Central Hemodynamic Parameters and Cardiointervalogram Features in Infants during Early Postnatal Adaptation

Central hemodynamic parameters were analyzed in 217 healthy full-term newborns. Echocardiography was performed during the first 6 h after birth; during the periods 6–12 and 12–24 h after birth; and at days 3, 5, and 7 of life. A cardiointervalogram (CIG) was recorded simultaneously. Blood pressure was measured in all newborns. Heart rate variability was estimated with standard methods, and differential criteria determined previously were used to identify three CIG types. The spectral analysis of the slow-wave oscillations was performed within the following ranges of frequencies: high frequencies, >0.15 Hz; low frequencies, 0.04 < 0.15 Hz; and very low frequencies, <0.04 Hz. The healthy newborns showed great individual variations of the cardiac index, which were associated with the hyper-, eu-, and hypokinetic types of hemodynamics, evidencing good adaptive capacity of the body. All groups of newborns had three CIG types, irrespective of the type of hemodynamics. The CIG type frequencies depended on the type of hemodynamics at the time of examination of the newborns. This was explained by different mechanisms regulating blood circulation under basal metabolic conditions during functional changes.     

Associations of Chronotype and Sleep With Cardiovascular Diseases and Type 2 Diabetes

In this study, the authors analyzed whether chronotypes, sleep duration, and sleep sufficiency are associated with cardiovascular diseases and type 2 diabetes by using the National FINRISK Study 2007 data (N?=?6258), being a representative sample of the population aged 25 to 74 living in five areas of Finland. Health status assessments and laboratory measurements from the participants (N?=?4589) of the DILGOM substudy were used for the detailed analysis of chronotype. Evening types had a 2.5-fold odds ratio for type 2 diabetes (p < .01) as compared with morning types, the association being independent of sleep duration and sleep sufficiency. Evening types had a 1.3-fold odds ratio for arterial hypertension (p < .05 after controlling for sleep duration or sleep sufficiency), a faster resting heart rate and a lower systolic blood pressure (both p < .01), and lower levels of serum total cholesterol and low-density lipoprotein cholesterol (both p < .0001) than morning types. There were significant 1.2- to 1.4-fold odds ratios for arterial hypertension among those with long or short sleep durations or reduced sleep sufficiency. To conclude, the behavioral trait towards eveningness is suggested to predispose individuals to type 2 diabetes in particular, whereas compromised sleep is robustly associated with arterial hypertension. (Author correspondence: ilona.merikanto@helsinki.fi)     

Effects of dihydroergotoxine methane sulphonate (Redergine) on sleep in cats deprived of paradoxical sleep

Dihydroergotoxine methane sulphonate (DHET 1.0 mg/kg i.p.) was administered to cats deprived of paradoxical sleep (PS) for 72 h and 23 h of recovery sleep were recorded. During the first 12 h of recovery sleep slow-wave sleep (SWS) was significantly increased. There were no significant changes in the amounts of wakefulness (W), PS and several sleep indices. Analysis of the entire 23 h of recording period revealed no significant changes in any of the parameters studied. The results suggest that DHET has SWS enhancing property in the condition where "pressure" for PS was increased.     

Translocation of Ethanolamine Phosphoglyceride is Required for Initiation of Apoptotic Death in OLN-93 Oligodendroglial Cells

The possible interplay between extracellular signal-regulated protein kinase (ERK) activation and ethanolamine phosphoglycerides (PG) membrane bilayer translocation following oxidative stress (OS) (0.5 mM H₂O₂/0.05 mM Fe²⁺), was examined in oligodendroglia, OLN93, cells with altered plasma membrane PG composition. Cells supplemented with 50 μM docosahexaenoic acid (DHA, 22:6n3) to increase the number of potential double bond targets for OS in ethanolamine-PG (EPG) were compared to cells with diminished content of EPG, attained by the addition of 0.5 mM N,N-dimethylethanolamine (dEa). After 30 min OS, EPG translocation accompanied by sustained ERK activation and nuclear translocation culminating in apoptosis was found in DHA-supplemented cells in contrast to no EPG translocation, a brief ERK activation, but no nuclear translocation, and no cell death in DHA/dEa-supplemented cells. DHA/dEa-supplemented cells pretreated with the protein-tyrosine phosphatases inhibitor Na₃VO₄ followed by OS, although expressing a sustained ERK activation and nuclear translocation, failed to show apoptosis and lacked EPG translocation. In DHA-supplemented cells U0126, a MEK inhibitor, prevented ERK activation and EPG translocation and protected from cell death. These findings most likely indicate that ERK activation is an indispensable component for the signaling cascades leading to EPG translocation but only activation of the latter is leading to OS-induced apoptotic cell death.     

Postoperative Neutrophil-to-Lymphocyte Ratio Change Predicts Survival of Patients with Small Hepatocellular Carcinoma Undergoing Radiofrequency Ablation

Background

An elevated preoperative neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor for hepatocellular carcinoma (HCC) patients after treatment. However, the clinical implication of postoperative NLR change remains unclear.

Materials and Methods

From May 2005 to Aug 2008, a cohort of consecutive 178 small HCC patients treated with radiofrequency ablation (RFA) was retrospectively reviewed. The NLR was recorded within 3 days before and 1 month after RFA. Baseline characteristics, overall survival (OS) and recurrence free survival (RFS) were compared according to preoperative NLR and/or postoperative NLR change. Prognostic factors were assessed by multivariate analysis.

Results

Compared with preoperative NLR level, postoperative NLR decreased in 87 patients and increased in 91 patients after RFA. No significant differences were identified between two groups in commonly used clinic-pathologic features. The 1, 3, 5 years OS was 98.8%, 78.6%, 67.1% for NLR decreased group, and 92.2%, 55.5%, 35.4% for NLR increased group respectively (P<0.001); the corresponding RFS was 94.2%, 65.2%, 33.8% and 81.7%, 46.1%, 12.4% respectively (P<0.001). In subgroup analysis, the survival of patients with lower or higher preoperative NLR can be distinguished more accurate by postoperative NLR change. Multivariate analysis showed that postoperative NLR change, but not preoperative NLR, was an independent prognostic factor for both OS (P<0.001, HR = 2.39, 95%CI 1.53–3.72) and RFS (P = 0.003, HR = 1.69, 95%CI 1.87–8.24).

Conclusion

The postoperative NLR change was an independent prognostic factor for small HCC patient undergoing RFA, and patients with decreased NLR indicated better survival than those with increased NLR.     

Evening Chronotype Is Associated with Changes in Eating Behavior,More Sleep Apnea,and Increased Stress Hormones in Short Sleeping Obese Individuals

Background

Short sleep duration and decreased sleep quality are emerging risk factors for obesity and its associated morbidities. Chronotype, an attribute that reflects individual preferences in the timing of sleep and other behaviors, is a continuum from morningness to eveningness. The importance of chronotype in relation to obesity is mostly unknown. Evening types tend to have unhealthy eating habits and suffer from psychological problems more frequently than Morning types, thus we hypothesized that eveningness may affect health parameters in a cohort of obese individuals reporting sleeping less than 6.5 hours per night.

Methodology and Principal Findings

Baseline data from obese (BMI: 38.5±6.4 kg/m²) and short sleeping (5.8±0.8 h/night by actigraphy) participants (n = 119) of the Sleep Extension Study were analyzed (www.ClinicalTrials.gov, identifier {"type":"clinical-trial","attrs":{"text":"NCT00261898","term_id":"NCT00261898"}}NCT00261898). Assessments included the Horne and Ostberg Morningness-Eveningness questionnaire, a three-day dietary intake diary, a 14-day sleep diary, 14 days of actigraphy, and measurements of sleep apnea. Twenty-four hour urinary free cortisol, 24 h urinary norepinephrine and epinephrine levels, morning plasma ACTH and serum cortisol, fasting glucose and insulin, and lipid parameters were determined. Eveningness was associated with eating later in the day on both working and non-working days. Progression towards eveningness was associated with an increase in BMI, resting heart rate, food portion size, and a decrease in the number of eating occasions and HDL-cholesterol. Evening types had overtly higher 24 h urinary epinephrine and morning plasma ACTH levels, and higher morning resting heart rate than Morning types. In addition, Evening types more often had sleep apnea, independent of BMI or neck circumference.

Conclusions

Eveningness was associated with eating later and a tendency towards fewer and larger meals and lower HDL-cholesterol levels. In addition, Evening types had more sleep apnea and higher stress hormones. Thus, eveningness in obese, chronically sleep-deprived individuals compounds the cardiovascular risk associated with obesity.     

Shortening of the photoperiod affects sleep distribution, EEG and cortical temperature in the Djungarian hamster

To asses the influence of photoperiod on sleep regulation EEG, EMG, and cortical temperature were continuously recorded for two baseline days and after 4 h sleep deprivation in Djungarian hamsters (Phodopus sungorus) adapted to a short photoperiod (light dark 816). Comparison to previous data collected in a long photoperiod (lightdark 168) showed several major effects of photoperiod: 1. A prominent change in the 24-h distribution, duration and number of vigilance state episodes, whereas the total amount of sleep and waking was unchanged; 2. Cortical temperature was 0.7°C lower in the short photoperiod; 3. There was a significant negative correlation between cortical temperature and the frequency of REM sleep episodes; and 4. Absolute EEG power density showed a marked reduction in the short photoperiod. After sleep deprivation EEG slow-wave activity (mean power density 0.75–4.0 Hz) in NREM sleep showed a remarkably similar increase in both photoperiods demonstrating the robustness of the homeostatic regulation of sleep. Cortical temperature remained above baseline values after sleep deprivation in the short photoperiod whereas a negative rebound was present in the long photoperiod. Our results support the hypothesis that cortical temperature has a strong influence on REM sleep propensity and indicate the possibility of an optimum cortical temperature for recovery sleep after sleep deprivation. The lower EEG power density in the short photoperiod may contribute to energy conservation.Abbreviations LP long photoperiod - NREM non-rapid-eye-movement - REM rapid-eye-movement - SCN suprachiasmatic nucleus - SD sleep deprivation - SP short photoperiod - SWA slow-wave activity - T _CRT cortical temperature     

The processes of methane production and oxidation in the soils of the Russian Arctic tundra

Methane emission from the following types of tundra soils was studied: coarse humic gleyey loamy cryo soil, peaty gleyey soil, and peaty gleyey midloamy cryo soil of the arctic tundra. All the soils studied were found to be potential sources of atmospheric methane. The highest values of methane emission were recorded in August at a soil temperature of 8–10°C. Flooded parcels were the sources of atmospheric methane throughout the observation period. The rates of methane production and oxidation in tundra soils of various types were studied by the radioisotope method at 5 and 15°C. Methane oxidation was found to occur in bog water, in the green part of peat moss, and in all the soil horizons studied. Methane production was recorded in the horizons of peat, in clay with plant roots, and in peaty moss dust of the bogey parcels. At both temperatures, the methane oxidation rate exceeded the rate of methane production in all the horizons of the mossy-lichen tundra and of the hillock tundra with flat-bottom depressions. Methanogenesis prevailed only in a sedge-peat moss bog at 15°C. Bacterial enrichment cultures oxidizing methane at 5 and 15°C were obtained. Different types of methanotrophic bacteria were shown to be responsible for methane oxidation under these conditions. A representative of type I methylotrophs oxidized methane at 5°C, and Methylocella tundrae, a psychroactive representative of an acidophilic methanotrophic genus Methylocella, at 15°C.__________Translated from Mikrobiologiya, Vol. 74, No. 2, 2005, pp. 261–270.Original Russian Text Copyright © 2005 by Berestovskaya, Rusanov, Vasileva, Pimenov.     

Purging behaviors relate to impaired subjective sleep quality in female patients with anorexia nervosa: a prospective observational study

Background

We examined how purging behaviors relate to subjective sleep quality and sleep patterns and how symptoms of disordered eating behaviors relate to global sleep quality in female patients with anorexia nervosa (AN).

Methods

Participants were new consecutive female inpatients with a primary diagnosis of AN admitted to the Department of Psychosomatic Medicine at Kohnodai Hospital between June 26 and December 25, 2015. We recorded patients’ habitual eating behaviors, laxative overuse, or uretic misuse, and administered the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI-J) and Center for Epidemiologic Studies Depression Scale. Raw PSQI-J data were used to determine sleep patterns (sleep-onset time, wake-up time, and sleep duration). To examine how purging behaviors related to sleep quality, we compared variables between AN restricting type (ANr) and AN binge-eating/purging type (ANbp). Spearman’s rank correlation analysis was used to examine which potential factors influence global PSQI-J score.

Results

Participants were 20 patients, of whom 12 had ANbp. Two ANr patients (25%) had global PSQI-J scores greater than 5, compared to 9 ANbp patients (75%; P < 0.05). Circadian rhythm disruption and abnormal sleep duration were significantly greater in ANbp patients than in ANr patients (P < 0.05). Global PSQI-J was significantly correlated with a diagnosis of ANbp (ρ = 0.525; P < 0.05), vomiting (ρ = 0.561; P < 0.05), and duration of illness (ρ = 0.536; P < 0.05).

Conclusions

ANbp patients had worse global sleep quality and greater disrupted sleep than did ANr patients. This suggests that treatments focusing on sleep would be useful, especially for ANbp patients. Furthermore, vomiting and duration of illness should be considered essential factors related to impaired global sleep quality.

Trial registration

Not applicable.

     

Acyl and alkenyl group composition of brain subcellular fractions of goldfish (Carassius auratus L.) acclimated to different environmental temperatures

Goldfish were acclimated to 5, 15, and 30°C, and the acyl group composition of choline phosphoglycerides (CPG) and ethanolamine phosphoglycerides (EPG) from whole brain and brain subcellular particles was examined. With the exception of synaptosomal CPG, the acyl group composition of CPG from whole brain and subcellular particles, including myelin, from cold-acclimated fish showed little response to the change in environmental temperature. Those changes that did occur were consistent with the expected trend toward a higher degree of unsaturation of the CPG acyl groups in fish acclimated to 5°C. The acyl group composition of CPG from synaptosomes of the cold-acclimated fish did, however, differ markedly in having a reduced unsaturation index (U.I.) and unsaturated: saturated fatty acid ratio (UFA:SFA) which was caused mainly by the decrease in 226n-3 content. In contrast, changes in the acyl group composition of EPG on cold acclimation were greater than those observed in any CPG fraction. The generally expected trend toward greater unsaturation was observed only in mitochondrial and myelin EPG. Moreover, in all fractions the amount of 226n-3 in EPG was lower at decreased environmental temperatures. In the synaptosomal and microsomal EPG, the reduction in 226n-3 was such that a markedly reduced U.I. was obtained. It is suggested that two compensatory mechanisms maintain the necessary degree of membrane permeability and fluidity in order to prevent transition to a crystalline state at lower temperatures.     

In Vivo Effect of Pneumonia on Surfactant Disaturated-Phosphatidylcholine Kinetics in Newborn Infants

Background

Bacterial pneumonia in newborns often leads to surfactant deficiency or dysfunction, as surfactant is inactivated or its production/turnover impaired. No data are available in vivo in humans on the mechanism of surfactant depletion in neonatal pneumonia. We studied the kinetics of surfactant''s major component, disaturated-phosphatidylcholine (DSPC), in neonatal pneumonia, and we compared our findings with those obtained from control newborn lungs.

Methods

We studied thirty-one term or near-term newborns (gestational age 39.7±1.7 weeks, birth weight 3185±529 g) requiring mechanical ventilation. Fifteen newborns had pneumonia, while 16 newborns were on mechanical ventilation but had no lung disease. Infants received an intratracheal dose of ¹³C labeled dipalmitoyl-phosphatidylcholine at the study start. We measured the amount and the isotopic enrichment of DSPC-palmitate from serial tracheal aspirates by gas chromatography and gas chromatography-mass spectrometry, respectively, and we calculated the DSPC half-life (HL) and pool size (PS) from the isotopic enrichment curves of surfactant DSPC-palmitate.

Results

The mean DSPC amount obtained from all tracheal aspirates did not differ between the two groups. DSPC HL was 12.7 (6.5–20.2) h and 25.6 (17.9–60.6) h in infants with pneumonia compared with control infants (p = 0.003). DSPC PS was 14.1 (6.6–30.9) mg/kg in infants with pneumonia and 34.1 (25.6–65.0) mg/kg in controls, p = 0.042. Myeloperoxidase (MPO) activity, as a marker of lung inflammation, was 1322 (531–2821) mU/ml of Epithelial Lining Fluid (ELF) and 371(174–1080) mU/ml ELF in infants with pneumonia and in controls, p = 0.047. In infants with pneumonia, DSPC PS and HL significantly and inversely correlated with mean Oxygenation Index (OI) during the study (DSPC PS vs. OI R = −0.710, p = 0.004 and HL vs. OI R = −0.525, p = 0.044, respectively).

Conclusions

We demonstrated for the first time in vivo in humans that DSPC HL and PS were markedly impaired in neonatal pneumonia and that they inversely correlated with the degree of respiratory failure.     

Stylet penetration by larvae of the greenhouse whitefly on cucumber

Probing behaviour of Trialeurodes vaporariorum (Westwood) larvae was monitored using the DC electrical penetration graph (EPG) technique on the host plant cucumber. EPGs were recorded for 16 h, simultaneously with honeydew excretion using a honeydew clock. Three waveforms were distinguished: a pathway waveform (C), and two phloem waveforms, one with a high (H), and one with a low frequency (L) signal. The C waveform mainly occurred in the crawler stage of the 1st instar larvae. EPGs recorded from larvae during and after moulting indicated that the process involves stylet withdrawal; hence the stylets of each new instar need to penetrate again from the leaf surface to the phloem.All sessile stages, from L1 to pre-pupa, spent almost their entire time in waveforms H and L. These waveforms alternated more frequently in the early instars than during the later ones, in which the H waveform became predominant. The H waveform was highly correlated with honeydew excretion and thus phloem sap ingestion. The L waveform was not related to honeydew excretion but EPGs indicated that the stylet tips remain in a sieve element during both waveforms. Periods of honeydew production demonstrated a delay of 30–40 min in relation to the onset and end of H and L waveforms. This delay is presumably related to the time needed for food passing through, or emptying of, the insect's gut. From the 1st instar to the pre-pupa, the frequency of excreted honeydew droplets decreased but their size increased, causing a net increase of the excretion rate.     

Spectral and polarized light sensitivity of photoreceptors in the compound eye of the cricket (Gryllus bimaculatus)

Summary Retinula cells in the compound eye of the cricket (Gryllus bimaculatus) were recorded intracellularly and stained with Lucifer yellow. Two different methods were used to determine the spectral sensitivity of these cells: a) the spectral scanning method, and b) the conventional flash method. Three spectral types, with S()-curves close to the rhodopsin-absorption functions, were found with _max at 332 nm (UV), 445 nm (blue) and 515 nm (green), respectively.Blue receptors were only recorded in the anatomically specialized dorsal rim area (DRA), and UV and green receptors in the dorsal region of the pigmented part of the eye, whereby green receptors were only found in the ventral eye. On the basis of these results, model calculations are presented for di- and trichromatic colour vision in the cricket.The fluorescence markings revealed green receptors whose axons project with short visual fibres to the lamina, and a UV receptor with a long visual fibre which projects through the lamina to the medulla. The blue receptors send their axons either to the lamina and medulla (long visual fibres) or only to the lamina (short visual fibres).The temporal dynamics of the three receptor types were examined. The blue receptors lack a phasic component of the receptor potential, and the time from stimulus on-set to peak potential is strongly increased compared to the UV and green receptors. Light adaptation reduces the latency to less than half of the dark adapted state.Spectral adaptation experiments revealed an unidirectional coupling between UV and green receptors, and it was found that polarization sensitivity (PS) in blue cells was much higher (PS= 6.5±1.5) than that of UV (PS=1.76±0.05) and green (2.26±0.57) receptors. The functional aspects of the three receptor types are discussed with respect to the presented physiological and morphological data.Abbreviations DA dorsal area - DRA dorsal rim area - PS polarization sensitivity     

Profile of mood states and stress-related biochemical indices in long-term yoga practitioners

Background

Both insufficient sleep and oversleeping have been reported as precipitating and aggravating factors of tension-type headache (TTH). However, previous studies relied on recalled self-reports, and the relationship has not been confirmed prospectively and objectively in a daily life situation. Recently, ecological momentary assessment (EMA) using electronic diaries, i.e., computerized EMA, is used to record subjective symptoms with the advantages of avoiding recall bias and faked compliance in daily settings. In addition, actigraphy has become an established method to assess sleep outside laboratories. Therefore, the aim of this study was to investigate the within-individual effect of sleep on the following momentary headache intensity in TTH patients during their daily lives utilizing EMA and actigraphy.

Methods

Twenty-seven patients with TTH wore watch-type computers as electronic diaries for seven consecutive days and recorded their momentary headache intensity using a visual analog scale of 0-100 approximately every six hours, on waking up, when going to bed, and at the time of headache exacerbations. They also recorded their self-report of sleep quality, hours of sleep and number of awakenings with the computers when they woke up. Physical activity was continuously recorded by an actigraph inside the watch-type computers. Activity data were analyzed by Cole's algorithm to obtain total sleep time, sleep efficiency, sleep latency, wake time after sleep onset and number of awakenings for each night. Multilevel modeling was used to test the effect of each subjective and objective sleep-related variable on momentary headache intensity on the following day.

Results

Objectively measured total sleep time was significantly positively associated with momentary headache intensity on the following day, while self-reported sleep quality was significantly negatively associated with momentary headache intensity on the following day.

Conclusions

Using computerized EMA and actigraphy, longer sleep and worse sleep quality were shown to be related to more intense headache intensity on within-individual basis and they may be precipitating or aggravating factors of TTH.     

An Inflammation Based Score Can Optimize the Selection of Patients with Advanced Cancer Considered for Early Phase Clinical Trials

Background

Adequate organ function and good performance status (PS) are common eligibility criteria for phase I trials. As inflammation is pathogenic and prognostic in cancer we investigated the prognostic performance of inflammation-based indices including the neutrophil (NLR) and platelet to lymphocyte ratio (PLR).

Methods

We studied inflammatory scores in 118 unselected referrals. NLR normalization was recalculated at disease reassessment. Each variable was assessed for progression-free (PFS) and overall survival (OS) on uni- and multivariate analyses and tested for 90 days survival (90DS) prediction using receiving operator curves (ROC).

Results

We included 118 patients with median OS 4.4 months, 23% PS>1. LDH≥450 and NLR≥5 were multivariate predictors of OS (p<0.001). NLR normalization predicted for longer OS (p<0.001) and PFS (p<0.05). PS and NLR ranked as most accurate predictors of both 90DS with area under ROC values of 0.66 and 0.64, and OS with c-score of 0.69 and 0.60. The combination of NLR+PS increased prognostic accuracy to 0.72. The NLR was externally validated in a cohort of 126 subjects.

Conclusions

We identified the NLR as a validated and objective index to improve patient selection for experimental therapies, with its normalization following treatment predicting for a survival benefit of 7 months. Prospective validation of the NLR is warranted.     

Shedding of Vaccine Viruses with Increased Antigenic and Genetic Divergence after Vaccination of Newborns with Monovalent Type 1 Oral Poliovirus Vaccine

For the final stages in the eradication of poliovirus type 1 (P1), the World Health Organization advocates the selective use of monovalent type 1 oral poliovirus vaccine (mOPV1). To compare the immunogenicity of mOPV1 with that of trivalent OPV (tOPV) in infants, a study was performed in Egypt in 2005. Newborns were vaccinated with mOPV1 or tOPV immediately after birth and were challenged with mOPV1 after 1 month. Vaccination with mOPV1 at birth resulted in significantly higher seroconversion against P1 viruses and lower excretion of P1 viruses than vaccination with tOPV. Intratypic differentiation of the viruses shed by the newborns revealed the presence of remarkably high numbers of antigenically divergent (AD) P1 isolates, especially in the mOPV1 study group. The majority of these AD P1 isolates (71%) were mOPV1 challenge derived and were shed by newborns who did not seroconvert to P1 after the birth dose. Genetic characterization of the viruses revealed that amino acid 60 of the VP3 region was mutated in all AD P1 isolates. Isolates with substitution of residue 99 of the VP1 region had significantly higher numbers of nonsynonymous mutations in the VP1 region than isolates without this substitution and were preferentially shed in the mOPV1 study group. The widespread use of mOPV1 has proven to be a powerful tool for fighting poliovirus circulation in the remaining areas of endemicity. This study provides another justification for the need to achieve high vaccination coverage in order to prevent the circulation of AD strains.Polioviruses are the causative agents of human poliomyelitis and belong to the genus Enterovirus in the family Picornaviridae. The virus is transmitted primarily by the fecal-oral route and replicates in the human intestinal tract. The virus may also be transmitted through respiratory droplets and may replicate for a short period in the upper respiratory tract and tonsillar tissue. From either site of primary replication, the virus may invade the central nervous system and cause paralysis following infection and destruction of motor neurons. Three serologically different types of poliovirus can be distinguished (poliovirus type 1 [P1], P2, and P3), and only limited cross-protection exists between serotypes (35).In 1988, the World Health Assembly passed a resolution to eradicate wild poliovirus globally. A worldwide vaccination campaign with the trivalent oral poliovirus vaccine (tOPV) was launched by the World Health Organization (WHO). This vaccine contains the three attenuated poliovirus vaccine strains developed by Albert Sabin in the proportion of 10:1:6 for P1, P2, and P3, respectively. These OPV strains have been selected to replicate successfully in the human intestinal tract but not in the cells of the central nervous system. In addition to a strong humoral response, these strains generate strong intestinal immunity (12). Sabin type 1 is considered to be the most stable of the three attenuated poliovirus serotypes (19). This strain has 54 mutations compared to the parental Mahoney strain, of which 6 are primarily responsible for attenuation. Sabin type 2 has two major determinants of attenuation, and Sabin type 3 has three determinants of attenuation (11, 32). Upon replication in the human intestinal tract, the sites of attenuation can mutate, which results in reversion of the Sabin strains toward a parental neurovirulent phenotype. Also as a consequence of replication in the host, antibodies are produced that recognize the antigenic sites of the Sabin strains (42). This immunogenic pressure could favor the selection of antigenically divergent (AD) viruses with substituted residues in parts of these antigenic sites. AD Sabin viruses might circulate among a population for a long period and evolve into vaccine-derived polioviruses (VDPVs; with differences of >1% from the prototype Sabin viruses in the VP1 region) capable of causing outbreaks. These viruses might escape current diagnostic screening methods, and the risk for generation of these viruses should be reduced as much as possible (1, 9, 16).The tOPV vaccination campaigns have been very successful, since the number of countries with endemic wild poliovirus circulation decreased from >125 in 1988 to 4 in 2006, and wild type 2 poliovirus has likely been eradicated since 1999 (5). The tOPV vaccine, however, is known to be less immunogenic against type 1 and 3 polioviruses. After tOPV administration, the superior replicative capacity of the P2 vaccine strain interferes with effective replication of the other two serotype viruses in the human intestine (30). To eradicate wild P1 as well, vaccination with monovalent type 1 oral poliovirus vaccine (mOPV1) was introduced in the remaining countries where poliovirus is endemic, since this vaccine is more immunogenic for type 1 than the tOPV (4, 20).In 2005/2006, a clinical study was conducted in Egypt to compare the immunogenicity of mOPV1 with that of the tOPV in newborns (15). Newborns were vaccinated with mOPV1 or tOPV as soon as possible after birth and were challenged with mOPV1 4 weeks later. Vaccination with mOPV1 at birth resulted in a higher humoral and mucosal protection against P1 at day 28 than vaccination with tOPV at birth.In line with the recommendations of the WHO Polio Laboratory Network, we determined the antigenic characters of all the viruses shed by the newborns of the Egyptian study by using an intratypic differentiation (ITD) enzyme-linked immunosorbent assay (ELISA). The outcome of this analysis, an unexpectedly high percentage of AD isolates, prompted further investigation. To determine the possible presence of VDPVs and to gain insight into the genetic and antigenic evolution of the mOPV1 and tOPV isolates shed by the newborns in this study, we determined the sequences of the capsid regions of these isolates. We looked for correlates with antigenic change and rates of mutagenesis in the viruses and compared the evolution rates of the viruses shed by vaccinees of both study groups. We also linked the serological data collected during the study to the excretion of Sabin 1 isolates.     

Photosynthesis and Water Use Efficiency in Twenty Tropical Tree Species of Differing Succession Status in a Brazilian Reforestation

Leaf gas exchange characteristics were measured in twenty woody species that differ in succession status ranging from pioneer species (PS) to late succession species (LS) in a Brazilian rain-reforestation ecosystem. Photon-saturated photosynthetic rate, calculated per either a leaf area (P _NA) or a dry mass (P _NM) basis, differed among species. P _NA and P _NM were highest in PS and lowest in LS. Variation among species was 3-fold (from 7 to 23 mol m^–2 s^–1) for P _NA, and 5-fold (from 50 to 275 mol kg^–2 s^–1) for P _NM. The highest P _NA (23 mol m^–2 s^–1) and P _NM (275 mol kg^–2 s^–1) values were recorded in PS Croton urucurana, while the lowest P _NA (7 mol m^–2 s^–1) and P _NM (50 mol kg^–2 s^–1) values were recorded in LS Aspidosperma cylindrocarpon. A considerable overlap was recorded between PS and LS in values of stomatal conductance (g _s), transpiration rate (E), and leaf mass to area ratio (ALM). However, C. urucurana also showed highest g _s and E. P _NM was highly correlated with ALM in both PS and LS (r=–0.75 and –0.90, respectively). The high values of instantaneous transpiration efficiency (ITE) and intrinsic water use efficiency (WUE_i) were also observed in the PS when compared with the LS.     

Thermophilic fungi in air samples in surroundings of compost piles of municipal,agricultural and horticultural origin

In this study, the effect of the thermophilic fungi of composts was analysed on the fungal composition of the air above. Air samples were collected with an Andersen air sampler at 1.5 m height in three large industrial composting facilities treating different waste types. Repetition was collected on three calm and rain-free days of three consecutive weeks in October 2011, in January, April and July 2012; five plates were exposed successively per sampling day. Compost samples were also collected (averaging 1 kg/compost piles). Air and compost samples were cultured at 50 °C. The thermophilic fungal composition of the air near the compost piles of different waste types differed significantly (p < 0.05) from that of the control site above a grassland ecosystem at each sampling time. Seasonal differences could be detected regarding the total number of thermophilic fungi in the air near the agricultural and horticultural compost types, but smaller differences were found near the municipal compost type. A total of 13 and 11 fungal species were detected in the compost and air samples where the dominant species were Thermomyces lanuginosus and Rasamsonia emersonii, respectively. The concentration of airborne thermophilic fungi was higher near the horticultural compost type and lower near the municipal compost. The results suggest that the differences between the incidences of some species in composts and associated aerosols refer to spore ontogeny and biological mechanisms of spore liberation.     

Association between Sleep Duration and Urinary Albumin Excretion in Patients with Type 2 Diabetes: The Fukuoka Diabetes Registry

Objective

Few studies have so far investigated the impact of sleep duration on chronic kidney disease in diabetic patients. The objective of the present study was to examine the relationship between sleep duration and albuminuria in type 2 diabetic patients.

Research Design and Methods

A total of 4,870 Japanese type 2 diabetic patients ≥20 years of age were divided into six groups according to self-reported sleep duration: less than 4.5 hours, 4.5–5.4 hours, 5.5–6.4 hours, 6.5–7.4 hours, 7.5–8.4 hours and more than 8.5 hours. The association between sleep duration and urinary albumin-creatinine ratio (UACR) was examined cross-sectionally.

Results

Both short and long sleep durations were significantly associated with higher UACR levels and higher proportions of patients with albuminuria (≥30 mg/g) and macroalbuminuria (≥300 mg/g) compared with a sleep duration of 6.5–7.4 hours (P for quadratic trend <0.001). A U-shaped association between sleep duration and UACR remained significant even after adjustment for potential confounders, including age, sex, duration of diabetes, current smoking habits, former smoking habits, current drinking habits, regular exercise habits, total energy intake, total protein intake, hypnotic use and estimated glomerular filtration rate. Furthermore, the association remained substantially unchanged after additional adjustment for body mass index, hemoglobin A_1c, systolic blood pressure, renin-angiotensin system inhibitor use and depressive symptoms.

Conclusions

Our findings suggest that sleep duration has a U-shaped association with the UACR levels in type 2 diabetic patients, independent of potential confounders.     

Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures

Background

Sucrose is widely used to manage procedural pain in term newborns despite a lack of evidence of its effectiveness for different procedures and infant populations. Our objectives were to evaluate the effectiveness and safety of sucrose in newborns undergoing various medical procedures within 2 days of birth.

Methods

We performed a double-blind, randomized controlled trial. We included newborns (≥ 36 weeks gestation) of diabetic mothers and nondiabetic mothers. Each newborn received 2 mL of a 24%-sucrose or placebo solution before all procedures. We used the Premature Infant Pain Profile to assess pain during intramuscular injection of vitamin K, venipuncture for the newborn screening test and the first 3 heel lances for glucose monitoring (newborns of diabetic mothers only). Scores ranged from from 0 (no pain) to 18 (maximum pain).

Results

We included 240 newborns (120 from diabetic mothers, 120 from nondiabetic mothers). The overall mean pain score was lower among newborns who received sucrose than among those who received a placebo (mean difference –1.3, 95% confidence interval [CI] –2.0 to –0.6). We found that pain scores during intramuscular injection did not differ significantly between the sucrose and placebo groups for newborns of diabetic or nondiabetic mothers (newborns of nondiabetic mothers: mean difference –1.1, 95% CI –2.4 to 0.2; newborns of diabetic mothers: mean difference –1.0, 95% CI –2.4 to 0.4). During venipuncture, newborns who received sucrose had lower pain scores compared with those who received a placebo (newborns of nondiabetic mothers: mean difference –3.2, 95% CI –4.6 to –1.8; newborns of diabetic mothers: mean difference –2.4, 95% CI –3.8 to –1.0). Among newborns of diabetic mothers, there was no difference in pain during the first 3 heel lances or mean glucose levels between the sucrose and placebo groups (p = 0.94 and p = 0.29 respectively).

Interpretation

We found a modest reduction of pain in newborns of both diabetic and nondiabetic mothers when sucrose was used for all medical procedures performed in the first 2 days after birth. However, when each procedure was analyzed separately, we found that the effectiveness of sucrose was limited to venipuncture for the newborn screening test. (http://Clinicaltrials.gov trial register no. {"type":"clinical-trial","attrs":{"text":"NCT00213213","term_id":"NCT00213213"}}NCT00213213.)All newborns experience pain from medical procedures in the first days after birth. At the very least, newborns receive an intramuscular injection of vitamin K and venipuncture or heel-lance for newborn screening tests. Newborns of diabetic mothers, about 4% of newborns, undergo additional heel-lances for monitoring glucose levels.^1,2 Untreated pain from these procedures can have long-lasting effects.^3,4 We previously reported that newborns of diabetic mothers who received an average of 10 heel-lances within 2 days of birth exhibited a heightened pain response during subsequent venipunctures compared with newborns from nondiabetic mothers.²Studies aimed at reducing pain and its consequences in newborns are clinically important.^5–7 Sucrose (table sugar) has great potential for routine use.⁶ Sucrose is a naturally occurring sweetener with analgesic effects in newborns. Although not fully understood, the mechanism of action is thought to involve activation of the endogenous opioid system through taste.⁸ This is supported by the presence of opioid receptors on the tongue and animal studies showing that analgesia can be reversed by opioid antagonists during noxious stimulation.⁹ Moreover, chronic consumption of sweeteners has been shown to negate the analgesic effects of opioids.¹⁰In systematic reviews, single doses of sucrose have been reported to reduce pain in newborns undergoing commonly performed medical procedures, including heel-lancing and venipuncture.^11,12 Based on these data, national and international pain management guidelines promote the widespread use of sucrose.^13–16 However, sucrose has not been evaluated for all commonly performed procedures in healthy term newborns, and there are concerns that sucrose may raise blood glucose levels in newborns of diabetic mothers. It is necessary to demonstrate that sucrose is effective and safe for varied procedures, repeated use and diverse infant populations.We sought to evaluate the effectiveness and safety of sucrose in newborns of diabetic mothers and nondiabetic mothers undergoing routine painful medical procedures during the first 2 days after birth. Our hypothesis was that sucrose reduces pain during intramuscular injection of vitamin K, venipuncture for the newborn screening test and heel lance for blood glucose monitoring without serious adverse effects.