Análisis de la microestructura de sueño en pacientes con insomnio idiopático

El objetivo principal de esta investigación fue describir la actividad electroencefalográfica durante el sueño y el patrón alternante cíclico (CAP) en pacientes con insomnio idiopático. Se incluyeron 22 pacientes (8 masculinos, 14 femeninos) con diagnóstico de insomnio idiopático con rango de edad de 19 a 45 años y promedio de 30 años, de recién diagnostico y sin tratamiento previo. Se realizaron estudios polisomnográficos con el montaje internacional 10-20 y referencias bi-polares (32 electrodos con 16 derivaciones), registro del electrooculograma, electromiograma, electrocardiograma, movimientos respiratorios tóraco-abdominal, flujo nasal y oximetría. De los 22 pacientes registrados 10, que representan el 45% de la muestra, no presentaron actividad anormal en el análisis de la actividad eléctrica cerebral; mientras que los 12 pacientes restantes (55%) presentaron actividad irritativa (puntas, ondas agudas en inversión de fase y brotes de actividad lenta) en el registro electroencefalográfico. La actividad anormal se presentó únicamente en hemisferio izquierdo en el 66% de los pacientes. En el 33% restante se presentó en ambos hemisferios. En relación a los estudios polisomnográficos se encontraron diferencias significativas entre grupos (pacientes con alteración en el EEG vs pacientes sin ella) en la latencia a sueño, tiempo total de sueño, tiempo total de vigilia, eficiencia de sueño, porcentaje de sueño ligero, porcentaje de sueño de ondas lentas y en el índice del subtipo A1 del patrón alternante cíclico. Estos hallazgos sugieren que dentro de la población de pacientes con insomnio idiopático, existe un sub-grupo cuyos síntomas son más severos y la queja de sueño (insomnio) podría estar asociada íntimamente a los hallazgos electroencefalográficos presentes durante el sueño.The main purpose of this research was to describe electroencephalographic activity during sleep and the cyclical alternating pattern (CAP) in patients with idiopathic insomnia. It included 22 patients (8 male, 14 female) with a diagnosis of idiopathic insomnia, ranging in age from 19 to 45 years old, the average being 30, who were recently diagnosed and without prior treatment. Sleep studies were performed with the international 10-20 system and bipolar montages (32 electrodes with 16 derivations), record of the electrooculogram, electromyography, electrocardiogram, chest/abdominal respiratory movements, nasal flow and oximetry. Of the 22 patients registered, 10 patients, who represented 45% of the sample, did not present with any abnormal activity in the analysis of the cerebral electrical activity, while the remaining 12 patients (55%) presented with irritative activity (spikes, acute waves in phase inversion and outbreaks of slow activity) in the electroencephalographic record. The abnormal activity presented only in the left hemisphere in 66% of the patients. It presented in both hemispheres for the remaining 33%. With regard to the sleep record, significant differences were found between the groups (patients with alterations in the EEG vs. patients without alterations) in sleep latency, total sleep time, total wake time, light sleep percentage, slow waves percentage and in the A1 sub-type index of the cyclical alternating pattern. These findings suggest that within the population of patients with idiopathic insomnia, there is a sub-group whose symptoms are more severe and whose sleep complaints (insomnia) could be closely related to the electroencephalographic findings present during sleep

A surgical model of short bowel syndrome induces a long-lasting increase in pancreatic beta-cell mass

Several surgical techniques are used nowadays as a severe treatment for obesity and diabetes mellitus type 2. These techniques are aggressive due to drastic changes in the nutrient flow and non-reversible modifications on the digestive tube. In this paper we present the effects of a massive intestinal resection on the pancreas. Results have shown that short bowel technique is less aggressive to normal anatomy and physiology of the intestinal tract than Gastric bypass or biliopancreatic diversion (e.g.). In this paper we reproduce a model of short bowel syndrome (SIC), with similar surgical conditions and clinical complications as seen in human cases. This work was conducted on normal Wistar rats, with no other concurrent factors, in order to determine the effects on normal pancreas islets. We measured pancreatic implications by histomorphometric studies, which included beta-cell mass by immunocytochemistry, and apoptosis/proliferation test with TUNEL technique and Ki-67. Briefly, we reported on an increased relative area of the islets of the pancreas, as well as an increase in the average size of islets in the SIC versus the control group. Furthermore we stated that this increase in size of the pancreatic islets is due to the mechanisms of proliferation of beta cells in animals undergoing SIC. These goals could reveal a direct influence of surgical modification of the digestive tract over the pancreatic beta cell homeostasis. In this sense, there are many potential stimulators of intestinal adaptation, including peptide hormones and growth components which are associated or involved as effectors of the endocrine pancreas

Bariatric Surgery Influences beta-Cell Turnover in Non Obese Rats.

Manuscrito en proceso de revisión editorialThe aim of this study was to investigate the different bariatric surgeries relationship with pancreatic beta-cell turnover. We used healthy adult male Wistar rats to undergo the different techniques. We developed three surgical techniques (malabsorptive, Sleeve gastrectomy and Roux-Y Gastric Bypass-), and two control groups (Sham and fasting control). Pancreatic beta-cell mass was measured, as well as apoptosis, proliferation and neogenesis related to cellular turnover. Otherwise, we measured the functional issues to elucidate the physiological role that these surgical techniques trigger in the carbohydrate metabolism (e.g. food intake, weight gain, intraperitoneal glucose tolerance test, and basal glycaemia). Results included the differences that these parameters underwent in each surgical model. The -cell mass presented modifications that were related with proliferation processes. We reported significant increase of -cell mass in the malabsorptive technique. Other while the peripheral resistance to insulin trended to reduce in rats underwent with malabsorptive and mixed techniques. The goal of the present study was to present how different bariatric surgical techniques affected on pancreatic beta-cell turnover. We considered that these implications of surgery over the endocrine pancreas must be one of the mechanisms related to the improvement of type 2 Diabetes mellitus afterward the bariatric surgery.41 paginas, que recogen toda la documentación enviada a consideración editoria

Nitric Oxide Is a Mediator of Antiproliferative Effects Induced by Proinflammatory Cytokines on Pancreatic Beta Cells

Nitric oxide (NO) is involved in several biological processes. In type 1 diabetes mellitus (T1DM), proinflammatory cytokines activate an inducible isoform of NOS (iNOS) in β cells, thus increasing NO levels and inducing apoptosis. The aim of the current study is to determine the role of NO (1) in the antiproliferative effect of proinflammatory cytokines IL-1β, IFN-γ, and TNF-α on cultured islet β cells and (2) during the insulitis stage prior to diabetes onset using the Biobreeding (BB) rat strain as T1DM model. Our results indicate that NO donors exert an antiproliferative effect on β cell obtained from cultured pancreatic islets, similar to that induced by proinflammatory cytokines. This cytokine-induced antiproliferative effect can be reversed by L-NMMA, a general NOS inhibitor, and is independent of guanylate cyclase pathway. Assays using NOS isoform specific inhibitors suggest that the NO implicated in the antiproliferative effect of proinflammatory cytokines is produced by inducible NOS, although not in an exclusive way. In BB rats, early treatment with L-NMMA improves the initial stage of insulitis. We conclude that NO is an important mediator of antiproliferative effect induced by proinflammatory cytokines on cultured β cell and is implicated in β-cell proliferation impairment observed early from initial stage of insulitis

Therapeutic Properties of <em>Trichinella spiralis</em> (Nematoda) in Chronic Degenerative Diseases

Diseases produced by helminth parasites occur frequently in underdeveloped countries where they present a serious public health problem. At the same time, in these regions, a lower rate of autoimmune and allergic diseases has been observed. Due to these observations, some researchers have proposed that some helminths, such as Trichinella spiralis or its proteins, have strong anti-inflammatory potential, or have assessed them as modulating agents of the immune response. T. spiralis shifts the host immune response from a Th1 profile, characterized by pro-inflammatory cytokines, to a Th2 profile, characterized by the release of different cytokines with anti-inflammatory properties. This parasite has shown high therapeutic potential in a wide variety of disease models. In one of the most promising, the experimental lupus model in mice, the release of anti-inflammatory cytokines IL-4 and IL-10 and delayed onset of the key clinical features of the experimental lupus model for at least 5 months were observed, when previously parasitized. This is the first study to date that focuses on the use of T. spiralis as an immunomodulator in lupus disease. In conclusion, further study of the immune response generated by the parasite is necessary to advance the development of new therapies for inflammatory diseases

Changes in pharyngeal anatomy and apnea/hypopnea index after a mandibular advancement device

Objectives: This study aimed to evaluate the therapeutic effcacy of custom-made mandibular advancement devices (MAD) in the control of primary snoring and sleep apnea and to correlate with anatomical changes identified through imaging tests. Methods: Patients (n = 17) diagnosed with sleep apnea or primary snoring were included in this study and subsequently treated with MADs. Changes were assessed using a polysomnographic study (PSG), the Epworth Sleepiness Scale (ESS), and an imaging study with computed tomography scanning (CT). Studies were performed before and after the use of MAD. Anteroposterior measurements were taken in the sagittal plane at the hard palate, glottis, and supraglottic levels along the hard palate axis. Afterward, measurements were taken in the axial plane at the same levels along the hard palate axis. Results: From the six recorded measurements, the airway caliber increased by five. However, these changes were significant only in two measurements (sagittal hard palate and axial supraglottic). Snoring was controlled in 16 of the 17 subjects. From these sixteen, 12 subjects had a correct opening of the airway at the hard palate level. Moreover, daytime sleepiness decreased in all subjects. Discussion: Present results suggest that sagittal hard palate and axial supraglottic opening after use of MAD are mainly responsible for eliminating snoring and improve sleep apnea

Cognitive behavioral therapy for insomnia helps to reverse cognitive impairment in insomnia patients

Introduction: Insomnia is the most common of sleep disorders, it induces a wide variety of organic symptoms, including somatic and cognitive impairments. There are pharmacological drugs nowadays that help diminish sleep impairments due to insomnia. However, most of them seem to be worsening cognitive impairments, benzodiazepine receptor agonists, in particular, seem to induce an even worst deterioration of cognitive function. On the other hand, cognitive behavioral therapy for insomnia (CBT-I) has shown to be a reliable tool to improve the whole picture of insomnia. Objectives: To analyze the effect of CBT-I on insomnia symptoms and cognitive performance in patients suffering from chronic insomnia. Material and Methods: Ten subjects with a diagnosis of insomnia and no pharmacological treatment were evaluated pre- and post-six biweekly sessions of CBT-I with two neuropsychological batteries, BANFE and NEUROPSI attention and memory. Results: CBT-I significantly improves both the symptoms of insomnia, measured subjectively with a sleep diary and the Athens insomnia scale, and the cognitive performance measured with the neuropsychological batteries. Discussion: CBT-I is not only an effective tool for the treatment of insomnia but also helps to ameliorate cognitive performance

Sleep, emotional and behavioral difficulties in children and adolescents.

Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce