Obstructive Sleep Apnea: a possible differential diagnosis of epilepsy

IntroductionObstructive sleep apnea syndrome (OSA) is the most common respiratory sleep disorder, although it is overlooked by practitioners. Clinical symptoms may include loud snoring, witnessed apneas, unrefreshing sleep, daytime somnolence, or alteration of cognition. Syncope is a rare mode of revelation of OSA. We report a case of OSA revealed by syncope.Case reportMr BM, 52, married who consults for recurrent episodes of loss of consciousness of less than 2 minutes without loss of urine or bite of the tongue. In his history, we find obesity (BMI at 31) and a notion of night snoring. According to his wife's testimony, loss of consciousness occurs mainly in the morning upon waking and after each loss of consciousness, the patient is awakened by auditory stimulation and remembers the episode. The clinical examination did not find any particular anomaly. A syncope of cardiac origin was mentioned given the brief nature of the loss of consciousness and the absence of amnesia of the episode. Cardiac evaluation included holter electrocardiography, stress testing and ambulatory blood pressure monitoring showed no evidence of conduction disorder, arrhythmia, ischemia, or orthostatic fluctuations in blood pressure. he complete electroencephalographic exploration does not reveal any particular anomaly. Biological explorations were normal.Polysomnography revealed loud snoring with an apnea-hypopnea index of 35 / h dominated by hypopnea events (index at 21.1 / h). The iterative sleep latency test (TILE) revealed an average sleep latency of 9 minutes 36 seconds, without REM sleep.At the end of these explorations, the diagnosis of OSAS revealed by a syncope was retained. Continuous positive airway pressure therapy has improved symptoms.ConclusionSyncope is a rare and unusual presentation of SAOS. The pathophysiological mechanisms of syncope in OSA are not well understood. Screening for OSA should be standard practice in exploring for unexplained syncope

Development of an animal experimental model to study the effects of levonorgestrel on the human endometrium

BACKGROUND: This study was designed to develop an animal model to test the response of endometrium to local progestin delivery. METHODS: Proliferative human endometrium was subcutaneously grafted in two groups of SCID mice that received, 2 days before, a subcutaneous estradiol (E2) pellet and, for half of them, an additional implant of levonorgestrel (LNG). Mice were sacrificed 1, 2, 3 or 4 weeks after endometrial implantation and grafts were histologically analysed. Proliferation, steroid hormone receptors, blood vessels and stromal decidualization in both groups (E2 and LNG) were immunohistologically evaluated and compared with proliferative endometrium and endometrium from women with an LNG intrauterine device. RESULTS: Grafts presented normal morphological endometrial characteristics. The expression of progesterone receptors was significantly decreased in glands and stroma of the LNG group as compared with the E2 group at all times. A significant decrease was also observed in the stromal expression of estrogen receptor- in the LNG group. At 4 weeks, the mean cross-sectional area of vessels was significantly higher after LNG treatment. CONCLUSIONS: These morphological and immunohistochemical characteristics are similar to those observed in women treated with local LNG. This mouse model might facilitate further investigations needed to understand the mechanisms responsible for the breakthrough bleeding frequently observed in progestin users

HoxA-11 and FOXO1A Cooperate to Regulate Decidual Prolactin Expression: Towards Inferring the Core Transcriptional Regulators of Decidual Genes

During the menstrual cycle, the ovarian steroid hormones estrogen and progesterone control a dramatic transcriptional reprogramming of endometrial stromal cells (ESCs) leading to a receptive state for blastocyst implantation and the establishment of pregnancy. A key marker gene of this decidualization process is the prolactin gene. Several transcriptional regulators have been identified that are essential for decidualization of ESCs, including the Hox genes HoxA-10 and HoxA-11, and the forkhead box gene FOXO1A. While previous studies have identified downstream target genes for HoxA-10 and FOXO1A, the role of HoxA-11 in decidualization has not been investigated. Here, we show that HoxA-11 is required for prolactin expression in decidualized ESC. While HoxA-11 alone is a repressor on the decidual prolactin promoter, it turns into an activator when combined with FOXO1A. Conversely, HoxA-10, which has been previously shown to associate with FOXO1A to upregulate decidual IGFBP-1 expression, is unable to upregulate PRL expression when co-expressed with FOXO1A. By co-immunoprecipitation and chromatin immunoprecipitation, we demonstrate physical association of HoxA-11 and FOXO1A, and binding of both factors to an enhancer region (−395 to −148 relative to the PRL transcriptional start site) of the decidual prolactin promoter. Because FOXO1A is induced upon decidualization, it serves to assemble a decidual-specific transcriptional complex including HoxA-11. These data highlight cooperativity between numerous transcription factors to upregulate PRL in differentiating ESC, and suggest that this core set of transcription factors physically and functionally interact to drive the expression of a gene battery upregulated in differentiated ESC. In addition, the functional non-equivalence of HoxA-11 and HoxA-10 with respect to PRL regulation suggests that these transcription factors regulate distinct sets of target genes during decidualization

Inhibition of the Progesterone Nuclear Receptor during the Bone Linear Growth Phase Increases Peak Bone Mass in Female Mice

Augmentation of the peak bone mass (PBM) may be one of the most effective interventions to reduce the risk of developing osteoporosis later in life; however treatments to augment PBM are currently limited. Our study evaluated whether a greater PBM could be achieved either in the progesterone nuclear receptor knockout mice (PRKO) or by using a nuclear progesterone receptor (nPR) antagonist, RU486 in mice. Compared to their wild type (WT) littermates the female PRKO mice developed significantly higher cancellous and cortical mass in the distal femurs, and this was associated with increased bone formation. The high bone mass phenotype was partially reproduced by administering RU486 in female WT mice from 1–3 months of age. Our results suggest that the inhibition of the nPR during the rapid bone growth period (1–3 months) increases osteogenesis, which results in acquisition of higher bone mass. Our findings suggest a crucial role for progesterone signaling in bone acquisition and inhibition of the nPR as a novel approach to augment bone mass, which may have the potential to reduce the burden of osteoporosis

Study of the effect of Kaolin in the mortar of cement matrices by confinement of ion exchange resins

Radioactive waste arising as a result of nuclear activities should be safely managed from its generation to final disposal in an appropriate conditioned form to reduce the risk of radiation exposure of technical personnel and of the public and to limit contamination of the environment. The immobilization of low and intermediate level radioactive wastes in cementitious matrices is the most commonly used technique to produce inexpensive waste matrix that complies with regulatory requirements in order to protect humans and the environment against nuisance caused by ionizing radiation. Cement based materials are used in radioactive waste management to produce stable waste forms. This matrix constitutes the first build engineering barrier in disposal facilities. In this work, the kaolin is used to enhance the mechanical performance of the matrix of confinement of ion exchange resins by gradually replacing the sand in mortar with kaolin clay. The Kaolin clay sample was a special pure product, sourced from a foreign country. The maximum quantity of resins that can be incorporated into the mortar formulation without the packages losing their strength is 13.915% which results in a better mechanical strength at 6.7686 MPA compression with kaolin

The effect of the addition of Alumina powder on the confinement properties of a cement mortar

Organic radioactive waste can occur in solid, liquid or rarely gaseous form. In general, organic components of radioactive waste Generally, the organic components of the radioactive waste have a contaminant effect stronger than most of the inorganic components, because of their low melting point, of their answer to the radiolyse or of their volatilitydu to their low melting point, to their answer to the radiolyse or to their volatility. This property can significantly affect the strategy adopted for their management. Organic radioactive waste results from the use of radioisotopes in the National Center for Energy, Nuclear Science and Technology (CNESTEN) and from medical applications. Organic radioactive waste requires management steps that take into account not only their radioactivity but also their chemical content. The aim of this study is the optimization of the stabilization of radioactive organic effluents in cementitious matrices. Thus, we study the effects of the addition of the alumina powder on the physicochemical and mechanical properties of the cement paste. The mortar was made by mixing Portland cement, sand, water and alumina powder (88 μm). The study showed that the addition of 12% alumina powder improves the compressive strength

Study of the effect of Kaolin in the mortar of cement matrices by confinement of ion exchange resins

Radioactive waste arising as a result of nuclear activities should be safely managed from its generation to final disposal in an appropriate conditioned form to reduce the risk of radiation exposure of technical personnel and of the public and to limit contamination of the environment. The immobilization of low and intermediate level radioactive wastes in cementitious matrices is the most commonly used technique to produce inexpensive waste matrix that complies with regulatory requirements in order to protect humans and the environment against nuisance caused by ionizing radiation. Cement based materials are used in radioactive waste management to produce stable waste forms. This matrix constitutes the first build engineering barrier in disposal facilities. In this work, the kaolin is used to enhance the mechanical performance of the matrix of confinement of ion exchange resins by gradually replacing the sand in mortar with kaolin clay. The Kaolin clay sample was a special pure product, sourced from a foreign country. The maximum quantity of resins that can be incorporated into the mortar formulation without the packages losing their strength is 13.915% which results in a better mechanical strength at 6.7686 MPA compression with kaolin

The effect of the addition of Alumina powder on the confinement properties of a cement mortar

Organic radioactive waste can occur in solid, liquid or rarely gaseous form. In general, organic components of radioactive waste Generally, the organic components of the radioactive waste have a contaminant effect stronger than most of the inorganic components, because of their low melting point, of their answer to the radiolyse or of their volatilitydu to their low melting point, to their answer to the radiolyse or to their volatility. This property can significantly affect the strategy adopted for their management. Organic radioactive waste results from the use of radioisotopes in the National Center for Energy, Nuclear Science and Technology (CNESTEN) and from medical applications. Organic radioactive waste requires management steps that take into account not only their radioactivity but also their chemical content. The aim of this study is the optimization of the stabilization of radioactive organic effluents in cementitious matrices. Thus, we study the effects of the addition of the alumina powder on the physicochemical and mechanical properties of the cement paste. The mortar was made by mixing Portland cement, sand, water and alumina powder (88 μm). The study showed that the addition of 12% alumina powder improves the compressive strength