according to Movement Disorder Society (MDS) Clinical Diagnostic Criteria. Participants were classified as early-stage PD if they were treatment-naïve or had no motor complications and had been diagnosed with PD within the previous 6 years. Advanced PD was defined as a disease duration equal to or more than 6 years with or without motor complications. RESULTS There was significantly shorter REM sleep latency in early as compared to advanced stage of PD. We found that the SINBAR EMG index and tonic EMG activity of the mentalis muscle in advanced-stage PD were significantly higher than in early-stage PD with a trend in phasic EMG activity of the flexor digitorum superficialis muscles. The SINBAR EMG index, tonic and any EMG activity of the mentalis muscle, and phasic EMG activity of flexor digitorum superficialis muscles significantly correlated with disease duration. CONCLUSIONS This study analyzed RWA using the SINBAR EMG montage in early- and advanced-stage of PD and showed higher RWA in mentalis and flexor digitorum superficialis muscles and SINBAR EMG index in advanced-PD patients compared to patients in the early stage. Also, PSG-confirmed RBD was more common in advanced versus early-stage patients. Our findings suggest that RWA worsens or is more intense or more frequent with disease progression.
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Affiliation(s)
- Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Chulalongkorn University, Bangkok, Thailand.,Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Marini
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Mario Werkmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Roberto De Marzi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Heinz Hackner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Carles Gaig
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.,Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alex Iranzo
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.,Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joan Santamaria
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.,Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Eduardo Tolosa
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.,Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Barbieri F, Adukauskaite A, Heidbreder A, Brandauer E, Bergmann M, Stefani A, Holzknecht E, Senoner T, Rubatscher A, Schgör W, Stühlinger M, Pfeifer BE, Bauer A, Hintringer F, Högl B, Dichtl W. Central Sleep Apnea and Pacing-Induced Cardiomyopathy. Am J Cardiol 2021; 139:97-104. [PMID: 33002463 DOI: 10.1016/j.amjcard.2020.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/13/2023]
Abstract
The role of central sleep apnea (CSA) in pacing-induced cardiomyopathy (PICM) remains speculative. In a prospective trial entitled UPGRADE, the presence of CSA was assessed by single-night polysomnography (PSG) in 54 PICM patients within 1 month after left ventricular lead implantation (with biventricular stimulation still not activated). CSA was diagnosed in half of patients (n = 27). Patients with moderate or severe CSA were randomized to cardiac resynchronization therapy (CRT) versus right ventricular pacing (RVP) in a double-blinded cross-over design and re-scheduled for a follow-up PSG within 3 to 5 months. After crossing-over of stimulation mode another PSG was conducted 3 to 5 months later. CRT led to a significant increase in left ventricular ejection fraction and significant reduction in left ventricular end systolic volumes and N-terminal pro brain natriuretic peptide plasma levels, whereas no significant effects were observed with ongoing RVP. CSA was significantly improved after 3.9 (3.2 to 4.4) months of CRT: apnea-hypopnea index decreased from 39.1 (32.1 to 54.0) events per hour at baseline to 22.2/h (10.9 to 36.7) by CRT (p <0.001). Central apnea index decreased from 27.1/h (17.7 to 36.1) at baseline to 6.8/h (1.1 to 14.4) after CRT activation (p <0.001). Ongoing RVP yielded only a minor improvement in apnea-hypopnea index and central apnea index. Pre-existent CSA did not affect structural response rate and had no impact on mid-term follow-up (median 2.8 years). In conclusion, CSA is highly prevalent in patients with PICM. CRT upgrading significantly improves CSA leading to a similar outcome in PICM patients without pre-existent CSA.
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Affiliation(s)
- Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Rubatscher
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wilfried Schgör
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Stühlinger
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria; Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
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Bergmann M, Germann CP, Nordmeyer J, Peters B, Berger F, Schubert S. Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients. Pediatr Cardiol 2021; 42:78-88. [PMID: 33009919 PMCID: PMC7864847 DOI: 10.1007/s00246-020-02456-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Interventional closure of congenital ventricular septal defects (VSD) is recording a continuous rise in acceptance. Complete atrioventricular block (cAVB) and residual shunting are major concerns during follow-up, but long-term data for both are still limited. We retrospectively evaluated the outcome of patients with interventional VSD closure and focused on long-term results (> 1 year follow-up). Transcatheter VSD closures were performed between 1993 and 2015, in 149 patients requiring 155 procedures (104 perimembranous, 29 muscular, 19 residual post-surgical VSDs, and 3 with multiple defects). The following devices were used: 65 × Amplatzer™ Membranous VSD Occluder, 33 × Duct Occluder II, 27 × Muscular VSD Occluder, 3 × Duct Occluder I, 24 × PFM-Nit-Occlud®, and 3 × Rashkind-Occluder. The median age at time of implantation was 6.2 (0.01-66.1) years, median height 117 (49-188) cm, and median weight 20.9 (3.2-117) kg. Median follow-up time was 6.2 (1.1-21.3) years and closure rate was 86.2% at last follow-up. Complications resulting in device explantation include one case of cAVB with a Membranous VSD occluder 7 days after implantation and four cases due to residual shunt/malposition. Six (4%) deaths occurred during follow-up with only one procedural related death from a hybrid VSD closure. Overall, our reported results of interventional VSD closure show favorable outcomes with only one (0.7%) episode of cAVB. Interventional closure offers a good alternative to surgical closure and shows improved performance by using softer devices. However, prospective long-term data in the current era with different devices are still mandatory to assess the effectiveness and safety of this procedure.
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Affiliation(s)
- M. Bergmann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. P. Germann
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Nordmeyer
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Peters
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Berger
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Schubert
- grid.418209.60000 0001 0000 0404Department of Pediatric Cardiology and Congenital Heart Diseases, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418457.b0000 0001 0723 8327Clinic for Pediatric Cardiology and Congenital Heart Defects, Herz- Und Diabeteszentrum NRW, Ruhr University of Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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Ledwoch J, Sievert K, Boersma L, Bergmann M, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov A, Betts T, Mazzone P, Sievert H. Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence regarding post-procedural antithrombotic regimes other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited.
Purpose
The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study.
Methods
A total of 998 patients with successful WATCHMAN implantation at 47 centers were available for the present analysis. The composite ischemic endpoint of stroke, TIA, systemic embolism and device thrombus as well as the bleeding endpoint defined as at least major bleeding according to BARC were assessed during an initial period (from implant until first medication change) and long-term period (from first change until up to 2 years).
Results
The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7% and no medication in 6%. In the long-term phase SAPT was used in 65%, DAPT in 23%, no therapy in 8% and OAC in 4%. No significant differences were found between the groups regarding the ischemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy; p=0.97) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy; p=0.36). With respect to bleeding events the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy (1.0% for DAPT vs. 0.8% for OAC vs. 7.4% for SAPT or no therapy; p=0.01). No differences in bleeding complications were observed during the second period (2.6% for SAPT vs. 2.9% for DAPT vs. 2.2% for no therapy; p=0.88).
Conclusions
Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischemic complications after LAA closure.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- J Ledwoch
- Klinikum Neuperlach, Munich, Germany
| | - K Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - L Boersma
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | | | - H Ince
- Vivantes Klinikum Am Urban, Berlin, Germany
| | - S Kische
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - T Gori
- Johannes Gutenberg University Mainz (JGU), Mainz, Germany
| | - F Meincke
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Protopopov
- Krasnoyarsk regional hospital, Krasnoyarsk, Russian Federation
| | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
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Bergmann M, Prieschl M, Stefani A, Heidbreder A, Walser G, Frauscher B, Unterberger I, Högl B. A prospective controlled study about sleep disorders in drug resistant epilepsy. Sleep Med 2020; 75:434-440. [DOI: 10.1016/j.sleep.2020.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
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Indumathy S, Pueschl D, Klein B, Fietz D, Bergmann M, Schuppe HC, Da Silva N, Loveland BE, Hickey MJ, Hedger MP, Loveland KL. Testicular immune cell populations and macrophage polarisation in adult male mice and the influence of altered activin A levels. J Reprod Immunol 2020; 142:103204. [PMID: 33130539 DOI: 10.1016/j.jri.2020.103204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Detailed morphological characterization of testicular leukocytes in the adult CX3CR1 gfp/+ transgenic mouse identified two distinct CX3CR1 + mononuclear phagocyte (macrophage and dendritic cell) populations: stellate/dendriform cells opposed to the seminiferous tubules (peritubular), and polygonal cells associated with Leydig cells (interstitial). Using confocal microscopy combined with stereological enumeration of CX3CR1gfp/+ cells established that there were twice as many interstitial cells (68%) as peritubular cells (32%). Flow cytometric analyses of interstitial cells from mechanically-dissociated testes identified multiple mononuclear phagocyte subsets based on surface marker expression (CX3CR1, F4/80, CD11c). These cells comprised 80% of total intratesticular leukocytes, as identified by CD45 expression. The remaining leukocytes were CD3+ (T lymphocytes) and NK1.1+ (natural killer cells). Functional phenotype assessment using CD206 (an anti-inflammatory/M2 marker) and MHC class II (an activation marker) identified a potentially tolerogenic CD206+MHCII+ sub-population (12% of total CD45+ cells). Rare testicular subsets of CX3CR1 +CD11c+F4/80+ (4.3%) mononuclear phagocytes and CD3+NK1.1+ (3.1%) lymphocytes were also identified for the first time. In order to examine the potential for the immunoregulatory cytokine, activin A to modulate testicular immune cell populations, testes from adult mice with reduced activin A (Inhba+/-) or elevated activin A (Inha+/-) were assessed using flow cytometry. Although the proportion of F4/80+CD11b+ leukocytes (macrophages) was not affected, the frequency of CD206+MHCII+cells was significantly lower and CD206+MHCII- correspondingly higher in Inha+/- testes. This shift in expression of MHCII in CD206+ macrophages indicates that changes in circulating and/or local activin A influence resident macrophage activation and phenotype and, therefore, the immunological environment of the testis.
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Affiliation(s)
- S Indumathy
- Centre for Reproductive Health, Hudson Institute of Medical Research, Victoria, Australia; Department of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany; Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Victoria, Australia.
| | - D Pueschl
- Centre for Reproductive Health, Hudson Institute of Medical Research, Victoria, Australia; Department of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany; Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Victoria, Australia
| | - B Klein
- Centre for Reproductive Health, Hudson Institute of Medical Research, Victoria, Australia; Department of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany
| | - D Fietz
- Department of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany
| | - M Bergmann
- Department of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany
| | - H-C Schuppe
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - N Da Silva
- Ohana Biosciences, Cambridge, Massachusetts, United States
| | | | - M J Hickey
- Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Victoria, Australia
| | - M P Hedger
- Centre for Reproductive Health, Hudson Institute of Medical Research, Victoria, Australia; Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Victoria, Australia
| | - K L Loveland
- Centre for Reproductive Health, Hudson Institute of Medical Research, Victoria, Australia; Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Victoria, Australia.
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Ellmerer P, Stefani A, Heim B, Bergmann M, Seppi K, Poewe W, Högl B, Djamshidian A. The Frontal Assessment Battery in RLS patients with and without augmentation. Sleep Med 2020; 75:456-458. [PMID: 32998091 DOI: 10.1016/j.sleep.2020.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We assessed frontal executive functions in patients with RLS/WED with and without augmentation and compared the results to healthy controls. METHODS We recruited 38 patients with RLS/WED. A total of 23 patients were treated with dopaminergic therapy and showed no signs of augmentation and 15 patients had a history of augmentation (AUG). Results were compared to 21 healthy controls. All individuals were assessed by the Frontal Assessment Battery (FAB) and the MMSE. Furthermore, impulsivity was assessed during a semi-structured interview. RESULTS Patients with AUG performed worse in the FAB than healthy controls and RLS/WED patients without AUG (p = 0.001, η2 = 0.201). When we assessed the subtests of the FAB separately, we found a significant difference in the subtest assessing inhibitory control (p = 0.008, η2 = 0.138). CONCLUSIONS Our findings suggest an impaired executive function in RLS/WED patients with augmentation compared to RLS/WED patients without augmentation and healthy controls. Long term neuroplastic changes within the prefrontal cortex may be the underlying cause for these results. However, further studies in a larger sample size and with a more extensive neuropsychological test battery are needed to confirm our preliminary results.
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Affiliation(s)
- Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria.
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Javor A, Zamarian L, Ransmayr G, Prieschl M, Bergmann M, Walser G, Luef G, Prokop W, Delazer M, Unterberger I. The role of cortisol in trust behavior: Results from an experimental study on healthy controls and patients with juvenile myoclonic epilepsy. Epilepsy Behav 2020; 110:107138. [PMID: 32464541 DOI: 10.1016/j.yebeh.2020.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
Trust is one of the foundations of human society and pervades all aspects of human live. Research on humans focused primarily on identifying the biological basis of trust behavior in healthy subjects, and this evidence hints to certain brain areas, hormones, and genetic factors to be fundamentally involved. The contribution of cortisol in trust has not yet elicited much attention in research, especially when specifically examined at basal cortisol levels. Trust has been previously studied in some neurological diseases but not in patients with epilepsy, and the influence of hormones on trust in these diseases remains yet unknown. Against this background, we designed an experimental study with a group of patients with juvenile myoclonic epilepsy and a group of healthy controls to compare trust behavior and plasma cortisol levels between the two groups. This economic game is frequently used in research to operationalize trust behavior. All participants further underwent neuropsychological assessment. Our results showed that there was no significant difference in trust behavior during the trust game, but a trend toward lower trust in patients. Furthermore, there was a significant difference in cortisol levels between groups with lower levels in patients. Interestingly, cortisol levels correlated with trust only in the patient group, but not in the control group. Future studies should specifically differentiate the effect of induced cortisol increases (e.g., acute stress) versus the effect of basal cortisol levels reflecting homeostasis or chronic stress on trust behavior and leverage the potential of comparison between patients and healthy controls.
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Affiliation(s)
- Andrija Javor
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Krankenhausstraße 7, 4021 Linz, Austria
| | - Laura Zamarian
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Krankenhausstraße 7, 4021 Linz, Austria
| | - Manuela Prieschl
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Gerald Walser
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Gerhard Luef
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Wolfgang Prokop
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Margarete Delazer
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Iris Unterberger
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria.
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Atanasova V, Tiefenbacher A, Clement J, Wöran K, Bergmann M, Dolznig H, Egger G. 482P Identification of proteome and secretome signatures in primary colorectal cancer associated fibroblasts. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ellmerer P, Heim B, Stefani A, Peball M, Werkmann M, Holzknecht E, Bergmann M, Brandauer E, Sojer M, Zamarian L, Delazer M, Seppi K, Högl B, Poewe W, Djamshidian A. Augmentation in restless legs syndrome: an eye tracking study on emotion processing. Ann Clin Transl Neurol 2020; 7:1620-1627. [PMID: 32786065 PMCID: PMC7480921 DOI: 10.1002/acn3.51144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To assess emotional processing and alexithymia in patients with restless legs syndrome (RLS) with augmentation versus those who never had augmentation. Methods We recruited 26 patients who had a history of augmentation (AUG), either current or past, 27 RLS patients treated with dopamine agonists who never had augmentation (RLS controls), and 21 healthy controls (HC). All participants were screened for impulse control disorders (ICDs). Alexithymia was assessed by means of the Toronto Alexithymia Scale – 20 (TAS‐20). Facial emotion recognition was tested through an eye‐tracking task. Furthermore, all participants performed neuropsychological tests assessing global cognitive status, impulsivity, anxiety, and depression. Results ICD symptoms occurred more frequently in AUG patients than in RLS controls (P = 0.047). Patients with AUG scored higher on the TAS‐20 (P = 0.007) and the attentional subdomain of an impulsivity scale (BIS‐11; P = 0.015) compared to HC. Patients with AUG also performed worse on the facial emotion recognition task relative to RLS controls (P = 0.009) and HC (P = 0.003). We found a group difference for the time to first fixation and the fixation count in the mouth region (P = 0.019 and P = 0.021, respectively). There were no other differences in the eye tracking examination. Interpretation This study showed evidence of poorer emotional processing in patients who had augmentation compared to RLS patients without augmentation and healthy controls. The altered exploration pattern of faces and the higher alexithymia scores suggest abnormalities in emotion processing in patients with augmentation.
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Affiliation(s)
- Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mario Werkmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Sojer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Waser M, Stefani A, Holzknecht E, Kohn B, Hackner H, Brandauer E, Bergmann M, Taupe P, Gall M, Garn H, Högl B. Automated 3D video analysis of lower limb movements during REM sleep: a new diagnostic tool for isolated REM sleep behavior disorder. Sleep 2020; 43:5861319. [PMID: 32573731 PMCID: PMC7658637 DOI: 10.1093/sleep/zsaa100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/09/2020] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES The differentiation of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) or its prodromal phase (prodromal RBD) from other disorders with motor activity during sleep is critical for identifying α-synucleinopathy in an early stage. Currently, definite RBD diagnosis requires video polysomnography (vPSG). The aim of this study was to evaluate automated 3D video analysis of leg movements during REM sleep as objective diagnostic tool for iRBD. METHODS A total of 122 participants (40 iRBD, 18 prodromal RBD, 64 participants with other disorders with motor activity during sleep) were recruited among patients undergoing vPSG at the Sleep Disorders Unit, Department of Neurology, Medical University of Innsbruck. 3D videos synchronous to vPSG were recorded. Lower limb movements rate, duration, extent, and intensity were computed using a newly developed software. RESULTS The analyzed 3D movement features were significantly increased in subjects with iRBD compared to prodromal RBD and other disorders with motor activity during sleep. Minor leg jerks with a duration < 2 seconds discriminated with the highest accuracy (90.4%) iRBD from other motor activity during sleep. Automatic 3D analysis did not differentiate between prodromal RBD and other disorders with motor activity during sleep. CONCLUSIONS Automated 3D video analysis of leg movements during REM sleep is a promising diagnostic tool for identifying subjects with iRBD in a sleep laboratory population and is able to distinguish iRBD from subjects with other motor activities during sleep. For future application as a screening, further studies should investigate usefulness of this tool when no information about sleep stages from vPSG is available and in the home environment.
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Affiliation(s)
- Markus Waser
- Competence Unit Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria,Corresponding author. Ambra Stefani, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Evi Holzknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Kohn
- Competence Unit Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Heinz Hackner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Melanie Bergmann
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Philip Taupe
- Competence Unit Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Markus Gall
- Competence Unit Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Heinrich Garn
- Competence Unit Sensing and Vision Solutions, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Bergmann M, Riedinger S, Stefani A, Mitterling T, Holzknecht E, Grassmayr P, Högl B. Effects of singing bowl exposure on Karolinska sleepiness scale and pupillographic sleepiness test: A randomised crossover study. PLoS One 2020; 15:e0233982. [PMID: 32479559 PMCID: PMC7263600 DOI: 10.1371/journal.pone.0233982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects on subjective and objective sleepiness of a stay above a large struck singing bowl compared to a relaxation period in a silent singing bowl. METHODS Fifty-eight healthy subjects were recruited for the study, 48 participated on two days, one week apart, during the same timeslot. The Karolinska sleepiness scale was used to evaluate current subjective sleepiness, and the relative pupillary unrest index to assess objective sleepiness. In this randomized cross-over study, the intervention consisted of a 20-minute stay in a hammock while the singing bowl, positioned beneath, was struck seven times. The controlled comparator was a 20-minute stay in the same hammock above the singing bowl, but without being struck. After these two interventions subjective and objective sleepiness were re-evaluated. RESULTS The mean relative pupillary unrest index values after relaxation in the struck and silent singing bowl groups were 0.74 and respectively 0.71 (p = 0.460). The median Karolinska sleepiness scale value after relaxation with the struck singing bowl was 3 compared with 4 (p = 0.041) for the silent singing bowl. DISCUSSION This study evaluated the influence of a struck singing bowl on sleepiness during daytime. Subjective sleepiness was significantly lower after relaxation above a struck singing bowl. After gender stratification, the difference was still significant in women. Objective sleepiness was not different in both groups. Finally, we can only speculate if women may be more susceptible to subjective improvements in case of sleepiness and show another perception of relaxation in a struck singing bowl compared to men.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Riedinger
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology 1, Kepler University Hospital, Linz, Austria
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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Barbieri F, Adukauskaite A, Heidbreder A, Brandauer E, Bergmann M, Senoner T, Rubatscher A, Schgoer W, Stuehlinger M, Pfeifer B, Bauer A, Hintringer F, Hoegl B, Dichtl W. P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome. Europace 2020. [DOI: 10.1093/europace/euaa162.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA
Background
Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA.
Methods
Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) > 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design.
Results
CSA (AHI > 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI > 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p < 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p < 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up.
Conclusions
CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator.
Abstract Figure.
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Adukauskaite
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Heidbreder
- Muenster University Hospital, Department of Neurology, Division of Sleep Medicine and Neuromuscular Disorders, Muenster, Germany
| | - E Brandauer
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - M Bergmann
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Rubatscher
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - W Schgoer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - M Stuehlinger
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - B Pfeifer
- University Teaching Hospital Hall in Tirol (UMIT), Institute of Electrical and Biomedical Engineering, Hall in Tyrol, Austria
| | - A Bauer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - F Hintringer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - B Hoegl
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
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Gaffuri P, Espeli V, Fulciniti F, Paone G, Bergmann M. Immune-related acute and lymphocytic gastritis in a patient with metastatic melanoma treated with pembrolizumab immunotherapy. Pathologica 2020; 111:92-97. [PMID: 31748755 PMCID: PMC8138491 DOI: 10.32074/1591-951x-24-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 01/10/2023] Open
Abstract
Here, we present a case of acute and lymphocytic gastritis related to therapy with pembrolizumab for metastatic melanoma. After an asymptomatic phase with moderate histological inflammation (observed at 9 months of immunotherapy), gastritis became symptomatic and severe on repeated biopsies (13 months after the beginning of pembrolizumab). Symptoms and histological lesions both improved with proton pump inhibitor and steroid therapy, as well as interruption of pembrozulimab. The interest of this case lays in the relative rarity of gastritis over small and large intestinal inflammatory lesions caused by immune checkpoint inhibitors as well as in the features of the inflammatory infiltrate, which may be purely lymphocytic (mainly T-cells, with a prevalence of CD8+ over CD4+ lymphocytes) or mixed lymphocytic and granulocytic, requiring the exclusion of other causes of disease. To our knowledge, only 7 cases of immune-related gastritis have been previously documented in the current literature, of which 4, included the current one, were exclusively associated with pembrozulimab therapy.
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Affiliation(s)
- P Gaffuri
- Repubblica e Cantone Ticino Istituto Cantonale di Patologia, Pathology
| | - V Espeli
- Istituto Oncologico della Svizzera Italiana, Oncology
| | - F Fulciniti
- Repubblica e Cantone Ticino Istituto Cantonale di Patologia, Pathology
| | - G Paone
- Department of Nuclear Medicine and TC-PET, Istituto Oncologico della Svizzera Italiana
| | - M Bergmann
- Repubblica e Cantone Ticino Istituto Cantonale di Patologia, Pathology
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Tekman MB, Wekerle C, Lorenz C, Primpke S, Hasemann C, Gerdts G, Bergmann M. Tying up Loose Ends of Microplastic Pollution in the Arctic: Distribution from the Sea Surface through the Water Column to Deep-Sea Sediments at the HAUSGARTEN Observatory. Environ Sci Technol 2020; 54:4079-4090. [PMID: 32142614 DOI: 10.1021/acs.est.9b06981] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Recent studies have shown that despite its remoteness, the Arctic region harbors some of the highest microplastic (MP) concentrations worldwide. Here, we present the results of a sampling campaign to assess the vertical distribution of MP particles (>11 μm) at five stations of the HAUSGARTEN observatory. Water column samples were taken with large volume pumps by filtering 218-561 L of seawater at two to four depth strata (near-surface, ∼300 m, ∼1000 m, and above seafloor), and sediment samples were taken with a multiple corer. MP concentrations in the water column ranged between 0 and 1287 N m-3 and in the sediment from 239 to 13 331 N kg-1. Fourier transform infrared spectroscopy (FTIR) imaging with automated data analysis showed that polyamide (39%) and ethylene-propylene-diene rubber (23%) were the most abundant polymers within the water samples and polyethylene-chlorinated (31%) in sediments. MPs ≤ 25 μm accounted for more than half of the synthetic particles in every sample. The largest MP particle recorded was in the 200 μm size class. The concentrations of fibers were not reported, as fiber detection by FTIR imaging was not available at the time of analyses. Two- and three-dimensional simulations of particle transport trajectories suggest different pathways for certain polymer types. A positive correlation between MP size composition and particulate organic carbon indicates interactions with biological processes in the water column.
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Affiliation(s)
- Mine B Tekman
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Am Handelshafen 12, 27570 Bremerhaven, Germany
| | - Claudia Wekerle
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Klußmannstrasse 3d, 27570 Bremerhaven, Germany
| | - Claudia Lorenz
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Kurpromenade, 27498 Helgoland, 27570 Bremerhaven, Germany
| | - Sebastian Primpke
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Kurpromenade, 27498 Helgoland, 27570 Bremerhaven, Germany
| | - Christiane Hasemann
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Am Handelshafen 12, 27570 Bremerhaven, Germany
| | - Gunnar Gerdts
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Kurpromenade, 27498 Helgoland, 27570 Bremerhaven, Germany
| | - Melanie Bergmann
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Am Handelshafen 12, 27570 Bremerhaven, Germany
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Unger LW, Argeny S, Stift A, Yang Y, Karall A, Freilinger T, Müller C, Bergmann M, Stift J, Riss S. Mesenteric granulomas independently predict long-term risk of surgical recurrence in Crohn's disease. Colorectal Dis 2020; 22:170-177. [PMID: 31393663 PMCID: PMC7028106 DOI: 10.1111/codi.14814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022]
Abstract
AIM The risk factors that predict surgical recurrence in Crohn's disease (CD) remain controversial. Postoperative anti-tumour necrosis factor (anti-TNF) therapy might lower recurrence rates whilst the presence of mesenteric granulomas has been postulated to increase the risk. We hypothesized that mesenteric granulomas indicate disease severity and might predict the risk of surgical recurrence, irrespective of immunosuppressive therapy. METHOD We performed a retrospective review of all consecutive patients undergoing operations for CD between January 2000 and December 2014 at a single tertiary referral centre and assessed the perioperative factors and histological findings at the time of surgery. Surgical recurrence rates and the immunosuppressive regimen were assessed through retrospective chart review and telephone interviews. RESULTS A total of 274 patients were eligible for analysis. Median follow-up was 8.54 (5.48-14.42) years. A total of 63 patients (23.0%) underwent surgery for recurrent CD after a median of 4.75 (2.10-7.96) years. In final histology, 35 (12.8%) patients had mesenteric granulomas. TNF inhibitors were administered postoperatively in 104 (38.0%) and thiopurines in 137 (50.0%) patients. In univariate analysis, only the presence of mesenteric granulomas [hazard ratio (HR) 1.95; 95% CI 1.05-3.62; P = 0.035] significantly increased the risk for recurrent surgery while postoperative anti-TNF (HR 0.85; 95% CI 0.49-1.50; P = 0.581) or thiopurine therapy (HR 1.03; 95% CI 0.61-1.73; P = 0.916) did not. In multivariate analysis, only the presence of mesenteric granulomas significantly influenced the risk of surgical recurrence (HR 1.94, 95% CI 1.04-3.60; P = 0.037). CONCLUSION Intestinal and mesenteric granulomas should be differentiated in pathology reports, because mesenteric, but not intestinal, granulomas may be associated with an increased risk of surgical recurrence.
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Affiliation(s)
- L. W. Unger
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - S. Argeny
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - A. Stift
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - Y. Yang
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - A. Karall
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - T. Freilinger
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - C. Müller
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - M. Bergmann
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
| | - J. Stift
- Clinical Institute of PathologyMedical University of ViennaViennaAustria
| | - S. Riss
- Division of General SurgeryDepartment of SurgeryMedical University of ViennaViennaAustria
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Germann CP, Bergmann M, Nordmeyer J, Peters B, Berger F, Schmitt K, Schubert S. Long-Term Performance after Interventional VSD Closure—Single Center Experience in Pediatric and Adult Patients. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Waser M, Stefani A, Holzknecht E, Garn H, Kohn B, Hackner H, Brandauer E, Bergmann M, Taupe P, Gall M, Högl B. A new diagnostic approach to identify isolated REM sleep behavior disorder (IRBD): 3D video analysis. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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