In Response: Maintenance ECT

Therapy resistance, relapsing illness, and rapid cycling are aspects of chronic affective illness that continue to frustrate us. ECT was re-introduced to answer the problem of therapy resistant depression. In their recent review, Matzen et al. (I), report their experience in eight cases treated with maintenance ECT. They argue that maintenance ECT should also be considered for relapsing depressive illness. No systematic study of maintenance ECT has been undertaken since the early I950s, and yet, as reported by Kramer (2) it continues to be used. Kramer directed inquiries to members of the International Association for the Advancement of Electrotherapy. Of 86 respondents, 51 reported they used maintenance treatments in 1986. Usage was small, however, approximately three patients per practitioner in a year. Despite the lack of experimentally derived guidelines, the procedures were relatively uniform. After an illness had responded to a course of ECT, treatments were given at weekly intervals, followed after a few weeks by bi-weekly, then monthly treatments. The treatment practice described by Matzen et al. are similar

Furosemide Enhances the Release of Endothelial Kinsis, Nitric Oxide and Prostacyclin

Despite a wealth of data, the mechanism of the direct dilator effect of furosemide on the systemic arterial and venous systems is far from being satisfactorily understood. Therefore, we investigated whether furosemide is capable of stimulating the production of the endogenous vasodilators nitric oxide and prostacyclin in primary cultured bovine aortic endothelial cells by an enhanced synthesis and release of endothelium-derived kinins. Nitric oxide production was assessed in terms of intracellular guanosine cyclic-3',5' monophosphate accumulation; kinin and prostacyclin release were determined by specific radioimmunoassays. Furosemide concentration- and time- dependently increased the formation of nitric oxide and prostacyclin. Maximal increases of both autacoids were already obtained after a 5-min incubation with 3 x 10(-7) to 10(-6) mol/l of furosemide. In the same concentration range, furosemide led to an enhanced release of kinins into the supernatant of the cells. This observation was supported by the inhibitory effect of the specific B2 kinin receptor antagonist icatibant (Hoe 140) on the furosemide-induced increase of nitric oxide and prostacyclin. Thus the hemodynamic effects, and in particular the direct early dilator effect, of furosemide may be explained in part by an enhanced endothelial synthesis and release of bradykinin and related kinins, which in turn stimulates endothelial autacoid formation via B2 kinin receptor activation

eine retrospektive Studie

Abstract Scientific background and aim The REM sleep is characterized by rapid eye movements as well as atonia of skeletal muscles. Healthy subjects show only few or no periodic leg movements (PLMS) in REM sleep. It is known that PLMS occur in sleep related movement disorders, narcolepsia, and REM sleep behaviour disorder. It is still unclear whether other sleep disorders such as insomnia or sleep related breathing disorder (SBAS) are associated with PLMS in REM sleep. Studies in literature rarely distinguish PLMS between NREM sleep and REM sleep. The retrospective study was aimed to assess the number of PLMS in both sleep stages in various sleep disorders. Methods Files and recordings of all patients that underwent a polysomnography with the Hardware-Software-System by EMBLA® at the Interdisziplinäres Schlafmedizinisches Zentrum der Charité between 2014 and 2017 were sifted. Confounding factors as pre-existing diseases, drug intake and methodical criteria were defined. The study is based on data of 138 patients with different sleep disorders and 16 control subjects without sleep disorders. Polysomnography data of the first night were used for statistical evaluation. Patients were classified into 5 diagnoses groups: SBAS, insomnia, and the comorbidities of SBAS with Restless Leg Syndrom (RLS), periodic limb movement disorder (PLMD) and insomnia. Results Patients with SBAS, insomnia, and the comorbidity SBAS-insomnia showed only a few PLMS in REM sleep and their PLMS Indices in total sleep were similar to literature and control subjects. Patients with the comorbidities SBAS-RLS und SBAS-PLMD showed PLMS in REM and NREM sleep, that differed significantly from patients with SBAS. It was stated by logistic regression, that the differences in the PLMS indices of the SBAS-RLS patients and SBAS patients were not influenced by age and gender. Discussion The hypothesis of higher PLMS in REM sleep in insomnia, SBAS or SBAS-insomnia was not confirmed. The increased PLMS in REM and NREM sleep in patients with SBAS-RLS and SBAS-PLMD can be explained by the neurological disorders. In patients with SBAS-PLMD the PLMS index in NREM sleep is predominantly increased, whereas in patients with SBAS-RLS the PLMS indices in NREM and REM sleep are similarly increased. It can be suggested that different neurobiological processes underlying the REM atonia are disturbed in these sleep disorders. A prospective study differentiating PLMS in REM and NREM sleep in patients with RLS and patients with PLMD could help to refine the diagnostic criteria of these sleep disorders.  Zusammenfassung Hintergrund und Zielsetzung Der REM-Schlaf ist gekennzeichnet durch schnelle Augenbewegungen bei gleichzeitiger Atonie der quergestreiften Muskulatur. Bei Gesunden finden sich im REM-Schlaf keine oder nur wenige periodische Beinbewegungen (PLMS). Es ist bekannt, dass bei schlafbezogenen Bewegungsstörungen, Narkolepsie und REM-Schlafverhaltensstörungen PLMS im REM-Schlaf auftreten. Bis jetzt ist nicht zielgerichtet untersucht worden, ob PLMS auch bei anderen Schlafstörungen wie Insomnie oder schlafbezogenen Atmungsstörungen (SBAS) im REM-Schlaf vorkommen. In der Literatur ist nur selten eine Differenzierung der PLMS nach REM- und NREM-Schlaf erfolgt. Ziel war es, in einer retrospektiven Studie zu untersuchen, bei welchen Schlafstörungen in welchem Ausmaß PLMS im REM-Schlaf auftreten. Es wurde angenommen, dass bei weiteren Schlafstörungen PLMS im REM-Schlaf auftreten. Methoden Unterlagen von allen Patienten des Schlaflabors des Schlafmedizinischen Zentrums der Charité, bei denen in den Jahren 2014 bis 2017 stationär Polysomnographien (PSG) mit dem Geräte-Software-System der Firma EMBLA® Systems durchgeführt worden waren, wurden gesichtet. Ein- und Ausschlusskriterien, die u. a. Vorerkrankungen und Medikamenteneinnahmen betreffen, wurden festgelegt. Der Studie lagen Daten von 138 Patienten und von 16 schlafgesunden Kontrollpersonen zugrunde. PSG Daten der ersten Nacht wurden verwendet. Die statistische Auswertung erfolgte nach Bildung von fünf Diagnosegruppen: SBAS, Insomnie und die Komorbiditäten von SBAS mit Restless Leg Syndrom (RLS), Periodischer Bewegungsstörung der Gliedmaßen (PLMD) oder Insomnie. Ergebnisse Patienten mit SBAS sowie mit Insomnie und Patienten mit der Doppelerkrankung SBAS-Insomnie zeigten wenige PLMS im REM-Schlaf. Ihr PLMS Index (PLMSI) über den Gesamtschlaf war vergleichbar mit Literaturangaben. Bei Patienten mit SBAS-RLS und SBAS-PLMD wurden im NREM- und im REM-Schlaf höhere PLMSI registriert als bei SBAS Patienten. Mittels der logistischen Regression wurde bei Patienten mit SBAS-RLS im Vergleich zu SBAS Patienten nachgewiesen, dass die Unterschiede in den PLMSI weder vom Alter noch vom Geschlecht der Patienten beeinflusst worden waren. Diskussion Die Hypothese, dass auch bei Insomnie, SBAS oder SBAS-Insomnie die PLMSI im REM-Schlaf höher als angenommen sind, wurde nicht bestätigt. Die erhöhten PLMSI im NREM- und REM-Schlaf bei Patienten mit SBAS-RLS und SBAS-PLMD können auf die neurologischen Erkrankungen zurückgeführt werden. Bei SBAS-PLMD ist vornehmlich der PLMSI im NREM-Schlaf erhöht, während bei SBAS-RLS die PLMSI im NREM- und REM-Schlaf gleichermaßen erhöht sind. Die Ergebnisse weisen darauf hin, dass bei diesen Erkrankungen unterschiedliche neurobiologische Prozesse, die für das Entstehen einer REM Atonie verantwortlich gemacht werden, gestört sind. Eine prospektive Studie zu PLMS getrennt nach NREM- und REM-Schlaf bei Patienten mit RLS und Patienten mit PLMD könnte einen Beitrag zur Verbesserung der diagnostischen Kriterien der Erkrankungen liefern

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Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79097/1/j.1600-0447.2010.01630.x.pd

Super Soldiers: The Ethical, Legal and Operational Implications (Part 2)

This is the second chapter of two on military human enhancement. In the first chapter, the authors outlined past and present efforts aimed at enhancing the minds and bodies of our warfighters with the broader goal of creating the “super soldiers” of tomorrow, all before exploring a number of distinctions—natural vs. artificial, external vs. internal, enhancement vs. therapy, enhancement vs. disenhancement, and enhancement vs. engineering—that are critical to the definition of military human enhancement and understanding the problems it poses. The chapter then advanced a working definition of enhancement as efforts that aim to “improve performance, appearance, or capability besides what is necessary to achieve, sustain, or restore health.” It then discussed a number of variables that must be taken into consideration when applying this definition in a military context. In this second chapter, drawing on that definition and some of the controversies already mentioned, the authors set out the relevant ethical, legal, and operational challenges posed by military enhancement. They begin by considering some of the implications for international humanitarian law and then shift to US domestic law. Following that, the authors examine military human enhancement from a virtue ethics approach, and finally outline some potential consequences for military operations more generally