Pathological spontaneous activity as a prognostic marker in chronic inflammatory demyelinating polyneuropathy.

BACKGROUND AND PURPOSE: Monitoring of the disease course of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) remains challenging because nerve conduction studies do not adequately correlate with functional disability. The prognostic value of pathological spontaneous activity (PSA) in needle electromyography (EMG) in different CIDP subgroups in a longitudinal context has, to date, not been analysed. We aimed to determine whether PSA was a prognostic marker or a marker of disease activity in a cohort of patients with CIDP. METHODS: A total of 127 patients with CIDP spectrum disorder were retrospectively analysed over 57 ± 47 months regarding the occurrence of PSA (fibrillations and positive sharp waves). The presence of PSA at diagnosis, newly occurring PSA, and continuously present PSA were longitudinally correlated with clinical disability using the Inflammatory Neuropathy Cause and Treatment Overall Disability Sum Score (INCAT-ODSS) and CIDP subtype. RESULTS: Pathological spontaneous activity occurred in 49.6% of all CIDP patients at first diagnosis. More frequent evidence of PSA was significantly associated with a higher INCAT-ODSS at the last follow-up. Continuous and new occurrence of PSA were associated with higher degree of disability at the last follow-up. The majority of patients with sustained evidence of PSA were characterized by an atypical phenotype, higher degree of disability, and the need for escalation of treatment. CONCLUSIONS: Pathological spontaneous activity was associated with a higher degree of disability and occurred more frequently in atypical CIDP variants according to the longitudinal data of a large cohort of patients with CIDP. Our results showed that EMG examination was an adequate marker for disease progression and should be evaluated during the disease course.

Analysis of organophosphate-Zn metalloporphyrin interactions via UV-vis spectroscopy and molecular modeling.

UV-vis absorption spectra of zinc tetraphenylporphine (ZnTPP) on interaction with six organophosphorus (OP) compounds in cyclohexane were compared using ab initio methods and the molecular and solvation ligand descriptors π(*), Vx, and σ. OPs with polarizable hydrocarbon substituents in the homologous series tri-ethyl, -pentyl, -octyl, and -phenyl phosphates and the toxicologically relevant methyl paraoxon (1a-e) each gave a red shift in the Soret band (λsor) of ZnTPP in the range of 8-10 nm. Sensitivity as ΔAsor-b/Δug OP for the spectral band of the ligand bound ZnTPP (λsor-b) decreased with increasing extent of alkyl and aromatic substitution. Calculated and combined energies for OP and ZnTPP examined as a function of distance (Å) between ligand and porphyrin center suggest increased steric crowding with increasing Vx, and aromatic content of the OP. Spectrally fitted K1:1 and ΔAsor-b/ug OP each vary exponentially with Vx/σ. Lack of a red shift in λsor-b where ZnTPP was titrated with the toxic diethyl chlorophosphate (1g) is consistent with a model in which the magnitude of ΔEsor is proportional to the donor capacity of the phosphoryl-O ligand.

Uranium and other natural radionuclides in the sediments of a Mediterranean fjord-like embayment, Amvrakikos Gulf (Ionian Sea), Greece.

The distribution of the natural radionuclides ((238)U, (232)Th, (226)Ra, (40)K) and the artificial (137)Cs was studied in sediment cores collected from Amvrakikos Gulf, a seasonal anoxic marine basin, using γ-ray spectrometry. The activity of radionuclides, along with the concentrations of Fe and Mn, were also studied in relation to the total organic carbon and the granulometric fractions of the sediments. The results obtained revealed higher (238)U activity concentrations in all the examined sediment samples compared to the world and Greek average values for soil. The high activity values of (238)U are attributed, besides the lattice-held fraction, to phosphate fertilizer inputs in the Gulf via major rivers and/or to alteration processes of phosphate ores located mainly in the drainage basin of the river Louros. The elevated activity values of (40)K could be attributed to the mineralogical composition of the sediments and to phosphate fertilizers containing potassium. Organic matter seems to be a more efficient sorbent for U than clay minerals and amorphous Fe and Mn-oxyhydroxides. Scanning electron microscopy, together with qualitative analysis of some smectites, reveals the occurrence of U, suggesting a limited absorption of U onto clay minerals. The applied BCR sequential extraction procedure revealed that U was found mainly in the refractory phase or associated with organic matter and to a lesser extent as surface-coating oxides, with the exception of one sediment core which is characterized by high content of fresh marine organic matter and presents high percentage of U in the exchangeable fraction.

Childhood obesity and associated factors in a rural Greek island.

INTRODUCTION: Childhood obesity has increased dramatically in the past few decades both in developed and developing countries. The objectives of this study were to estimate the prevalence of increased weight in children and adolescents on a remote Greek island in the Aegean Sea, and to assess the factors influencing this phenomenon. METHODS: A cross-sectional study was conducted involving children and adolescents aged 8-16 years, resident on the island of Kalymnos, Greece. Their height and weight were measured in the school environment. Information about the children's leisure habits, a plain dietary history, whether they were exposed to tobacco smoke at home, parental nutritional status and socioeconomic status were collected via a written questionnaire. Obesity was defined according to the International Obesity Task Force curves. Univariable and multivariable logistic regression analysis were conducted in order to identify any factor correlated to increased weight. RESULTS: In total, 232 children took part in the study (91.6% participation), and 20.6% (n=48) were classified as overweight while 8.1% (n=19) were obese. The majority of the children (85.9%) had been breastfed and 45.6% (n=106) were exposed to smoke at home. In the multivariable analysis, statistically significant terms associated with childhood increased weight were: maternal obesity, maternal occupation and weekly consumption of sugar-sweetened soft drinks. CONCLUSIONS: The high prevalence of increased weight in children and adolescents on this remote island is part of the major global public health problem. The evidence suggests that maternal nutritional status and occupation, together with children's dietary habits, are associated with childhood body weight.

Effect of pulmonary rehabilitation on muscle remodelling in cachectic patients with COPD.

It is known that non-cachectic patients with chronic obstructive pulmonary disease (COPD) respond well to pulmonary rehabilitation, but whether cachectic COPD patients are capable of adaptive responses is both important and unknown. 10 cachectic and 19 non-cachectic COPD patients undertook high-intensity cycling training, at the same relative intensity, for 45 min x day(-1), 3 days x week(-1) for 10 weeks. Before and after rehabilitation vastus lateralis muscle biopsies were analysed morphologically and for the expression of muscle remodelling factors (insulin-like growth factor (IGF)-I, myogenic differentiation factor D (MyoD), tumour necrosis factor (TNF)-alpha, nuclear factor (NF)-kappaB and myostatin) and key components of ubiquitin-mediated proteolytic systems (muscle ring finger protein (MURF)-1 and Atrogin-1). Rehabilitation improved peak work-rate and the 6-min walk distance similarly in non-cachectic (18+/-3% and 42+/-13 m, respectively) and cachectic (16+/-2% and 53+/-16 m, respectively) patients, but quality of life only improved in non-cachectic COPD. Mean muscle fibre cross-sectional area increased in both groups, but significantly less in cachectic (7+/-2%) than in non-cachectic (11+/-2%) patients. Both groups equally decreased the proportion of type IIb fibres and increased muscle capillary/fibre ratio. IGF-I mRNA expression increased in both groups, but IGF-I protein levels increased more in non-cachectic COPD. MyoD was upregulated, whereas myostatin was downregulated at the mRNA and protein level only in non-cachectic patients. Whilst rehabilitation had no effect on TNF-alpha expression, it decreased the activation of the transcription factor NF-kappaB in both groups by the same amount. Atrogin-1 and MURF-1 expression were increased in cachectic COPD, but it was decreased in non-cachectic patients. Cachectic COPD patients partially retain the capacity for peripheral muscle remodelling in response to rehabilitation and are able to increase exercise capacity as much as those without cachexia, even if they exhibit both quantitative and qualitative differences in the type of muscle fibre remodelling in response to exercise training.

Exercise-induced skeletal muscle deoxygenation in O-supplemented COPD patients.

This study was designed to assess quadriceps oxygenation during symptom-limited and constant-load exercise in patients with chronic obstructive pulmonary disease (COPD) and healthy age-matched controls. Thirteen male COPD patients [FEV(1): 43 +/- 5% predicted (mean +/- SEM)] and seven healthy male controls performed an incremental exercise test at peak work rate (WR) and a constant-load test at 75% peak WR on a cycle ergometer. Quadriceps hemoglobin saturation (StO2) was measured by continuous-wave near-infrared spectrophotometry throughout both exercise tests. StO2 is the ratio of oxygenated hemoglobin to total hemoglobin and reflects the relative contributions of tissue O2 delivery and tissue O2 utilization. Oxygen was supplemented to all patients in order to maintain arterial O2 saturation normal (> 95%). The StO2 decreased during symptom-limited exercise, reaching the nadir at peak WR. The decrease in StO2 was greater (P < 0.05) in healthy subjects (from 74 +/- 2% to 38 +/- 6%) compared with that in COPD patients (from 61 +/- 5% to 45 +/- 4%). However, when StO2 was normalized relative to the WR, the slope of change in StO2 during exercise was nearly identical between COPD patients and healthy subjects (0.47 +/- 0.10%/W and 0.51 +/- 0.04%/W, respectively). During constant-load exercise, the kinetic time constant of StO2 desaturation after the onset of exercise (i.e., equivalent to time to reach approximately 63% of StO2 decrease) was not different between COPD patients and healthy subjects (19.0 +/- 5.2 and 15.6 +/- 2.5 s, respectively). In O2-supplemented COPD patients, peripheral muscle oxygenation for a given work load is similar to that in healthy subjects, thus suggesting that skeletal muscle O2 consumption becomes normal for a given O2 delivery in COPD patients

Chest wall volume regulation during exercise in COPD patients with GOLD stages II to IV.

The present study investigated how end-expiratory ribcage and abdominal volume regulation during exercise is related to the degree of dynamic chest wall hyperinflation in patients with different spirometric severity of chronic obstructive pulmonary disease (COPD) based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. In total, 42 COPD patients and 11 age-matched healthy subjects were studied during a ramp-incremental cycling test to the limit of tolerance (W(peak)). Volume variations of the chest wall (at end expiration (EEV(cw)) and end inspiration) and its compartments (ribcage (V(rc)) and abdominal (V(ab))) were computed by optoelectronic plethysmography. At W(peak), only patients in GOLD stages III and IV exhibited a significant increase in EEV(cw) (increase of 454+/-509 and 562+/-363 mL, respectively). These patients did not significantly reduce end-expiratory V(ab), whereas patients in GOLD stage II resembled healthy subjects with significantly reduced end-expiratory V(ab) (decrease of 287+/-350 mL). In patients, the greater the increase in EEV(cw) at W(peak), the smaller the reductions in end-expiratory V(ab) and the greater the increase in end-expiratory V(rc). In chronic obstructive pulmonary disease patients with different spirometric disease severity, greater degrees of exercise-induced dynamic chest wall hyperinflation were accompanied by lower degrees of end-expiratory abdominal volume displacement and larger increases in end-expiratory ribcage volume.

Quadriceps oxygenation during isometric exercise in sailing.

The aim of the present study was to investigate why blood lactate after prolonged quadriceps contraction during hiking is only marginally increased. Eight sailors performed five 3-min hiking bouts interspersed with 5-s recovery periods. Whole body oxygen uptake, heart rate and lactate were recorded, along with continuous-wave near-infrared spectroscopy measures of quadriceps oxygenation. The time for 50% re-oxygenation was also assessed as an indication of the degree of localized oxygen delivery stress. Hiking elicited a significant (p = 0.001) increase in mean (+/- SD) heart rate (124 +/- 10 beats . min (-1)) which was accompanied by a disproportionately low oxygen uptake (12 +/- 2 ml.kg(-1).min(-1)). Lactate was significantly (p = 0.001) increased throughout hiking manoeuvres, though post-exercise it remained low (3.2 +/- 0.9 mmol.l(-1)). During the hiking bouts mean quadriceps oxygenation was significantly (p = 0.001) reduced compared to baseline (by 33 +/- 5%), indicating an imbalance between muscle oxygen accessibility and oxygen demand. During rest intervals quadriceps oxygenation was partially restored. After the end of the final bout the time for 50 % re-oxygenation was only 8 +/- 2 s, whereas recovery of quadriceps oxygenation and oxygen uptake was completed within 3 min. We conclude that the observed low lactate could be attributed to the small oxygen and energy deficits during hiking as the muscles' oxygen accessibility is presumably partially restored during the brief rest intervals.