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Guenzler V, Arzt M, Grimm M, Ebert A, Zeman F, Linz D, Woehrle H, Tamisier R, Cowie M, Fisser C. Temporal association of ventricular arrhythmias and respiratory events in heart failure patients with central sleep apnoea. Sleep Med 2024; 118:59-62. [PMID: 38608416 DOI: 10.1016/j.sleep.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
In contrast to obstructive sleep apnoea, the peak of sympathetic tone in central sleep apnoea occurs during the hyperventilation phase. To explore the temporal association of premature ventricular complex (PVC) burden in the context of the apnoea/hypopnoea-hyperpnoea cycle, the duration of apnoea/hypopnoea was defined as 100 %. We assessed the PVC burden throughout the apnoea/hypopnoea-hyperpnoea cycle during the periods of ±150 % in 50 % increments before and after the apnoea/hypopnoea phase. In this subanalysis of 54 SERVE-HF patients, PVC burden was 32 % higher in the late hyperventilation period (50-100 % after apnoea/hypopnoea) compared to the apnoea/hypopnoea phase.
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Affiliation(s)
- Valentin Guenzler
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Marjorie Grimm
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Amelie Ebert
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Holger Woehrle
- Sleep and Ventilation Centre Blaubeuren, Lung Centre Ulm, Ulm, Germany
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM, Grenoble Alps University Hospital, U1300, Grenoble, France
| | - Martin Cowie
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Malik S, Jeanpierre L, Cianferoni A, Ruffner M, Sullivan KE. A patient with Pitt-Hopkins syndrome with concomitant common variable immunodeficiency. Am J Med Genet A 2024; 194:e63490. [PMID: 38066705 DOI: 10.1002/ajmg.a.63490] [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: 08/22/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 03/10/2024]
Abstract
In patients with 18q deletion syndrome (18q-), immunodeficiency, autoimmunity, and allergies have been described in a subset. Pitt-Hopkins syndrome represents a specific subset of patients with 18q- who have a proximal deletion involving the TCF4 gene or a TCF4 variant. Immunodeficiency has been reported in the overall 18q- population; however, immunodeficiency with Pitt-Hopkins syndrome has not been highlighted. This case report details the immunologic evaluations and the associated infections seen in a young adult with Pitt-Hopkins syndrome to underscore the challenges of managing adults with a complex phenotype who develop frequent infections. This patient with Pitt-Hopkins syndrome ultimately fulfilled the diagnostic criteria for common variable immunodeficiency. Immunoglobulin replacement has led to a somewhat improved infection pattern, although she continues to have aspiration events leading to pneumonia. This case highlights the clinical evolution of Pitt-Hopkins syndrome and serves as a reminder that immunodeficiency can occur in this syndrome.
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Affiliation(s)
- Shahzara Malik
- College of Medicine and Health Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Latoya Jeanpierre
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Melanie Ruffner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Costa AF, Rodríguez I. Paroxysmal hemidystonia as the initial presentation of multiple sclerosis: an illustrative video depicting hyperventilation-triggered dystonia. Acta Neurol Belg 2024; 124:645-646. [PMID: 37589817 DOI: 10.1007/s13760-023-02359-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Aldo F Costa
- Department of Neurology, University Hospital Reina Sofía, Menéndez Pidal, S/N Av., 14004, Córdoba, Spain.
| | - Ignacio Rodríguez
- Department of Neurology, University Hospital Reina Sofía, Menéndez Pidal, S/N Av., 14004, Córdoba, Spain
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Rana M, Steenari M, Shrey D. Hyperventilation and Seizures: Not a New Sense: A Literature Review. Neuropediatrics 2023; 54:359-364. [PMID: 37813123 DOI: 10.1055/s-0043-1774808] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/11/2023]
Abstract
Hyperventilation and seizures have a long association in the clinical literature and were known to have a relationship long before the electroencephalogram (EEG) was used to record changes in brain activity. As the use of EEG recording progressed, hyperventilation was the first activation method used to assist with diagnosis of epilepsy. Along with slowing of brain activity, hyperventilation can activate epileptiform spiking activity in patients with epilepsy. Currently, hyperventilation is used in standard practice to assist with the diagnosis of epilepsy during EEG recording. Hyperventilation activates epileptiform spiking activity more often than seizures but can trigger clinical seizures in up to 50% of patients with generalized epilepsy. It is more likely to trigger events in children with absence seizures than adults, and it acts as a trigger in patients with focal epilepsy far less often. However, while some clinicians suggest that its diagnostic value is limited, especially in adults with focal epilepsies, others suggest that it is simple, safe, and an important diagnostic tool, even in these patients. This review presents the history of hyperventilation and seizures, its use in the clinical practice, and possible mechanisms involved.
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Affiliation(s)
- Mandeep Rana
- Department of Pediatrics, Section of Pediatric Neurology, Carilion Clinic, Virginia Tech Carilion School of Medicine Roanoke, Virginia, United States
| | - Maija Steenari
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
| | - Daniel Shrey
- Department of Pediatrics, University of California, Irvine Division of Neurology, CHOC, 1201 W La Veta Avenue, Orange, California, United States
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Tagliabue S, Kacprzak M, Serra I, Maruccia F, Fischer JB, Riveiro-Vilaboa M, Rey-Perez A, Expósito L, Lindner C, Báguena M, Durduran T, Poca MA. Transcranial, Non-Invasive Evaluation of Potential Misery Perfusion During Hyperventilation Therapy of Traumatic Brain Injury Patients. J Neurotrauma 2023; 40:2073-2086. [PMID: 37125452 PMCID: PMC10541939 DOI: 10.1089/neu.2022.0419] [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] [Indexed: 05/02/2023] Open
Abstract
Hyperventilation (HV) therapy uses vasoconstriction to reduce intracranial pressure (ICP) by reducing cerebral blood volume. However, as HV also lowers cerebral blood flow (CBF), it may provoke misery perfusion (MP), in which the decrease in CBF is coupled with increased oxygen extraction fraction (OEF). MP may rapidly lead to the exhaustion of brain energy metabolites, making the brain vulnerable to ischemia. MP is difficult to detect at the bedside, which is where transcranial hybrid, near-infrared spectroscopies are promising because they non-invasively measure OEF and CBF. We have tested this technology during HV (∼30 min) with bilateral, frontal lobe monitoring to assess MP in 27 sessions in 18 patients with traumatic brain injury. In this study, HV did not lead to MP at a group level (p > 0.05). However, a statistical approach yielded 89 events with a high probability of MP in 19 sessions. We have characterized each statistically significant event in detail and its possible relationship to clinical and radiological status (decompressive craniectomy and presence of a cerebral lesion), without detecting any statistically significant difference (p > 0.05). However, MP detection stresses the need for personalized, real-time assessment in future clinical trials with HV, in order to provide an optimal evaluation of the risk-benefit balance of HV. Our study provides pilot data demonstrating that bedside transcranial hybrid near-infrared spectroscopies could be utilized to assess potential MP.
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Affiliation(s)
- Susanna Tagliabue
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Michał Kacprzak
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Isabel Serra
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jonas B Fischer
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- HemoPhotonics S.L., Castelldefels (Barcelona), Spain
| | | | - Anna Rey-Perez
- Neurotrauma Intensive Care Unit, and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lourdes Expósito
- Neurotrauma Intensive Care Unit, and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Claus Lindner
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Marcelino Báguena
- Neurotrauma Intensive Care Unit, and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Turgut Durduran
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - María Antonia Poca
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
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van Dijk JG, Gagaouzova BS, van Houwelingen MJ, Reijntjes RHAM, Kerkhof FI, van Rossum IA, Thijs RD. A case showing how hyperventilation may decrease blood pressure in neurogenic orthostatic hypotension. Clin Auton Res 2023; 33:549-552. [PMID: 37450088 DOI: 10.1007/s10286-023-00964-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Affiliation(s)
- J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Boriana S Gagaouzova
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Marc J van Houwelingen
- Department of Experimental Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Robert H A M Reijntjes
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fabian I Kerkhof
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ineke A van Rossum
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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Istanbullu C, Kayan Ocakoglu B, Karacetin G. A case of Pitt-Hopkins syndrome: psychopharmacological approach for anxiety, insomnia, and agitation. Neurocase 2023; 29:117-120. [PMID: 38700147 DOI: 10.1080/13554794.2024.2348230] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Pitt-Hopkins syndrome (PTHS) is a rare genetic disorder resulting from TCF4 gene mutations which is characterized by dysmorphic facial features, psychomotor delay, intellectual disability, breathing anomalies, and seizures. Psychiatric conditions are occasionally seen. We present the case report of a seven-year-old PTHS patient with anxiety, insomnia, and agitation. We discuss the psychopharmacological intervention options for this patient. The present case study reports on a 7-year-old female with PTHS, autism spectrum disorder (ASD), and intellectual disability. She had insomnia, crying spells and agitation complaints. For anxiety symptoms and agitation, risperidone, fluoxetine, and clonazepam treatment were given by the neurologist which caused behavioral disinhibition, paroxysmal agitation and no benefit. After admission to our hospital, aripiprazole and hydroxyzine were prescribed for anxiety and ASD-related irritability. She showed a minimal improvement but hyperventilation attacks were still ongoing. Hydroxyzine was stopped, and quetiapine was given to eliminate sleep disturbance. Her sleep period went up to eleven hours. For the anxiety symptoms, escitalopram was prescribed. She showed improvements in sleep, diminished hyperactivity and decreased frequency of abnormal breathing spells. Also, enhancement of social communication skills like increased eye contact and response to her name was observed. Patients with genetic syndromes may have various psychiatric complaints. Psychopharmacological interventions should be administered carefully for the side effects.
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Affiliation(s)
- Cemre Istanbullu
- Child And Adolescent Psychiatry, Istanbul Bakirkoy Prof Dr Mazhar Osman Mental and Nervous Diseases, Training and Research Hospital, Istanbul, Turkey
| | - Binay Kayan Ocakoglu
- Child And Adolescent Psychiatry, Istanbul Bakirkoy Prof Dr Mazhar Osman Mental and Nervous Diseases, Training and Research Hospital, Istanbul, Turkey
| | - Gul Karacetin
- Child And Adolescent Psychiatry, Istanbul Bakirkoy Prof Dr Mazhar Osman Mental and Nervous Diseases, Training and Research Hospital, Istanbul, Turkey
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Alessandro O, Rene W, Stefan W, Miodrag F, Martin S, Oliver B, Urs P. C-reactive protein elevation predicts in-hospital deterioration after aneurysmal subarachnoid hemorrhage: a retrospective observational study. Acta Neurochir (Wien) 2022; 164:1805-1814. [PMID: 35618852 PMCID: PMC9233629 DOI: 10.1007/s00701-022-05256-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
Background There is increasing evidence that inflammation plays a role in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH) and in the development of delayed cerebral ischemia (DCI). However, the assessment and interpretation of classically defined inflammatory parameters is difficult in aSAH patients. The objective of this study was to investigate the relationship between easily assessable findings (hyperventilation, fever, white blood cell count (WBC), and C-reactive protein (CRP)) and the occurrence of DCI and unfavorable neurological outcome at discharge in aSAH patients. Methods Retrospective analysis of prospectively collected data from a single center cohort. We evaluated the potential of clinical signs of inflammation (hyperventilation, fever) and simple inflammatory laboratory parameters CRP and WBC to predict unfavorable outcomes at discharge and DCI in a multivariate analysis. A cutoff value for CRP was calculated by Youden’s J statistic. Outcome was measured using the modified Rankin score at discharge, with an unfavorable outcome defined as modified Rankin scale (mRS) > 3. Results We included 97 consecutive aSAH patients (63 females, 34 males, mean age 58 years) in the analysis. Twenty-one (22%) had major disability or died by the time of hospital discharge. Among inflammatory parameters, CRP over 100 mg/dl on day 2 was an independent predictor for worse neurological outcome at discharge. The average C-reactive protein level in the first 14 days was higher in patients with a worse neurological outcome (96.6, SD 48.3 vs 56.3 mg/dl, SD 28.6) in the first 14 days after aSAH. C-reactive protein on day 2 was an indicator of worse neurological outcome. No inflammatory parameter was an independent predictor of DCI. After multivariate adjustment, DCI, increased age, and more than 1 day of mechanical ventilation were significant predictors of worse neurological outcome. Conclusions Early elevated CRP levels were a significant predictor of worse neurological outcome at hospital discharge and may be a useful marker of later deterioration in aSAH.
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Affiliation(s)
- Ostini Alessandro
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland.
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Warschkow Rene
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Wolf Stefan
- Department of Neurosurgery, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Filipovic Miodrag
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Seule Martin
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bozinov Oliver
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pietsch Urs
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kramer KEP, Anderson EE. Hyperventilation-Induced Hypocapnia in an Aviator. Aerosp Med Hum Perform 2022; 93:470-471. [PMID: 35551718 DOI: 10.3357/amhp.5975.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Physiological episodes are a top safety concern for aviators across the United States military. While many cases and a variety of causes for physiological episodes have been described, few cases, if any, have been reported of hyperventilation-induced hypocapnia and transient loss of consciousness.CASE REPORT: Here we describe a case of an aviator who experienced tingling extremities, confusion, and loss of consciousness during a flight. The aviator incorrectly believed he was experiencing hypoxia and continued to take multiple steps to troubleshoot the wrong underlying problem for his symptoms. Evaluation after landing suggested this was instead a stress-induced hyperventilation that resulted in symptomatic hypocapnia.DISCUSSION: We report this case to add to the body of literature in understanding this phenomenon as well as to provide aviators, physiologists, and flight surgeons with practical suggestions for recognizing hyperventilation-induced hypocapnia and awareness of how to remedy this situation when they recognize it.Kramer KEP, Anderson EE. Hyperventilation-induced hypocapnia in an aviator. Aerosp Med Hum Perform. 2022; 93(5):470-471.
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Macchiaiolo M, Panfili FM, Gonfiantini MV, Mastrogiorgio G, Buonuomo PS, Gaspari S, Longo D, Zollino M, Bartuli A. Langerhans cell histiocytosis in a young patient with Pitt-Hopkins syndrome. Am J Med Genet A 2020; 182:2746-2750. [PMID: 32945094 DOI: 10.1002/ajmg.a.61840] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 11/07/2022]
Abstract
Pitt-Hopkins syndrome (PTHS, MIM #610954) is a rare neurodevelopmental disease characterized by the association of intellectual disability, characteristic facial gestalt and episodes of abnormal and irregular breathing. PTHS is due to heterozygous loss-of-function variants in the TCF4 gene (transcription factor 4, MIM #602272) encoding for a basic helix-loop-helix transcription factor. TCF4 is highly expressed during early development of the nervous system, and it is involved in cellular differentiation and proliferation. Since the first clinical description in 1978, less than 200 PTHS patients have been described. A comprehensive phenotype, especially regarding cancer predisposition, is not yet well defined. We report the case of a 7-year-old boy affected by PTHS with a 4-week history of progressive swelling of the frontal bones diagnosed with Langerhans cell histiocytosis.
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Affiliation(s)
- Marina Macchiaiolo
- Rare Diseases and Genetic Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Michaela Veronika Gonfiantini
- Rare Diseases and Genetic Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gerarda Mastrogiorgio
- Rare Diseases and Genetic Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Genetic Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefania Gaspari
- Hematology/Oncology, Cellular and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marcella Zollino
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Genetica, Rome, Italy
- Università Cattolica Sacro Cuore, Istituto di Medicina Genomica, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Genetic Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Du Pasquier D, Fellrath JM, Sauty A. [Hyperventilation syndrome and dysfunctional breathing : update]. Rev Med Suisse 2020; 16:1243-1249. [PMID: 32558453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysfunctional breathing is a group of respiratory disorders that cause dyspnea, with no organic cause, or that are disproportionate to the organ involvement. Hyperventilation syndrome is the best-known manifestation of dysfunctional breathing. It is very often associated or secondary to anxiety disorders. When the diagnosis of dysfunctional breathing is not considered, it can lead to multiple and unnecessary investigations, further increasing anxiety. The diagnosis is based on various tests, none of which is really specific, and remains based on a bundle of arguments. Management must be adapted for each patient and is based on respiratory rehabilitation techniques.
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Affiliation(s)
- Daphné Du Pasquier
- Service de pneumologie, Réseau hospitalier neuchâtelois, Hôpital Pourtalès, 2000 Neuchâtel
| | - Jean-Marc Fellrath
- Service de pneumologie, Réseau hospitalier neuchâtelois, Hôpital Pourtalès, 2000 Neuchâtel
| | - Alain Sauty
- Service de pneumologie, Réseau hospitalier neuchâtelois, Hôpital Pourtalès, 2000 Neuchâtel
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12
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Nasreddine W, Fakhredin M, Makke Y, Hmaimess G, Sabbagh S, Beaini S, El Tourjuman O, Beydoun A. Hyperventilation-induced high-amplitude rhythmic slowing: A mimicker of absence seizures in children. Epilepsy Behav 2020; 103:106510. [PMID: 31645312 DOI: 10.1016/j.yebeh.2019.106510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Hyperventilation (HV) in children can lead to HV-induced high-amplitude rhythmic slowing (HIHARS) on the EEG (electroencephalogram) which is sometimes associated with altered awareness (AA) and concomitant semiological features. Our aims were to determine the frequency of HIHARS in children, to assess if the associated semiological features were temporally related to HV, and to evaluate if specific semiological features can differentiate HIHARS with AA from absence seizures. METHODS Consecutive children with suspected new onset seizure(s) underwent HV and awareness testing during video-EEG acquisition. Hyperventilation-induced high-amplitude rhythmic slowing was defined as 2.5- to 5-Hz generalized rhythmic slowing with amplitude ≥100 μv lasting for ≥3 s. The associated semiological features were compared between the group of children with HIHARS and AA, an age- and gender-matched control group without HIHARS, and in children who experienced absence seizures during HV. RESULTS One hundred sixteen children with a mean age of 9.8 years were included. Hyperventilation-induced high-amplitude rhythmic slowing occurred in 39 children (33.6%) with AA documented in 30 (76.9%). The probability of developing AA during HIHARS was significantly and positively correlated with the HIHARS duration. The frequencies of HIHARS were not significantly different between children diagnosed with seizure(s) and those with nonepileptic spells. Hyperventilation cessation and staring did not occur in any child of the control group. Fidgeting and yawning were significantly more common in the group with HIHARS with AA while staring and blinking were significantly more frequent in the group of children with absence seizures. CONCLUSIONS We ascertained that HIHARS with AA is a relatively common occurrence in children and most likely represents an age-related nonepileptic phenomenon. When associated with fidgeting or yawning, it can help differentiate this phenomenon from absence seizures. However, recording the concomitant presence of generalized spike wave discharges on the EEG remains essential to confirm the diagnosis of absence seizures.
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Affiliation(s)
- Wassim Nasreddine
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Fakhredin
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yamane Makke
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Ghassan Hmaimess
- Department of Pediatrics, St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - Sandra Sabbagh
- Department of Pediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Shawkat Beaini
- Department of Internal Medicine, Ain Wazein Medical Village, Chouf, Lebanon
| | | | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
Loss of consciousness occurs in post-hyperventilation apnea, but its pathophysiology remains unclear. We herein report a patient with post-hyperventilation apnea showing spindle activity on electroencephalogram (EEG). The patient was alert and breathing spontaneously before the hyperventilation test, but loss of consciousness and apnea with spindle activity on EEG occurred when the end-tidal CO2 decreased during the hyperventilation test. She recovered consciousness and spontaneous breathing with the disappearance of the spindle activity on EEG when the end-tidal CO2 increased after the hyperventilation test. The loss of consciousness during post-hyperventilation apnea might be due to the focal involvement of the ascending-activating mesodiencephalic reticular formation.
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Affiliation(s)
- Jun Ueda
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
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15
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Abstract
Chronic fatigue syndrome (CFS), including myalgic encephalomyelitis (ME) and postviral syndrome (PVS), is a term used today to describe a condition of incapacity for making and sustaining effort, associated with a wide range of symptoms. None of the reviews of CFS has provided a proper consideration of the effort syndrome caused by chronic habitual hyperventilation. In 100 consecutive patients, whose CFS had been attributed to ME or PVS, the time course of their illness and the respiratory psychophysiological studies were characteristic of chronic habitual hyperventilation in 93. It is suggested that the labels ‘CFS’, ‘ME’ or TVS' should be withheld until chronic habitual hyperventilation - for which conventional rehabilitation is available - has been definitively excluded.
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Affiliation(s)
- S D Rosen
- Department of Cardiology, Charing Cross Hospital, London
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16
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Williamson CA, Sheehan KM, Tipirneni R, Roark CD, Pandey AS, Thompson BG, Rajajee V. The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage. Neurocrit Care 2016; 23:330-8. [PMID: 25846710 DOI: 10.1007/s12028-015-0138-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome. METHODS This is a retrospective analysis of data from a prospectively collected cohort of SAH patients at an academic medical center. Spontaneous hyperventilation was defined by PaCO2 <35 mmHg and pH >7.45 and subdivided into moderate and severe groups. Clinical and demographic characteristics of patients with and without spontaneous hyperventilation were compared using χ (2) or t tests. Bivariate and multivariable logistic regression analyses were conducted to examine the association of moderate and severe hyperventilation with DCI and discharge neurological outcome. RESULTS Of 207 patients, 113 (55 %) had spontaneous hyperventilation. Spontaneously hyperventilating patients had greater illness severity as measured by the Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), and SAH sum scores. They were also more likely to develop the following complications: pneumonia, neurogenic myocardial injury, systemic inflammatory response syndrome (SIRS), radiographic vasospasm, DCI, and poor neurological outcome. In a multivariable logistic regression model including age, gender, WFNS, SAH sum score, pneumonia, neurogenic myocardial injury, etiology, and SIRS, only moderate [odds ratio (OR) 2.49, 95 % confidence interval (CI) 1.10-5.62] and severe (OR 3.12, 95 % CI 1.30-7.49) spontaneous hyperventilation were associated with DCI. Severe spontaneous hyperventilation (OR 4.52, 95 % CI 1.37-14.89) was also significantly associated with poor discharge outcome in multivariable logistic regression analysis. CONCLUSION Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.
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Affiliation(s)
- Craig A Williamson
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Kyle M Sheehan
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Renuka Tipirneni
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, 48109, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher D Roark
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Venkatakrishna Rajajee
- Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
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17
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Kennedy AJ, Rahn EJ, Paulukaitis BS, Savell KE, Kordasiewicz HB, Wang J, Lewis JW, Posey J, Strange SK, Guzman-Karlsson MC, Phillips SE, Decker K, Motley ST, Swayze EE, Ecker DJ, Michael TP, Day JJ, Sweatt JD. Tcf4 Regulates Synaptic Plasticity, DNA Methylation, and Memory Function. Cell Rep 2016; 16:2666-2685. [PMID: 27568567 PMCID: PMC5710002 DOI: 10.1016/j.celrep.2016.08.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [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: 06/30/2015] [Revised: 05/31/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022] Open
Abstract
Human haploinsufficiency of the transcription factor Tcf4 leads to a rare autism spectrum disorder called Pitt-Hopkins syndrome (PTHS), which is associated with severe language impairment and development delay. Here, we demonstrate that Tcf4 haploinsufficient mice have deficits in social interaction, ultrasonic vocalization, prepulse inhibition, and spatial and associative learning and memory. Despite learning deficits, Tcf4(+/-) mice have enhanced long-term potentiation in the CA1 area of the hippocampus. In translationally oriented studies, we found that small-molecule HDAC inhibitors normalized hippocampal LTP and memory recall. A comprehensive set of next-generation sequencing experiments of hippocampal mRNA and methylated DNA isolated from Tcf4-deficient and WT mice before or shortly after experiential learning, with or without administration of vorinostat, identified "memory-associated" genes modulated by HDAC inhibition and dysregulated by Tcf4 haploinsufficiency. Finally, we observed that Hdac2 isoform-selective knockdown was sufficient to rescue memory deficits in Tcf4(+/-) mice.
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Affiliation(s)
- Andrew J Kennedy
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Chemistry, Bates College, Lewiston, ME 04240, USA
| | - Elizabeth J Rahn
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Brynna S Paulukaitis
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
| | - Katherine E Savell
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Jing Wang
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - John W Lewis
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jessica Posey
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah K Strange
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mikael C Guzman-Karlsson
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Scott E Phillips
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kyle Decker
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | | | | | | | - Jeremy J Day
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - J David Sweatt
- Department of Neurobiology and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA.
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18
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Dawoud S, Ingram JB. Top 10 Facts You Should Know about Absence Epilepsy. J Miss State Med Assoc 2016; 57:210-212. [PMID: 28485556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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19
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Ku BD, Park KC, Yoon SS. Fatal ischemic stroke in a case of progressive moyamoya vasculopathy associated with uncontrolled thyrotoxicosis. Korean J Intern Med 2015; 30:543-6. [PMID: 26161023 PMCID: PMC4497344 DOI: 10.3904/kjim.2015.30.4.543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 09/22/2008] [Accepted: 11/10/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bon D. Ku
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Key-Chung Park
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Sang Yoon
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
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20
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Johnston TP, Tam-Williams J, Schmandt M, Patel AC, Cleveland C, Coste F, Kemp JS. Behavioral Hyperventilation and Central Sleep Apnea in Two Children. J Clin Sleep Med 2015; 11:487-9. [PMID: 26106657 DOI: 10.5664/jcsm.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Behavioral hyperventilation is a rarely recognized cause of central sleep apnea (CSA) among children. We report two pediatric patients who presented with prolonged central sleep apnea secondary to behavioral hyperventilation. One patient also had a prolonged corrected QT (QT(C)) interval resulting from hyperventilation
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21
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Boyd C, Levy A, McProud T, Huang L, Raneses E, Olson C. Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviors - New York State, 1988-2011. MMWR Morb Mortal Wkly Rep 2015; 64:518-21. [PMID: 25996093 PMCID: PMC4584570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drowning is an important cause of preventable injury and mortality, ranking fifth among leading causes of unintentional injury death in the United States. In 2011, two healthy young men died in a drowning incident at a New York City (NYC)-regulated swimming facility. The men became unconscious underwater after performing intentional hyperventilation before submersion. The phenomenon of healthy swimmers becoming unconscious underwater has been described elsewhere as hypoxic blackout. Prompted by this incident, the NYC Department of Health and Mental Hygiene (DOHMH) in collaboration with the New York State Department of Health (SDOH) conducted a case review of New York state fatal and nonfatal drownings reported during 1988-2011 to investigate similar behaviors in other incidents. DOHMH identified 16 cases, three in NYC, with a consistent set of voluntary behaviors associated with unintentional drowning and designated this class of behaviors as "dangerous underwater breath-holding behaviors" (DUBBs). For this small sample, the frequency of different DUBBs varied by age and swimming level, and practicing more than one DUBB increased the risk for fatality. This research contributes to the literature on drowning by focusing on contributing behaviors rather than drowning outcomes. NYC recently enacted public health education and regulations that discourage DUBBs; these interventions have the potential to effectively reduce unintentional drowning related to these behaviors and could be considered by other municipalities and jurisdictions.
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Affiliation(s)
- Christopher Boyd
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
| | - Amanda Levy
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
| | - Trevor McProud
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
| | - Lilly Huang
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
| | - Eli Raneses
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
| | - Carolyn Olson
- Division of Environmental Health, New York City Department of Health and Mental Hygiene
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22
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Lewis NCS, Bain AR, MacLeod DB, Wildfong KW, Smith KJ, Willie CK, Sanders ML, Numan T, Morrison SA, Foster GE, Stewart JM, Ainslie PN. Impact of hypocapnia and cerebral perfusion on orthostatic tolerance. J Physiol 2014; 592:5203-19. [PMID: 25217373 PMCID: PMC4262334 DOI: 10.1113/jphysiol.2014.280586] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/01/2014] [Indexed: 12/25/2022] Open
Abstract
We examined two novel hypotheses: (1) that orthostatic tolerance (OT) would be prolonged when hyperventilatory-induced hypocapnia (and hence cerebral hypoperfusion) was prevented; and (2) that pharmacological reductions in cerebral blood flow (CBF) at baseline would lower the 'CBF reserve', and ultimately reduce OT. In study 1 (n = 24; aged 25 ± 4 years) participants underwent progressive lower-body negative pressure (LBNP) until pre-syncope; end-tidal carbon dioxide (P ET , CO 2) was clamped at baseline levels (isocapnic trial) or uncontrolled. In study 2 (n = 10; aged 25 ± 4 years), CBF was pharmacologically reduced by administration of indomethacin (INDO; 1.2 mg kg(-1)) or unaltered (placebo) followed by LBNP to pre-syncope. Beat-by-beat measurements of middle cerebral artery blood flow velocity (MCAv; transcranial Doppler), heart rate (ECG), blood pressure (BP; Finometer) and end-tidal gases were obtained continuously. In a subset of subjects' arterial-to-jugular venous differences were obtained to examine the independent impact of hypocapnia or cerebral hypoperfusion (following INDO) on cerebral oxygen delivery and extraction. In study 1, during the isocapnic trial, P ET , CO 2 was successfully clamped at baseline levels at pre-syncope (38.3 ± 2.7 vs. 38.5 ± 2.5 mmHg respectively; P = 0.50). In the uncontrolled trial, P ET , CO 2 at pre-syncope was reduced by 10.9 ± 3.9 mmHg (P ≤ 0.001). Compared to the isocapnic trial, the decline in mean MCAv was 15 ± 4 cm s(-1) (35%; P ≤ 0.001) greater in the uncontrolled trial, yet the time to pre-syncope was comparable between trials (544 ± 130 vs. 572 ± 180 s; P = 0.30). In study 2, compared to placebo, INDO reduced resting MCAv by 19 ± 4 cm s(-1) (31%; P ≤ 0.001), but time to pre-syncope remained similar between trials (placebo: 1123 ± 138 s vs. INDO: 1175 ± 212 s; P = 0.53). The brain extracted more oxygen in face of hypocapnia (34% to 53%) or cerebral hypoperfusion (34% to 57%) to compensate for reductions in delivery. In summary, cerebral hypoperfusion either at rest or induced by hypocapnia at pre-syncope does not impact OT, probably due to a compensatory increase in oxygen extraction.
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Affiliation(s)
- Nia C S Lewis
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - Anthony R Bain
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - David B MacLeod
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Kevin W Wildfong
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - Kurt J Smith
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - Christopher K Willie
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | | | - Tianne Numan
- MIRA, University of Twente, Enschede, The Netherlands
| | - Shawnda A Morrison
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada Jozef Stefan Institute, Ljubljana, Slovenia
| | - Glen E Foster
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | | | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Canada
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23
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Antonelli D, Freedberg NA, Turgeman Y. [Ventricular fibrillation following hyperventilation and apneic underwater swimming]. Harefuah 2014; 153:579-625. [PMID: 25518074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case study of an 18 years old boy who lost consciousness during apneic underwater swimming. When cardiopulmonary resuscitation was initiated ventricular fibrillation was seen on cardiac monitoring. Bradycardia, atrial and ventricular premature beats are a known response to hyperventilation and apneic underwater diving. This case is the first documentation of ventricular fibritllation as a cause of sudden cardiac death during apneic underwater swimming.
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24
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Santra G, Paul R, Das S, Pradhan S. Hyperventilation of pregnancy presenting with flaccid quadriparesis due to hypokalaemia secondary to respiratory alkalosis. J Assoc Physicians India 2014; 62:536-538. [PMID: 25856925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hyperventilation in pregnancy is a cause of chronic respiratory alkalosis. Alkalosis either metabolic or respiratory may cause intracellular shift of potassium ions that may lead to hypokalaemia. However, the resultant hypokalaemia in respiratory alkalosis is usually mild and does not cause much clinical features. A five-months-pregnant female of the age 25 years presented with sudden onset flaccid weakness of both lower limbs associated with thigh muscle pain followed by weakness of both upper limbs within three days. Subsequent investigation revealed severe hypokalaemia due to acute exacerbation of chronic respiratory alkalosis secondary to hyperventilation of pregnancy, other causes of hypokalaemia being ruled out. Respiratory alkalosis causes tetany and other clinical manifestations. But hypokalaemia and such weakness is rarely found. Thisis probably the first report of this type from India.
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25
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van Leeuwen RB, Bruintjes TD. Dizziness in the elderly: diagnosing its causes in a multidisciplinary dizziness unit. Ear Nose Throat J 2014; 93:162-167. [PMID: 24817230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
We conducted a study to determine the causes of dizziness in patients aged 70 years and older who had been referred to our multidisciplinary dizziness clinic between Nov. 1, 2000, and Dec. 31, 2008. This population was made up of 731 patients--254 men (34.7%) and 477 women (65.3%). During their consultations, all of these patients were evaluated simultaneously by an ENT surgeon and a neurologist. We were able to identify the cause of dizziness in 620 of these patients (84.8%). The two most common causes were benign paroxysmal positional vertigo (BPPV), which was found in 202 patients (27.6%), and hyperventilation/anxiety, which was diagnosed in 112 patients (15.3%). Based on our findings, we conclude that the cause of dizziness can be established in the vast majority of elderly patients. We also compare our findings in these older patients with those of a group of 2,556 younger patients who were seen at our hospital and with the findings reported in other studies.
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Affiliation(s)
- Roeland B van Leeuwen
- Department of Neurology, Gelre Hospital, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.
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26
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Hanson D. Difficulties achieving orthodontic stability? The answer may be blowing in the wind. Int J Orthod Milwaukee 2014; 25:57-58. [PMID: 25745726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity.
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Affiliation(s)
- Teresa Paiva
- Sleep Medicine Centre, Medical Faculty of Lisbon, Lisbon, Portugal.
| | - Hrayr Attarian
- Circadian Rhythms and Sleep Research Laboratory, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ritz T, Meuret AE, Simon E. Cardiovascular activity in blood-injection-injury phobia during exposure: evidence for diphasic response patterns? Behav Res Ther 2013; 51:460-8. [PMID: 23747585 DOI: 10.1016/j.brat.2013.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 02/20/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
Abstract
Exposure to feared stimuli in blood-injection-injury (BII)-phobia is thought to elicit a diphasic response pattern, with an initial fight-flight-like cardiovascular activation followed by a marked deactivation and possible fainting (vasovagal syncope). However, studies have remained equivocal on the importance of such patterns. We therefore sought to determine the prevalence and clinical relevance of diphasic responses using criteria that require a true diphasic response to exceed cardiovascular activation of an emotional episode of a negative valence and to exceed deactivation of an emotionally neutral episode. Sixty BII-phobia participants and 20 healthy controls were exposed to surgery, anger and neutral films while measuring heart rate, blood pressure, respiratory pattern, and end-tidal partial pressure of carbon dioxide (as indicator of hyperventilation). Diphasic response patterns were observed in up to 20% of BII-phobia participants and 26.6% of healthy controls for individual cardiovascular parameters. BII-phobia participants with diphasic patterns across multiple parameters showed more fear of injections and blood draws, reported the strongest physical symptoms during the surgery film, and showed the strongest tendency to hyperventilate. Thus, although only a minority of individuals with BII phobia shows diphasic responses, their occurrence indicates significant distress. Respiratory training may add to the treatment of BII phobia patients that show diphasic response patterns.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
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29
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Kościelska M, Mieczkowski M. [Alkalosis]. Wiad Lek 2013; 66:329-333. [PMID: 24490489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An elevation of arterial blood pH called alkalosis remains an underestimated condition in hospitalized patients. Serious alkalosis can be associated with high risk of death. The disorder can be caused by increased concentration of bicarbonate (metabolic alkalosis) or decreased concentration of carbon dioxide (respiratory alkalosis). In most cases of metabolic alkalosis it is generated by vomiting or diuretic use, whereas respiratory alkalosis is provoked by hyperventilation associated with respiratory or neurological disorder. Maintenance of metabolic alkalosis is possible only in patients with impaired renal base excretion which is most often produced by hypochloremia. In both respiratory and metabolic alkaloses treatment depends on the underlying factor. In hyperventilation syndrome is based on behavioral therapy. In most cases of metabolic alkalosis the administration of sodium and potassium chloride forms a substantial part of therapy.
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Affiliation(s)
- Malgorzata Kościelska
- Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnetrznych, Warszawski Uniwersytet Medyczny.
| | - Mariusz Mieczkowski
- Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnetrznych, Warszawski Uniwersytet Medyczny
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Marsden KR, Haykowsky MJ, Smirl JD, Jones H, Nelson MD, Altamirano-Diaz LA, Gelinas JC, Tzeng YC, Smith KJ, Willie CK, Bailey DM, Ainslie PN. Aging blunts hyperventilation-induced hypocapnia and reduction in cerebral blood flow velocity during maximal exercise. Age (Dordr) 2012; 34:725-35. [PMID: 21559869 PMCID: PMC3337932 DOI: 10.1007/s11357-011-9258-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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: 12/05/2010] [Accepted: 04/26/2011] [Indexed: 05/22/2023]
Abstract
Cerebral blood flow (CBF) increases from rest to ∼60% of peak oxygen uptake (VO(2peak)) and thereafter decreases towards baseline due to hyperventilation-induced hypocapnia and subsequent cerebral vasoconstriction. It is unknown what happens to CBF in older adults (OA), who experience a decline in CBF at rest coupled with a blunted ventilatory response during VO(2peak). In 14 OA (71 ± 10 year) and 21 young controls (YA; 23 ± 4 years), we hypothesized that OA would experience less hyperventilation-induced cerebral vasoconstriction and therefore an attenuated reduction in CBF at VO(2peak). Incremental exercise was performed on a cycle ergometer, whilst bilateral middle cerebral artery blood flow velocity (MCA V (mean); transcranial Doppler ultrasound), heart rate (HR; ECG) and end-tidal PCO(2) (P(ET)CO(2)) were monitored continuously. Blood pressure (BP) was monitored intermittently. From rest to 50% of VO(2peak), despite greater elevations in BP in OA, the change in MCA V(mean) was greater in YA compared to OA (28% vs. 15%, respectively; P < 0.0005). In the YA, at intensities >70% of VO(2peak), the hyperventilation-induced declines in both P(ET)CO(2) (14 mmHg (YA) vs. 4 mmHg (OA); P < 0.05) and MCA V(mean) (-21% (YA) vs. -7% (OA); P < 0.0005) were greater in YA compared to OA. Our findings show (1), from rest-to-mild intensity exercise (50% VO(2peak)), elevations in CBF are reduced in OA and (2) age-related declines in hyperventilation during maximal exercise result in less hypocapnic-induced cerebral vasoconstriction.
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Affiliation(s)
- K. R. Marsden
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - M. J. Haykowsky
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada T6G 2G4
| | - J. D. Smirl
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - H. Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF UK
| | - M. D. Nelson
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada T6G 2G4
| | | | - J. C. Gelinas
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - Y. C. Tzeng
- Cardiovascular Systems Laboratory, Department of Surgery & Anesthesia, University of Otago, Wellington, New Zealand
| | - K. J. Smith
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - C. K. Willie
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
| | - D. M. Bailey
- Neurovascular Research Laboratory, Faculty of Health, Science and Sport, University of Glamorgan, Wales, UK
| | - P. N. Ainslie
- Department of Human Kinetics, University of British Columbia Okanagan, Kelowna, BC Canada V1V 2Y5
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Aslam U, Afzal S, Syed S. Hyperventilation provokes symptoms of carpal tunnel syndrome. Hand Surg 2012; 17:337-339. [PMID: 23061942 DOI: 10.1142/s021881041250027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hyperventilation causes respiratory alkalosis. The nervous system is more excitable in alkalosis. This phenomenon can be observed as paraesthesia in fingers and toes as well as around the lips in anxious patients breathing rapidly. We wanted to test this phenomenon on already irritable nerves like the median nerve in carpal tunnel syndrome (CTS). We deployed 50 patients who came in to the day case unit for carpal tunnel decompression with electro-physiologically proven diagnosis. We devised a test whereby patients were made to hyperventilate under prescribed conditions and repeated Phalen's test and Tinel's sign for comparison. These were compared with a control group chosen randomly among hospital staff. 86% patients had a positive result which was just behind Phalen's test in sensitivity. It was also 100% specific as there were no false positives. Hyperventilation is a phenomenon which provokes carpal tunnel syndrome. Its clinical value remains to be seen due to cumbersome method and probable patient non-compliance but it is a new discovery. It may be useful in other irritable-nerve-syndromes as a test to add to our available armament. It may be an additional factor or a primary reason for nocturnal paraesthesias in CTS patients.
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Affiliation(s)
- U Aslam
- Dudley Group of Hospitals NHS Trust, Pensnett Road, Dudley, DY1 2HQ, UK.
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Cuthbert S, Rosner A. Physical causes of anxiety and sleep disorders. Altern Ther Health Med 2011; 17:30-34. [PMID: 22314717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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David P, Laval D, Terrien J, Petitjean M. Postural control and ventilatory drive during voluntary hyperventilation and carbon dioxide rebreathing. Eur J Appl Physiol 2011; 112:145-54. [PMID: 21505845 DOI: 10.1007/s00421-011-1954-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 03/29/2011] [Indexed: 12/30/2022]
Abstract
The present study sought to establish links between hyperventilation and postural stability. Eight university students were asked to stand upright under two hyperventilation conditions applied randomly: (1) a metabolic hyperventilation induced by 5 min of hypercapnic-hyperoxic rebreathing (CO(2)-R); and, (2) a voluntary hyperventilation (VH) of 3 min imposed by a metronome set at 25 cycles per min. Recordings were obtained with eyes open, with the subjects standing on a force plate over 20-s periods. Ventilatory response, displacements in the centre of pressure in both the frontal and sagittal planes and fluctuations in the three planes of the ground reaction force were monitored in the time and frequency domains. Postural changes related to respiratory variations were quantified by coherence analysis. Myoelectric activities of the calf muscles were recorded using surface electromyography. Force plate measurements revealed a reduction in postural stability during both CO(2)-R and VH conditions, mainly in the sagittal plane. Coherence analysis provided evidence of a ventilatory origin in the vertical ground reaction force fluctuations during VH. Electromyographic analyses showed different leg muscles strategies, assuming the existence of links between the control of respiration and the control of posture. Our results suggest that the greater disturbing effects caused by voluntary hyperventilation on body balance are more compensated when respiration is under automatic control. These findings may have implications for understanding the organisation of postural and respiratory activities and suggest that stability of the body may be compromised in situations in which respiratory demand increases and requires voluntary control.
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Affiliation(s)
- Pascal David
- Université Paris Ouest Nanterre La Défense, Paris, France
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34
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Vestergaard A, Ruddox VDB. [Trousseaus sign with main d'acoucheur caused by hyperventilation]. Ugeskr Laeger 2010; 172:3342-3343. [PMID: 21118666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Trousseaus sign and "main d'acoucheur" is a clinical sign of increased neuromuscular sensitivity and can be seen in patients with hypocalcaemia. The fingers gather in a pyramid and the wrist if flexed. We report three different cases with hyperventilation as the apparent reason for main d'acoucheur. The treatment is simple and quick; removal of the underlying cause, reassurance and re-breathing.
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35
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Prashantha DK, Pal PK, Bharath RD. Hyperventilation-induced painful tonic spasms secondary to a structural lesion of the pons. Parkinsonism Relat Disord 2010; 16:618-9. [PMID: 20685149 DOI: 10.1016/j.parkreldis.2010.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 07/05/2010] [Accepted: 07/08/2010] [Indexed: 11/16/2022]
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36
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Biniwale M, Kleinman M. Safety of surfactant administration before transport of premature infants. Air Med J 2010; 29:170-177. [PMID: 20599151 DOI: 10.1016/j.amj.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/16/2010] [Accepted: 04/11/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the safety of surfactant administration prior to transport of premature infants. DESIGN/METHODS We performed a retrospective review of 24- to 34-weeks premature infants admitted to the Newborn Intensive Care Unit (NICU) between July 1, 1999 and September 30, 2004. Outcome measures were the presence of hyperventilation (PCO2 <40 mm Hg) and/or pneumothorax on admission to the NICU. Factors associated with the presence of hyperventilation and pneumothorax were identified. RESULTS 955 infants born at 24 to 34 weeks' gestation were admitted to the NICU during the study period. 217 (22.7%) received surfactant prior to transport within 48 hours of birth. The incidence of hyperventilation was 18.9%. Hyperventilated infants had longer transport times, lower birth weights, and lower PCO2 on blood gases obtained prior to transport. Pneumothorax occurred in six subjects (2.9%). Neonates with pneumothorax had lower APGAR scores. CONCLUSIONS We found the administration of surfactant prior to transport to be safe as evidenced by a low incidence of pneumothorax. Pneumothorax was more likely to occur in infants who needed significant resuscitation at birth. The incidence of hyperventilation appeared to be high and was inversely associated with birth weight.
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Affiliation(s)
- Manoj Biniwale
- Center for Fetal and Neonatal Medicine and the USC Division of Neonatal Medicine, Los Angeles, CA, USA.
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37
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Chin LMK, Heigenhauser GJF, Paterson DH, Kowalchuk JM. Pulmonary O2 uptake and leg blood flow kinetics during moderate exercise are slowed by hyperventilation-induced hypocapnic alkalosis. J Appl Physiol (1985) 2010; 108:1641-50. [PMID: 20339012 PMCID: PMC2886676 DOI: 10.1152/japplphysiol.01346.2009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [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: 12/03/2009] [Accepted: 03/23/2010] [Indexed: 11/22/2022] Open
Abstract
The effect of hyperventilation-induced hypocapnic alkalosis (Hypo) on the adjustment of pulmonary O2 uptake (VO2p) and leg femoral conduit artery ("bulk") blood flow (LBF) during moderate-intensity exercise (Mod) was examined in eight young male adults. Subjects completed four to six repetitions of alternate-leg knee-extension exercise during normal breathing [Con; end-tidal partial pressure of CO2 (PetCO2) approximately 40 mmHg] and sustained hyperventilation (Hypo; PetCO2 approximately 20 mmHg). Increases in work rate were made instantaneously from baseline (3 W) to Mod (80% estimated lactate threshold). VO2p was measured breath by breath by mass spectrometry and volume turbine, and LBF (calculated from mean femoral artery blood velocity and femoral artery diameter) was measured simultaneously by Doppler ultrasound. Concentration changes of deoxy (Delta[HHb])-, oxy (Delta[O2Hb])-, and total hemoglobin-myoglobin (Delta[HbTot]) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). The kinetics of VO2p, LBF, and Delta[HHb] were modeled using a monoexponential equation by nonlinear regression. The time constants for the phase 2 VO2p (Hypo, 49+/-26 s; Con, 28+/-8 s) and LBF (Hypo, 46+/-16 s; Con, 23+/-6 s) were greater (P<0.05) in Hypo compared with Con. However, the mean response time for the overall Delta[HHb] response was not different between conditions (Hypo, 23+/-5 s; Con, 24+/-3 s), whereas the Delta[HHb] amplitude was greater (P<0.05) in Hypo (8.05+/-7.47 a.u.) compared with Con (6.69+/-6.31 a.u.). Combined, these results suggest that hyperventilation-induced hypocapnic alkalosis is associated with slower convective (i.e., slowed femoral artery and microvascular blood flow) and diffusive (i.e., greater fractional O2 extraction for a given DeltaVO2p) O2 delivery, which may contribute to the hyperventilation-induced slowing of VO2p (and muscle O2 utilization) kinetics.
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Affiliation(s)
- Lisa M K Chin
- Canadian Centre for Activity and Aging, School of Kinesiology, Department of Physiology and Pharmacology, Arthur and Sonia Labatt Health Sciences Bldg., Rm. 411C, The University of Western Ontario, London, ON, Canada N6A 5B9
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38
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Palamarthy AB. Role of breathing exercises in hyperventilating subjects. Thorax 2010; 64:824; author reply 824. [PMID: 19717716 DOI: 10.1136/thx.2009.113597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Sergienko DV, Boklag SP. [Bronchial asthma: characteristics of modern diagnostics]. Lik Sprava 2010:31-39. [PMID: 20608025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bronchial asthma, including its not severe forms, is chronic inflammatory disease of bronchial tubes, requiring application of anti-inflammatory therapy, foremost the use corticosteroids, which are capable to improve considerably prognosis for such patients. At the same to diagnose bronchial asthma is not easy task and presents some difficulty. The questions of correct diagnostics and treatment of this disease, its aspirin-sensitive form, and also such associated with bronchial asthma illnesses as bronchopulmonary aspergillosis, Churg-Strauss syndrome are discussed in the article. The role of gastrooesophageal reflux in forming of bronchial constriction is shown.
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40
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Gyselaers W, Indrato R, Westerhuis M, Visser G, Rosén K. STAN®-recorded intrapartum loss of beat-to-beat variation associated with prolonged QT-interval: Indicative for fetal hypocalcemia? J Matern Fetal Neonatal Med 2009; 20:69-73. [PMID: 17437203 DOI: 10.1080/02331930601128048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Mortensen SA, Vilhelmsen R, Sandøe E. Prinzmetal's variant angina)(PVA). Circadian variation in response to hyperventilation. Acta Med Scand Suppl 2009; 644:38-41. [PMID: 6941641 DOI: 10.1111/j.0954-6820.1981.tb03116.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The study reports on the outcome of hyperventilation tests in a 57-year-old male with Prinzmetal's variant angina, formerly often complicated by ventricular fibrillation. It was found that hyperventilation for a period of 6 min after a delay of 4 to 6 min was followed by the development of ST-elevation and pain, but only when the test was performed in the morning, whereas the outcome of tests performed later in the day were negative. Pretreatment with calcium blockers, nifedipine or verapamil proved effective in preventing the anginal response to the test, also when it was performed in the morning. It is concluded that hyperventilation performed in the early morning, but not later in the day, may prove to be an effective and safe procedure for provoking Prinzmetal's variant angina, and that hyperventilation may be useful in the evaluation of the efficacy of drug therapy.
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42
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Karpova OI. [Reflex cough: etiology, clinical features, diagnosis, and treatment]. Vestn Otorinolaringol 2009:27-30. [PMID: 19738587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Etiologic factors responsible for the development of reflex coughing are described. A highly efficacious and safe method is proposed for the management of this condition of psychogenic origin associated with hyperventilation by intradermal novocaine blockade of the laryngeal Head's zones in conjunction with preventive treatment of coughing attacks.
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43
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Bouaziz H, Charfî N, Kaffel N, Mnif M, Abid M. [Rare complication of diabetic acidoketosis: the pneumomediastinum]. Rev Pneumol Clin 2007; 63:327-330. [PMID: 18166937 DOI: 10.1016/s0761-8417(07)74211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pneumomediastinum is a rare condition with an incidence of 1/33,000. It can be a rare complication of diabetic acidoketosis. We present the cases of two diabetic patients and review the literature, focusing our analysis on the interrelationships between these two diseases. Both patients were young subjects, a 21-year-old woman and an 18-year-old man with type 1 diabetes who were admitted for acidoketosis. Clinically, the patients presented the cardinal signs of diabetes and a flu-like syndrome associated with dyspnea and chest pain. Physical examination revealed a poor general health status, tachycardia and polymnea, as well as a painful diffuse tumefaction of the neck with subcutaneous emphysema. Blood tests disclosed elevated glycemia and urine was positive for acetone. The diagnosis of severe metabolic acidosis was retained. The chest x-ray demonstrated the subcutaneous emphysema and air in the anterior mediastinum. On the computed tomography scan obtained in the second patient, the heart was silhouetted with a hyperlucent zone laterally. Treatment consisted in strict bed rest with oxygen therapy, fluid replacement, insulin and heparin. The pneumomediastinum resolved in both patients within three days on average. The causal effect of diabetic acidoketosis in the development of pneumomediastinum in our two patients was retained after ruling out all other potential causes, including chest trauma and asthma.
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Affiliation(s)
- H Bouaziz
- Service d'Endocrinologie, CHU Hedi-Chaker, Sfax 3029, Tunisia.
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45
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Choi KD, Kim JS, Kim HJ, Koo JW, Kim JH, Kim CY, Oh CW, Kee HJ. Hyperventilation-induced nystagmus in peripheral vestibulopathy and cerebellopontine angle tumor. Neurology 2007; 69:1050-9. [PMID: 17785675 DOI: 10.1212/01.wnl.0000271378.54381.6a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the incidence and characteristics of hyperventilation-induced nystagmus (HIN) in cerebellopontine angle (CPA) tumors and unilateral peripheral vestibulopathy (UPV), and to elucidate differential contribution of hyperventilation to bring out vestibular asymmetry between acute and chronic phases of UPV. METHODS We recorded horizontal HIN in 33 patients with CPA tumors and 145 with UPV. The UPV included patients of either acute (7 days or less from symptom onset, n = 47) or chronic (more than 7 days from symptom onset, n = 98) phases. RESULTS The incidence of HIN was higher in the CPA tumor than in the UPV group (82 vs 34%, p < 0.01) and was also higher in the acute than in the chronic UPV group (60 vs 21%, p < 0.01). Furthermore, HIN was more commonly ipsilesional (i-HIN) in the CPA tumor than in the UPV group (52 vs 8%, p < 0.01) and more commonly ipsilesional in the acute than in the chronic UPV group (21 vs 1%, p < 0.01). The patients with i-HIN and acoustic neuroma had a tendency to harbor smaller tumors and to have less severe caloric asymmetry. CONCLUSIONS The contribution of hyperventilation on vestibular nystagmus differs depending on the disease phase or underlying pathologies. Our study demonstrates that hyperventilation-induced nystagmus (HIN) beating to the side of reduced caloric response, hearing impairment, or abnormal auditory brainstem response responses may be a valuable sign for bedside detection of cerebellopontine angle (CPA) tumors. CPA tumor should be a prime suspicion in patients with acute vertigo and ipsilesional HIN, especially when the vertigo accompanies hearing impairments.
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Affiliation(s)
- K-D Choi
- Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
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46
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Ito N, Fukumoto S. [Symptoms and management of tetany]. Clin Calcium 2007; 17:1234-1239. [PMID: 17660621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Tetany is a series of symptoms characterized by painful muscle cramp that derives from enhanced neuromuscular excitability due to hypocalcemia, hypomagnesemia or alkalosis. In a broad sense, tetany includes associated sensory disturbance. Typical symptoms of tetany include carpopedal spasm, laryngospasm and generalized seizure. Chvostek and Trousseau signs are provocative tests for diagnosis of latent tetany. Many diseases including endocrine disorders like hypoparathyroidism and alkalosis by hyperventilation can cause tetany. Infusion of calcium or magnesium is effective as an acute therapy for tetany. However, subsequent diagnosis and treatment of underlining diseases are mandatory.
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Affiliation(s)
- Nobuaki Ito
- The University of Tokyo Hospital, Department of Internal Medicine, Division of Nephrology and Endocrinology, Japan
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47
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Bogaerts K, Hubin M, Van Diest I, De Peuter S, Van Houdenhove B, Van Wambeke P, Crombez G, Van den Bergh O. Hyperventilation in patients with chronic fatigue syndrome: the role of coping strategies. Behav Res Ther 2007; 45:2679-90. [PMID: 17719001 DOI: 10.1016/j.brat.2007.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 07/08/2007] [Accepted: 07/16/2007] [Indexed: 11/15/2022]
Abstract
Hyperventilation has been suggested as a concomitant and possible maintaining factor that may contribute to the symptom pattern of chronic fatigue syndrome (CFS). Because patients accepting the illness and trying to live with it seem to have a better prognosis than patients chronically fighting it, we investigated breathing behavior during different coping response sets towards the illness in patients with CFS (N=30, CDC criteria). Patients imagined a relaxation script (baseline), a script describing a coping response of hostile resistance, and a script depicting acceptance of the illness and its (future) consequences. During each imagery trial, end-tidal PCO2 (Handheld Capnograph, Oridion) was measured. After each trial, patients filled out a symptom checklist. Results showed low resting values of PetCO2 overall, while only imagery of hostile resistance triggered a decrease and deficient recovery of PetCO2. Also, more hyperventilation complaints and complaints of other origin were reported during hostile resistance imagery compared with acceptance and relaxation. In conclusion, hostile resistance seems to trigger both physiological and symptom perception processes contributing to the clinical picture of CFS.
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Affiliation(s)
- Katleen Bogaerts
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium
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48
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Sikter A, Frecska E, Braun IM, Gonda X, Rihmer Z. The role of hyperventilation: hypocapnia in the pathomechanism of panic disorder. Rev Bras Psiquiatr 2007; 29:375-9. [PMID: 17713689 DOI: 10.1590/s1516-44462006005000048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 04/02/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The authors present a profile of panic disorder based on and generalized from the effects of acute and chronic hyperventilation that are characteristic of the respiratory panic disorder subtype. The review presented attempts to integrate three premises: hyperventilation is a physiological response to hypercapnia; hyperventilation can induce panic attacks; chronic hyperventilation is a protective mechanism against panic attacks. METHOD: A selective review of the literature was made using the Medline database. Reports of the interrelationships among panic disorder, hyperventilation, acidosis, and alkalosis, as well as catecholamine release and sensitivity, were selected. The findings were structured into an integrated model. DISCUSSION: The panic attacks experienced by individuals with panic disorder develop on the basis of metabolic acidosis, which is a compensatory response to chronic hyperventilation. The attacks are triggered by a sudden increase in (pCO2) when the latent (metabolic) acidosis manifests as hypercapnic acidosis. The acidotic condition induces catecholamine release. Sympathicotonia cannot arise during the hypercapnic phase, since low pH decreases catecholamine sensitivity. Catecholamines can provoke panic when hyperventilation causes the hypercapnia to switch to hypocapnic alkalosis (overcompensation) and catecholamine sensitivity begins to increase. CONCLUSION: Therapeutic approaches should address long-term regulation of the respiratory pattern and elimination of metabolic acidosis.
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Affiliation(s)
- Andras Sikter
- Department of Internal Medicine, St. Rokus Hospital, Budapest, Hungary
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49
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Chin LMK, Leigh RJ, Heigenhauser GJF, Rossiter HB, Paterson DH, Kowalchuk JM. Hyperventilation-induced hypocapnic alkalosis slows the adaptation of pulmonary O2 uptake during the transition to moderate-intensity exercise. J Physiol 2007; 583:351-64. [PMID: 17584832 PMCID: PMC2277242 DOI: 10.1113/jphysiol.2007.132837] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The effect of voluntary hyperventilation-induced hypocapnic alkalosis (RALK) on pulmonary O2 uptake (VO2) kinetics and muscle deoxygenation was examined in young male adults (n=8) during moderate-intensity exercise. Subjects performed five repetitions of a step-transition in work rate from 20 W cycling to a work rate corresponding to 90% of the estimated lactate threshold during control (CON; PET,CO2, approximately 40 mmHg) and during hyperventilation (RALK; PET,CO2, approximately 20 mmHg). was measured breath-by-breath and relative concentration changes in muscle deoxy- (DeltaHHb), oxy- (DeltaO2Hb) and total (DeltaHbtot) haemoglobin were measured continuously using near-infrared (NIR) spectroscopy (Hamamatsu, NIRO 300). The time constant for the fundamental, phase 2, VO2 response (tau VO2) was greater (P<0.05) in RALK (48+/-11 s) than CON (31+/-9 s), while tauHHb was similar between conditions (RALK, 12+/-4 s; CON, 11+/-4 s). The DeltaHb(tot) was lower (P<0.05) in RALK than CON, prior to (RALK, -3+/-5 micromol l(-1); CON, -1+/-4 micromol l(-1)) and at the end (RALK, 1+/-6 micromol l(-1); CON, 5+/-5 micromol l(-1)) of moderate-intensity exercise. Although slower adaptation of during RALK may be related to an attenuated activation of PDH (and other enzymes) and provision of oxidizable substrate to the mitochondria (i.e. metabolic inertia), the present findings also suggest a role for a reduction in local muscle perfusion and O2 delivery.
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Affiliation(s)
- Lisa M K Chin
- Canadian Centre for Activity and Aging, School of Kinesiology, Faculty of Health Sciences, Department of Physiology and Pharmacology, HSB 411C, University of Western Ontario, London, Ontario, Canada N6A 5B9
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50
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Abstract
PURPOSE The relationship between hyperventilation and the associated increase in flicker sensitivity is poorly defined but may be relevant to display viewing. This exploratory study investigates the potential for quantifying the relationship between the severity of hypocapnia and critical flicker frequency (CFF). METHOD Repeated ascending (fusion) and descending (flicker) measurements were made while breathing normally (normocapnia), and at four levels of progressive, mild to moderate hypocapnia that were induced by voluntary hyperventilation and controlled using continuous respiratory mass spectrometry. The mesopic stimulus was a 2.6 degree-Gaussian blob viewed through a 5.2-mm-diameter artificial pupil. RESULTS Five discrete respiratory conditions were generated. The influences of intersubject variability and severity of hypocapnia upon mean CFF were examined using two-way analysis of variance, demonstrating a statistically significant effect of target end-tidal partial pressure of carbon dioxide [F(4,40) = 4.63, p = 0.005]. The relationship between decreasing mean end-tidal partial pressure of carbon dioxide and increasing mean CFF was consistent with a linear correlation (Pearson R = -0.949, p = 0.013). CONCLUSIONS The results support a close relationship between the respiratory partial pressure of carbon dioxide and flicker sensitivity. However, the absolute magnitude of the underlying increase in flicker sensitivity with hypocapnia is small and the effect is unlikely to be relevant in aviation.
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Affiliation(s)
- Desmond Connolly
- QinetiQ, Human Protection and Performance Enhancement Group, Cody Technology Park, Farnborough, United Kingdom.
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