Multicenter assessment of quantitative sensory testing (QST) for the detection of neuropathic-like pain responses using the topical capsaicin model

Background: The use of quantitative sensory testing (QST) in multicenter studies has been quite limited, due in part to lack of standardized procedures among centers. Aim: The aim of this study was to assess the application of the capsaicin pain model as a surrogate experimental human model of neuropathic pain in different centers and verify the variation in reports of QST measures across centers. Methods: A multicenter study conducted by the Quebec Pain Research Network in six laboratories allowed the evaluation of nine QST parameters in 60 healthy subjects treated with topical capsaicin to model unilateral pain and allodynia. The same measurements (without capsaicin) were taken in 20 patients with chronic neuropathic pain recruited from an independent pain clinic. Results: Results revealed that six parameters detected a significant difference between the capsaicin-treated and the control skin areas: (1) cold detection threshold (CDT) and (2) cold pain threshold (CPT) are lower on the capsaicin-treated side, indicating a decreased in cold sensitivity; (3) heat pain threshold (HPT) was lower on the capsaicin-treated side in healthy subjects, suggesting an increased heat pain sensitivity; (4) dynamic mechanical allodynia (DMA); (5) mechanical pain after two stimulations (MPS2); and (6) mechanical pain summation after ten stimulations (MPS10), are increased on the capsaicin-treated side, suggesting an increased in mechanical pain (P < 0.002). CDT, CPT and HPT showed comparable effects across all six centers, with CPT and HPT demonstrating the best sensitivity. Data from the patients showed significant difference between affected and unaffected body side but only with CDT. Conclusion: These results provide further support for the application of QST in multicenter studies examining normal and pathological pain responses

Automatic Detection and Prediction of the Transition Between the Behavioural States of a Subject Through a Wearable CPS

The PRESLEEP project is aimed at the fine assessment and validation of the proposed proprietary methodology/technology, for the automatic detection and prediction of the transition between the behavioural states of a subject (e.g. wakefulness, drowsiness and sleeping) through a wearable Cyber Physical System (CPS). The Intellectual Property (IP) is based on a combined multi-factor and multi-domain analysis thus being able to extract a robust set of parameters despite of the, generally, low quality of the physiological signals measured through a wearable system applied to the wrist of the subject. An application experiment has been carried out at AVL, based on reduced wakefulness maintenance test procedure, to validate the algorithm’s detection and prediction capability once the subject is driving in the dynamic vehicle simulator

High Altitude Affects Nocturnal Non-linear Heart Rate Variability: PATCH-HA Study.

Background: High altitude (HA) exposure can lead to changes in resting heart rate variability (HRV), which may be linked to acute mountain sickness (AMS) development. Compared with traditional HRV measures, non-linear HRV appears to offer incremental and prognostic data, yet its utility and relationship to AMS have been barely examined at HA. This study sought to examine this relationship at terrestrial HA. Methods: Sixteen healthy British military servicemen were studied at baseline (800 m, first night) and over eight consecutive nights, at a sleeping altitude of up to 3600 m. A disposable cardiac patch monitor was used, to record the nocturnal cardiac inter-beat interval data, over 1 h (0200-0300 h), for offline HRV assessment. Non-linear HRV measures included Sample entropy (SampEn), the short (α1, 4-12 beats) and long-term (α2, 13-64 beats) detrend fluctuation analysis slope and the correlation dimension (D2). The maximal rating of perceived exertion (RPE), during daily exercise, was assessed using the Borg 6-20 RPE scale. Results: All subjects completed the HA exposure. The average age of included subjects was 31.4 ± 8.1 years. HA led to a significant fall in SpO2 and increase in heart rate, LLS and RPE. There were no significant changes in the ECG-derived respiratory rate or in any of the time domain measures of HRV during sleep. The only notable changes in frequency domain measures of HRV were an increase in LF and fall in HFnu power at the highest altitude. Conversely, SampEn, SD1/SD2 and D2 all fell, whereas α1 and α2 increased (p < 0.05). RPE inversely correlated with SD1/SD2 (r = -0.31; p = 0.002), SampEn (r = -0.22; p = 0.03), HFnu (r = -0.27; p = 0.007) and positively correlated with LF (r = 0.24; p = 0.02), LF/HF (r = 0.24; p = 0.02), α1 (r = 0.32; p = 0.002) and α2 (r = 0.21; p = 0.04). AMS occurred in 7/16 subjects (43.8%) and was very mild in 85.7% of cases. HRV failed to predict AMS. Conclusion: Non-linear HRV is more sensitive to the effects of HA than time and frequency domain indices. HA leads to a compensatory decrease in nocturnal HRV and complexity, which is influenced by the RPE measured at the end of the previous day. HRV failed to predict AMS development

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures

Sleep problems during COVID-19 pandemic and its’ association to psychological distress: a systematic review and meta-analysis

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress. Methods: Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644. Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively. Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced

Heart rate variability: a tool to explore the sleeping brain?

Sleep is divided into two main sleep stages: (1) non-rapid eye movement sleep (non-REMS), characterized among others by reduced global brain activity; and (2) rapid eye movement sleep (REMS), characterized by global brain activity similar to that of wakefulness. Results of heart rate variability (HRV) analysis, which is widely used to explore autonomic modulation, have revealed higher parasympathetic tone during normal non-REMS and a shift toward sympathetic predominance during normal REMS. Moreover, HRV analysis combined with brain imaging has identified close connectivity between autonomic cardiac modulation and activity in brain areas such as the amygdala and insular cortex during REMS, but no connectivity between brain and cardiac activity during non-REMS. There is also some evidence for an association between HRV and dream intensity and emotionality. Following some technical considerations, this review addresses how brain activity during sleep contributes to changes in autonomic cardiac activity, organized into three parts: (1) the knowledge on autonomic cardiac control, (2) differences in brain and autonomic activity between non-REMS and REMS, and (3) the potential of HRV analysis to explore the sleeping brain, and the implications for psychiatric disorders

Développement préclinique de dérivés imidazo [1,2-a] quinoxaliniques à visée anticancéreuse : synthèse chimique, formulation galénique et validation de méthode de dosage en milieu biologique

The project relates to heterocyclic molecules, low molecular weight, having cytotoxic activities similar to those presented by the best anticancer agents currently on the market. These molecules are originals, protected by an international patent and a selection patent filed in December 2014. The synthesis of the first molecules leader is under control and the exemplification of molecular diversity is underway. Studies to define their activity profile allow to identify quite original features. The project, in its academic preclinical development phase, enabled the identification of leader’s compounds with potential for development as anticancer. The exact mechanism of the molecules developed is still under study and will determine whether there is a single or multiple mode of action. Several series leads were identified with apparently different modes of action. Indeed, compounds EAPB0203 and EAPB0503 show a dose effect from 1 µM on tubulin polymerization but compound EAPB02303, the more active on A375 cell line (IC50 = 10 nM, ten times to hundred times more active than the preceding two), shows no binding to tubulin at a dose of 1 µM suggesting a different and original mechanism of action. The research topic presented concerns the preclinical development of these anticancer molecules. The first line of work was to develop a galenic formulation of EAPB0503 in the form of lipid nanocapsules. To optimize the bioavailability of the compounds, without losing their intrinsic activity, we achieved chemical modulation on the most active structure Imiqualines: EAPB02303. To improve the overall balance hydrophilic / lipophilic (HLB) of compounds derived from EAPB02303, we considered grafting amino acids on position 4. Finally, the development of a method for assaying EAPB02303 and EAPB02302 in plasma for a pharmacokinetic study has been the final focus of the thesis work.Le projet concerne des molécules hétérocycliques, de faible poids moléculaire, présentant des activités cytotoxiques comparables à celles des meilleurs anticancéreux actuellement sur le marché. Ces molécules sont originales, protégées par un brevet international et un brevet de sélection déposé en décembre 2014. La synthèse des premières molécules leaders est maîtrisée et l’exemplification de la diversité moléculaire est en cours. Les études menées pour définir leur profil d’activité permettent d’identifier des caractéristiques tout à fait originales. Le projet, en phase de développement préclinique académique, a permis l’identification de composés leaders présentant des potentiels de développement en tant qu’anticancéreux. Le mécanisme exact des molécules développées est encore en cours d’étude et permettra de définir s’il s’agit d’un mode d’action unique ou multiple. Plusieurs têtes de séries ont pu être identifiées avec visiblement des modes d’actions différents. En effet, les composés EAPB0203 et EAPB0503 montrent un effet dose à partir de 1 µM sur la polymérisation de la tubuline mais la molécule EAPB02303, la plus active sur la lignée A375 (CI50 = 10 nM, de dix fois à cent fois plus active que les deux précédentes), ne montre aucune fixation à la tubuline à la dose de 1µM suggérant un mécanisme d’action différent et original. Le sujet de recherche présenté concerne le développement des études précliniques de ces molécules à visée anticancéreuse. Le premier axe de travail a été de mettre au point une formulation galénique de l'EAPB0503 sous forme de nanocapsules lipidiques. Afin d’optimiser la biodisponibilité des composés, sans perdre leur activité intrinsèque, nous avons ensuite réalisé une modulation chimique sur la structure la plus active des Imiqualines : l’EAPB02303. Afin d’améliorer la balance globale hydrophilie/lipophilie (HLB) des composés dérivés de l’EAPB02303, nous avons greffé un résidu acide aminé en position 4. Enfin, la mise au point d’une méthode de dosage de l’EAPB02303 et l’EAPB02302 en milieu plasmatique en vue d’une étude pharmacocinétique a été le dernier axe du travail de thèse

Autonomic reactivity to aversives stimulations during sleep in humans

L’objectif de ce travail de thèse a été d’étudier la réactivité autonomique cardiaque à des stimulations aversives au cours du sommeil et les phénomènes pouvant la moduler. Pour ce faire, nous avons utilisé une technique d’analyse temps-fréquence de la variabilité du signal RR (inverse de la fréquence cardiaque), basée sur des transformées en ondelettes de ce signal, lors de stimuli nociceptifs chez des sujets sains et en réponse à des évènements respiratoires obstructifs chez des patients apnéiques. Notre première étude suggère que la réactivité autonomique cardiaque en réaction à des stimuli nociceptifs est dépendante d’une activation sympathique qui est préservée dans tous les stades du sommeil. De plus, bien que cette réactivité cardiaque soit présente même lorsque la stimulation ne donne pas lieu à une réaction d’éveil, elle est plus importante si la stimulation est suivie d’une réaction d’éveil cortical, et ceci quelque soit le stade de sommeil. La deuxième étude, réalisée chez des patients apnéiques, montre que la réactivité autonomique en réponse aux évènements respiratoires obstructifs est dépendante essentiellement de la réactivité sympathique qui est modulée par le processus de réaction d’éveil plutôt que par les stades de sommeil ou par la sévérité des évènements respiratoires. Enfin, la troisième étude révèle qu’un niveau d’activité sympathique cardiaque élevé avant les stimulations nociceptives ou pendant les évènements respiratoires obstructifs peut favoriser l’apparition de réactions d’éveil. En conclusion, nos résultats sont en faveur du maintien de la réactivité sympathique cardiaque à des évènements aversifs au cours du sommeil et ceci dans tous les stades de sommeil. Cette réactivité sympathique est essentiellement modulée par le processus qui mène à la réaction d’éveil cortical, processus auquel semble participer un niveau sympathique basal élevéThe aim of this work was to study cardiac autonomic reactivity to aversive stimulations during sleep and the phenomena that could modulate this reactivity. We used time-frequency method of RR intervals variability (or heart rate variability), based on wavelet transform during nociceptive stimulations in healthy subjects and obstructive respiratory events in apnoeic patients. Our first study showed that the cardiac autonomic reactivity to nociceptive stimulations is sympathetically-driven cardiac activation in reaction, and preserved during all sleep stages. Furthermore, albeit cardiac reactivity persisted even in the absence of arousals, it was higher when a cortical arousal followed the noxious stimulus whatever the sleep stages. Our second work showed, in apnoeic patients, that cardiac autonomic reactivity in response to obstructive respiratory events was also dependent on sympathetic reactivity, mainly modulated by arousal process rather than sleep stages or severity of respiratory events. At last, our third work showed that cardiac sympathetic level before nociceptive stimuli or during respiratory events could favour cortical arousal. In conclusion, cardiac sympathetic reactivity in response to aversive stimuli during sleep is preserved during all sleep stages. This sympathetic reactivity is modulated by arousal process rather than sleep stages or severity of respiratory events. Cardiac sympathetic activity during sleep could take part in arousal process, by favouring cortical arousa