Sinus arrest during REM sleep in young adults

Four apparently healthy young adults with vague chest symptoms during the day, two of whom had infrequent syncope while ambulatory at night, had periods of asystole up to nine seconds in duration occurring repeatedly during rapid-eye-movement (REM) sleep. Extensive evaluations, including electrophysiologic studies in two patients, were normal. It is therefore suggested that the underlying pathophysiology involved autonomic dysfunction. REM sleep-related sinus arrests such as these, which may occur in apparently healthy subjects but are undetected, may explain some cases of sudden, unexpected death during sleep. Polygraphic monitoring during sleep may be helpful in delineating the pathophysiology of the sleep-related arrhythmia in persons with daytime cardiac arrhythmias thought to be secondary to abnormal vagal tone. The possibility of nocturnal asystole should be considered in patients such as those described here.

Tracheostomy and hemodynamic changes in sleep-inducing apnea

Because pulmonary hypertension and systemic hypertension occur during sleep-induced obstructive apnea, six patients underwent overnight hemodynamic monitoring before and after tracheostomy. Variables studied included heart rate, pulmonary artery pressure, femoral artery pressure, and arterial oxygen tension (Po2). After tracheostomy, significant reductions were noted during sleep in mean pulmonary artery pressure from 45 +/- 6 mm Hg (mean +/- SEM) to 22 +/- 2 mm Hg (P less than 0.05) and in mean femoral artery pressure from 137 +/- 6 mm Hg to 97 +/- 3 mm Hg (P less than 0.005). There was also a significant increase for the group in arterial Po2 recorded during the apneic episodes from 38 +/- 3 mm Hg before tracheostomy to 71 +/- 2 mm Hg (P less than 0.001) after tracheostomy. We conclude that tracheostomy improves the hemodynamic abnormalities and hypoxemia that occur during sleep in patients with sleep-induced obstructive apnea.

Obstructive sleep apnea and cardiac index

Seventeen men (age range, 21 to 58 years) with severe obstructive sleep apnea syndrome (OSAS) documented by nocturnal polysomnography underwent hemodynamic investigations during sleep. We studied the evolution of the cardiac index during apneic events in both NREM and REM sleep using the thermodilution technique. Regardless of the patient's age, the sleep state, or the mechanism inducing the OSAS, the cardiac index decreased significantly from baseline during an apneic event and increased significantly from baseline at the resumption of ventilation.

B-haplotype influence on Marek's disease, Rous sarcoma, and lymphoid leukosis virus-induced tumors in chickens

Experiments were conducted to establish whether B-haplotype genes that determine resistance to RSV-induced tumors would also influence resistance to Marek's disease and lymphoid leukosis. Matings of line 6(3) x 15(1) F3 or F4 breeders segregating for the Ea-B locus antigens that are markers for B2 and B5 haplotypes of the B major histocompatibility complex were made to produce B2B2, B2B5, and B5B5 chicks. The chicks were infected with a standard inoculum of one of the three tumor viruses in separate experiments. The B2 haplotype from 6(3) conveyed greater resistance to tumors induced by all three viruses than the B5 from 15(1) chickens. This finding suggests that some gene(s) in the B-haplotype may determine a general ability to resist tumor formation or cause tumor regression.

Cardiac abnormalities in myotonic dystrophy. Electrophysiologic and histopathologic studies

Eight young adult male patients with myotonic dystrophy, mean age 26 years, underwent 24-hour Holter electrocardiographic monitoring and intracardiac electrophysiologic study. Right ventricular endomyocardial biopsies were performed at the end of the electrophysiologic study in five of them. The atrial to His[A-H] interval was 155 msec in one case and less than or equal to 55 msec in all patients. Twenty-four hour Holter electrocardiographic monitoring demonstrated more than 4 premature ventricular contractions per minute in two patients and marked cyclical sinus arrhythmia during sleep in two others. Electron microscopic analysis of the endomyocardial biopsy specimens disclosed no prominent sarcoplasmic reticulum abnormalities but prominent I bands compared to previously obtained controls. Myofibrillar degeneration was seen in all cases and was associated with abnormal mitochondria in two. Cardiac abnormalities can be detected very early in the evolution of myotonic dystrophy, even prior to the onset of cardiac symptoms. The reported abnormalities appear closely related to the pathologic process affecting other skeletal muscles.

Respiratory and hemodynamic study during wakefulness and sleep in myotonic dystrophy

Six young male patients with grade I (mild) myotonic dystrophy and a complaint of excessive daytime sleepiness were studied during wakefulness and sleep. Pulmonary function tests during wakefulness showed evidence of mild abnormality related to respiratory muscle weakness. During sleep, some patients developed a sleep apnea syndrome with high sleep Apnea Indices. There was no relation between hypoxic and hypercapnic ventilatory responses during wakefulness and sleep Apnea Indices. But hypoxemia and hypercapnia worsened considerably during REM sleep. Myotonic dystrophy patients with sleep apnea presented increased pulmonary and systemic arterial pressures during sleep. It was also during sleep that arrhythmias were observed.

The accuracy of transrectal ultrasound prostate volume estimation: clinical correlations

Sonographic estimates of prostate volume have been applied to the diagnosis and management of prostate cancer. However, we have observed wide variation between transrectal sonographic estimates of prostate volume (TRUS-V) and the corresponding volumes of unfixed radical prostatectomy specimens (P-V). Because TRUS-V may influence the management of men with prostate disease, the relationship between TRUS-V and P-V was characterized for 100 consecutive men undergoing a radical retropubic prostatectomy (RRP). For the entire cohort, TRUS-V (35.9 +/- 16.9 mL) underestimated P-V (45.4 +/- 22.9 mL, p < .01). Mean signed percentage error between TRUS-V and P-V was -16 +/- 32%. The relationship of TRUS-V to P-V was volume dependent (p < .001). For volumes (P-V) < 30 mL, TRUS-V overestimated P-V. For volumes (P-V) > 30 mL. TRUS-V increasingly underestimated P-V. In summary, transrectal ultrasound estimates of prostate volumes differ significantly from the volume of unfixed RRP specimens. The direction and magnitude of TRUS-V error is volume dependent. Applied clinically, treatment paradigms employing prostate-volume-dependent management algorithms derived from nonuniform methods of volume estimation may not accurately reflect volume nomograms derived from uniform methods of measurement, and thus alter patient management.

Evaluation of asymptomatic microhematuria

OBJECTIVES

The purpose of this study was to evaluate a comprehensive urine cytodiagnostic assay to assist in localizing the site of origin and the etiology of asymptomatic microhematuria. This analysis, which assesses various qualitative and quantitative aspects of the voided urine, is compared simultaneously with controls obtained from the established routine urologic evaluation.

METHODS

One hundred consecutive subjects who presented solely for the evaluation of asymptomatic microhematuria were evaluated by the established routine urologic evaluation and a refined urine cytodiagnostic assay. For the purpose of this study, only calculi and neoplasms were considered significant findings.

RESULTS

The incidence of significant urologic disease was 13% (3 renal neoplasms, 2 urothelial bladder carcinomas, and 8 urinary calculi). The refined urine cytodiagnostic assay identified both uroepithelial vesical neoplasms, 7 of the 8 urinary calculi, and none of the 3 renal neoplasms. The presence of dysmorphic urinary red blood cells (RBCs) and RBC casts was strongly suggestive of renal parenchymal bleeding. Overall, 43 of 44 subjects (98%) with dysmorphic RBCs and RBC casts failed to demonstrate any significant urologic etiology.

CONCLUSIONS

These preliminary results suggest that the refined cytodiagnostic urine assay may be helpful in distinguishing whether a given patient's microhematuria is of a significant urologic or a renal parenchymal cause. The addition of this specialized urinalysis may prove a useful adjunct in improving the diagnostic yield in patients with asymptomatic microhematuria.

Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial

OBJECTIVES

The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly individuals.

METHODS

Initially, ninety-two elderly individuals were included in the study and were allocated into the depression group (n=16) and nondepression group (n=14). Both groups engaged in the aquatic exercise program for 12 weeks, including two weekly sessions (45 min/session) at a low intensity (between 50% and 60% of maximal heart rate or Borg scale scores of 13 to 14) throughout the intervention. All outcomes were evaluated at baseline and 12 weeks later.

RESULTS

The patients were 63.5±8.8 years old. The following scores were decreased after training in the depressed group: depression (53%), anxiety (48%), and Timed Up & Go (33%). The following scores increased: Berg Balance Scale (9%) and flexibility (44%). Regarding the blood-based parameters, there were decreases in protein carbonylation (46%) and nitric oxide (60%) and increases in glutathione (170%) and superoxide dismutase (160%) in the depression group (p<0.005).

CONCLUSIONS

The aquatic exercise program reduces depression and anxiety, improves functional autonomy and decreases oxidative stress in depressed elderly individuals.

Associations of Linear Growth and Relative Weight Gain in Early Life with Human Capital at 30 Years of Age

OBJECTIVE

To assess the associations of birthweight, nutritional status and growth in childhood with IQ, years of schooling, and monthly income at 30 years of age.

STUDY DESIGN

In 1982, the 5 maternity hospitals in Pelotas, Brazil, were visited daily and 5914 live births were identified. At 30 years of age, 3701 subjects were interviewed. IQ, years of schooling, and income were measured.

RESULTS

On average, their IQ was 98 points, they had 11.4 years of schooling, and the mean income was 1593 reais. After controlling for several confounders, birthweight and attained weight and length/height for age at 2 and 4 years of age were associated positively with IQ, years of years of schooling, and income, except for the association between length at 2 years of age and income. Conditional growth analyses were used to disentangle linear growth from relative weight gain. Conditional length at 2 years of age ≥1 SD score above the expected value, compared with ≥1 SD below the expected, was associated with an increase in IQ (4.28 points; 95% CI, 2.66-5.90), years of schooling (1.58 years; 95% CI, 1.08-2.08), and monthly income (303 Brazilian reais; 95% CI, 44-563). Relative weight gain, above what would be expected from linear growth, was not associated with the outcomes.

CONCLUSION

In a middle-income setting, promotion of linear growth in the first 1000 days of life is likely to increase adult IQ, years of schooling, and income. Weight gain in excess of what is expected from linear growth does not seem to improve human capital.

B5 and B15 associated with progressive Marek's disease, Rous sarcoma, and avian leukosis virus-induced tumors in inbred 15I4 chickens

RPRL 15I4 inbred chickens are nearly histocompatible except for the B5 and B15 haplotypes that determine the major transplantation antigens. B5B5 and B15B15 15I4 chickens were equally and highly susceptible to tumors induced by Marek's disease, Rous sarcoma, or avian leukosis viruses (ALV), suggesting both of these haplotypes may determine a general influence leading to tumor development. The 15I4 birds were highly susceptible to erythroblastosis, and most developed immunological tolerance to the virus after ALV infection.

Caesarean section and adiposity at 6, 18 and 30 years of age: results from three Pelotas (Brazil) birth cohorts

Background

Association between caesarian section (C-section) and obesity is controversial and mostly based on body mass index (BMI), which has inherent limitations. Using direct estimates of body fat mass, we aimed to assess the association between C-section and adiposity using fat mass index and BMI z-score in three birth cohort studies from Pelotas, Brazil.

Methods

We measured weight, height and fat mass (using dual X-ray absorptiometry (DXA)) at ages 6, 18 and 30 years among participants in the 2004, 1993 and 1982 population-based Pelotas Birth Cohort Studies, respectively. We used multiple linear regression analysis to examine the crude and adjusted association between C-section and the body composition indicators. We also modelled height as an outcome to explore the presence of residual confounding.

Results

We observed that fat mass index and BMI z-score were strongly and positively associated with C-section in the crude analysis. However, when we adjusted for socioeconomic characteristics, maternal BMI, parity, age and smoking during pregnancy, effect estimates were attenuated towards the null, except for 30-year-old women. In those women from the 1982 cohort, C-section remained associated with fat mass index (β = 0.82; CI95% 0.32;1.32) and BMI z-score (β = 0.15; CI95% 0.03;0.28), even after adjusting for all potential confounders, suggesting an increase in fat mass index and BMI at 30 years among those born by C-section.

Conclusion

We found no consistent association of C-section with fat mass index measured by DXA and BMI z-score in individuals aged 6, 18 and 30 years, except for women in the latter group, which might be explained by residual confounding. Confounding by socioeconomic and maternal characteristics accounted for all the other associations.

Torsion of an indirect hernia sac: an unusual cause of acute scrotal swelling in children

OBJECTIVES

An indirect inguinal hernia is a common cause of inguinoscrotal swelling in young boys. We describe 3 cases of an extremely unusual entity that has a similar clinical presentation to more commonly diagnosed intrascrotal processes.

METHODS

Two patients presented with acute hemiscrotal enlargement and pain, and a third patient presented with scrotal enlargement only. All patients underwent a scrotal ultrasound evaluation and subsequent inguinoscrotal exploration.

RESULTS

All patients had a multiseptated peritesticular fluid-filled mass on ultrasound evaluation. Subsequent inguinoscrotal exploration revealed a torsion of the indirect hernia sac in each case. A high ligation and excision of the sac was curative.

CONCLUSIONS

Torsion of a hernia sac is an extremely rare entity, and current sonographic imaging fails to clearly diagnose this unusual phenomenon. Because pediatric urologists are commonly called to evaluate a child with an acutely swollen scrotum, awareness of this diagnosis is important.

Skin-graft histocompatibility within Regional Poultry Research Laboratory inbred chicken lines

Skin grafts were exchanged between specific-pathogen-free chicks within the Regional Poultry Research Laboratory (RPRL) inbred lines that are characterized for retrovirus susceptibility and immunogenetic traits. Lines 61 and 63 were histocompatible whereas lines 15I4 and 15I5 were nearly histocompatible. The RPRL Line 7(2) is only histocompatible within families at present, and line 100 has considerable heterogeneity for minor histoantigens. Reaseheath Line C (RH-C) has been established at the RPRL and its histocompatible. Numerous males in lines 6(1), 6(3), 15I4, and RH-C are able to reject female grafts containing the female-specific histoantigen. Two Ea-B alleles in 15I4 previously detected by blood-typing determined rapid skin graft rejection.

Congenital renal arteriovenous malformation in pregnancy presenting with hypertension

Congenital renal arteriovenous malformations (AVMs) are rare, with approximately 50 cases reported in the literature. Typically, they are small (1 to 2 cm) and the majority present with hematuria and symptoms and signs of congestive heart failure. Review of the literature revealed only 4 cases reported in pregnant patients and their presentation was with hematuria and rupture of the AVM. We present a case of a young female patient with a 6 cm congenital renal AVM who was otherwise asymptomatic until her first pregnancy, when she developed and presented with symptoms of hypertension and an abdominal bruit. Her symptoms persisted postpartum. Hematuria and rupture of the AVMs were not part of her clinical course. A partial nephrectomy was curative.

Chronic obstructive airflow disease and sleep studies

Twenty-six patients with chronic obstructive airflow disease (23 also complained of excessive daytime somnolence) were monitored during sleep, using noninvasive techniques, for evaluation of respiratory and sleep variables. Ten of the 26 had a second more extensive evaluation, including measurement of endoesphageal pressure; 5 underwent a study of nocturnal hemodynamics, with measurement of systemic and pulmonary pressures; 5 received O2 in air during sleep under controlled conditions. Eight of the studied patients underwent tracheostomy and were restudied postoperatively. Both sleep stage and type of abnormal respiratory event during sleep affected oxygenation levels. A mean of 92% of all abnormal respiratory events during sleep contained an obstructive component. Apneic events may affect systemic and pulmonary arterial pressures during sleep. Administration of O2 in air may, in some cases, be detrimental to the sleeping patient. Tracheostomy unexpectedly improved the daytime, awake blood gas readings of somee patients. The mechanism of daytime somnolence was not elucidated in all cases.

Early sugar introduction associated with early childhood caries occurrence

Consensus has yet to be reached on the impact of early sugar introduction on early childhood dental caries (ECC). This study aimed to evaluate the association between the time of introduction of sugar in the infant's diet and ECC at 48 months, using data from the 2015 Pelotas Birth Cohort Study. This Cohort comprises 4,275 children. At 48 months, 3,654 (91.1%) children had their oral health clinically evaluated by a team of 12 trained and calibrated dentists and their dental caries experience and cavitated lesions was assessed. The period of life in which sugar was first introduced into the child's diet was considered the primary exposure of the study, collected through questionnaires at 3, 12, 24, and 48 months of age. Analyses were conducted using Stata, version 15.0. Descriptive analyses were initially performed. Poisson regression with robust variance adjustment for the crude and adjusted analysis was used to estimate the effect of the sugar introduction on ECC. The highest prevalence of caries experience (43.3%) was in children in which sugar was introduced into the infant's diet before 12 months of age. A higher prevalence of caries experience was found for less educated (49.8%) and younger (51.7%) mothers, and in poorer families (48.3%).In the adjusted analysis, the experience of caries was 48% greater in the group with sugar introduction before 12 months of age, compared to those where sugar was introduced after 24 months of age In conclusion, our results support the adoption of preventive measures to delay the supply of sugar in early life in order to reduce the caries experience in children.

Tests of association of lymphocyte alloantigen genotypes with resistance to viral oncogenesis in chickens. 1. Marek's disease in F7 progeny derived from 6(3) X 15(1) crosses

Marek's disease (MD)-susceptible progeny of the B5B5 genotype from the F7 generation derived from crosses of Regional Poultry Research Laboratory inbred lines 6(3) and 15(1) were tested for variation in MD resistance associated with the T lymphocyte antigen loci Ly-4 and Th-1. The four double homozygous genotypic classes of Ly-4 and Th-1 were tested in a 2 X 2 design. The Ly-4bb/Th-1aa chickens were significantly more resistant to MD oncogenesis than the other three genotypes. Thus, resistance within B5B5 genotypes appears to be associated with genetic interaction between two T cell antigen loci, which are not linked with the B complex.

Pericardial effusions in patients with end-stage renal disease

Echocardiography has greatly increased the accurate recognition of pericardial effusion. Echocardiograms were performed prospectively on the total group of 35 stable asymptomatic patients on chronic haemodialysis to determine the incidence of pericardial effusion. Effusions were shown in 11 per cent (4/35); only 6 per cent (2/35) were estimated as greater than 100 ml. For comparison, records were reviewed retrospectively from 41 haemodialysis patients referred during a 27-month period for echocardiographic assessment of suspected pericardial effusion. These 41 patients came from a total group of 108 patients treated with chronic dialysis over this interval. Of 41 examined, 21 (51%) or 21 of 108 (19%) of the population at risk had an effusion. Of 21 with echocardiographic effusions, 15 (71%), or 15 of 41 (37%) of those with clinically suspected effusion, had more than 100 ml fluid. Gross (greater than 100 ml) pericardial effusions are infrequent in stable, asymptomatic patients with end-stage renal disease. When clinical findings suggest pericardial disease, the echocardiographic demonstration of over 100 ml pericardial fluid is indicative of new effusion, rather than coincidental pre-existing effusion.

Adolescence and Later Life Disease Burden: Quantifying the Contribution of Adolescent Tobacco Initiation From Longitudinal Cohorts

PURPOSE

Adolescence is a time of initiation of behaviors leading to noncommunicable diseases (NCDs). We use tobacco to illustrate a novel method for assessing the contribution of adolescence to later burden.

METHODS

Data on initiation of regular smoking during adolescence (10-19 years) and current adult smoking were obtained from the 1958 British Birth Cohort, the U.S. National Longitudinal Study of Adolescent Health (Add Health), the Pelotas 1982 Birth Cohort, and the Victorian Adolescent Health Cohort Study. We estimated an "adolescent attributable fraction" (AAF) by calculating the proportion of persisting adult daily smoking initiated < age 20 years. We used findings to estimate AAFs for >155 countries using contemporary surveillance data.

RESULTS

In the 1958 British Birth Cohort, 81.6% of daily smokers at age 50 years initiated < age 20 years, with a risk ratio of 6.1 for adult smoking related to adolescent initiation. The adjusted AAF was 69.1. Proportions of smokers initiating <20 years, risk ratio, and AAFs were 83.3%, 7.0%, and 70.4% for Add Health; 75.5%, 3.7%, and 50.2% in Victorian Adolescent Health Cohort Study; and 70.9%, 5.8%, and 56.9% in Pelotas males and 89.9%, 6.4%, and 75.9% in females. Initiation <16 years resulted in the highest AAFs. Estimated AAFs globally ranged from 35% in China to 76% in Argentina.

CONCLUSIONS

The contribution of adolescent smoking initiation to adult smoking burden is high, suggesting a need to formulate and implement effective actions to reduce smoking initiation in adolescents. Similar trends in other NCD risks suggest that adolescents will be central to future efforts to control NCDs.

Development and Validation of a 3D Clinostat for the Study of Cells during Microgravity Simulation

The clinostat was originally used to find out why plant roots appear to grow predominantly toward the center of the Earth. Over the last 2-3 decades, slow- and fast-rotating 2D and 3D clinostats have been used to assess cellular adaptation to this environment. A cell culture is placed in a spin module of the clinostat platform and its rotation is set empirically (2-3 rpm). The machine is then allowed to run for a specified period (hours to days) after which the cultures are removed and assayed for specific properties, such as cell growth, size and shape, distribution of receptors, integrity of the cytoskeleton or gene expression. A 3D clinostat was developed by the Microgravity Laboratory/IPCT-PUCRS group and validated by the Stem Cell Group of Kingston University London, which used 4 different types of human cancer cells and cord blood stem cells (CBSC). After rotation for 19h at 37degC, 5%CO2 humidified atmosphere, the 3D clinostat significantly improved proliferation potential of all tested cell populations when compared to static cultures. After only 5 days, high definition microscopic analysis revealed that all CBSC adhered and expanded onto the BDtrade 3D collagen composite scaffolds, and cross-developed into hepatocyte-like cells upon stimulation.