bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptom burden of sleep-disordered breathing in mild-to-moderate congestive heart failure patients
Authors: Hastings P. C. , Vazir A. , O'Driscoll D. M. , Morrell M. J. , Simonds A. K.
Published: April 2006

The symptom burden resulting from sleep-disordered breathing (SDB) in patients with mild-to-moderate congestive heart failure (CHF) is unclear. The current authors monitored 24-h activity levels and compared subjective and objective measures of daytime sleepiness in 39 CHF patients, New York Heart Association class 2–3, on optimal medication. A total of 22 patients were classified as SDB (apnoea/hypopnoea index (AHI) median (range) 22.3 (16.6–100) events·h−1), and 17 as no SDB (NoSDB; AHI 3.7 (0–12.3) events·h−1). SDB was defined as AHI ≥15 events·h−1. Patients were assessed by 24-h activity monitoring (actigraphy) for a period of up to 14 days, a single objective sleepiness test (Oxford Sleep Resistance test) and Epworth Sleepiness Scale.

The duration of daytime activity was significantly shorter in the SDB group compared with the NoSDB group. The SDB group also had increased time in bed and poorer sleep quality, as shown by the fragmentation index. Objectively the SDB group when compared with the NoSDB group were significantly sleepier, subjectively the groups did not differ. The amount of napping was similar for both groups.

Despite the lack of subjective symptoms of daytime sleepiness, congestive heart failure patients with sleep-disordered breathing were objectively sleepier during the day and had reduced daytime activity with longer periods in bed and poorer sleep quality when compared with those without sleep-disordered breathing.
Antioxidant status in patients with sleep apnoea and impact of continuous positive airway pressure treatment
Authors: Barceló A. , Barbé F. , de la Peña M. , Vila M. , Pérez G. , Piérola J. , Durán J. , Agustí A. G. N.
Published: April 2006

The episodes of hypoxia/re-oxygenation associated with the respiratory disturbances observed in patients with obstructive sleep apnoea syndrome (OSAS) may induce the generation of oxygen free radicals. Indeed, several studies suggest that OSAS is associated with oxidative stress. The present study tested the hypothesis that patients with OSAS have an alteration in antioxidant defences.

The plasma levels of total antioxidant status (TAS), glutathione peroxidase (GPX), γ-glutamyltransferase (GGT), vitamins A, E, B12and folate, and homocysteine were determined in 47 patients with OSAS and 37 healthy subjects. Of these, 27 patients who used continuous positive airway pressure (CPAP) for >4 h·night−1were re-examined 12 months later.

Patients with OSAS had lower TAS (1.4±0.16versus1.50±0.10 mmol·L−1), vitamin A (64±19versus74±17 μg·dL−1) and vitamin E levels (1,525±499versus1,774±503 μg·dL−1), and increased values of GGT (42±22versus32±16 U·L−1) than controls. There was no difference between groups in GPX, homocysteine, vitamin B12and folate plasma levels. CPAP treatment normalised the levels of TAS (1.50±0.13 mmol·L−1) and the activity of GGT (30±14 U·L−1) without any influence on vitamins levels.

In conclusion, the results indicate that patients with obstructive sleep apnoea syndrome have a decreased antioxidant capacity that is partially reversed by continuous positive airway pressure treatment.
Sources of variation in forced expiratory volume in one second and forced vital capacity
Authors: Chinn S. , Jarvis D. , Svanes C. , Burney P.
Published: April 2006

Published prediction equations for lung function differ considerably, but the components of population variation responsible for the differences are unknown.

Data were analysed for 6,323 never-smoking adults who did not report wheeze or asthma, from 42 centres participating in the European Community Respiratory Health Survey. Means and components of variance were estimated for males and females aged 20–24 yrs, and the relationships with age and height were examined in those aged 25–44 yrs.

Mean lung function for those aged 20–24 yrs differed between centres, but variation could not be wholly attributed to differences in population or equipment. The maximum difference in means by equipment type was 101 mL for FVC in males. Equipment differences were not statistically significant adjusted for country, but differences in mean forced expiratory volume in one second and forced vital capacity by country, adjusted for instrument, were statistically significant in males. Differences between centres in relation to age and height had less influence on predicted values.

In conclusion, there are unexplained differences in lung function between ethnically similar nonsmoking symptom-free populations. Neither national reference curves nor those based on the same ethnic group can be guaranteed to give accurate norms of lung health.
Mechanisms of dyspnoea and its language in patients with asthma
Authors: Laveneziana P. , Lotti P. , Coli C. , Binazzi B. , Chiti L. , Stendardi L. , Duranti R. , Scano G.
Published: April 2006

This study hypothesises that regardless of the global score of dyspnoea intensity, different descriptors may be selected by asthmatic patients during short cardiopulmonary exercise test (sCPET) and methacholine (Mch) inhalation. It also examines whether different qualitative dyspnoea sensations can help explain the underlying mechanisms of the symptom.

Minute ventilation (V′E), tidal volume (VT) and inspiratory capacity (IC) were measured in 22 stable asthmatic patients, and the sensation of dyspnoea during Mch inhalation and sCPET was quantitatively (Borg scale) and qualitatively (descriptors) assessed. The work rate and oxygen uptake (V′O2) were also measured during sCPET.

Airway obstruction and hyperinflation, as measured by IC reduction, were the best correlates for dyspnoea with Mch. During sCPET, changes in WR,V′O2,V′EandVTsignificantly correlated with Borg score, withV′Ebeing the best predictor of dyspnoea; IC decreased in eight patients. Furthermore, chest tightness (68%) was the highest reported descriptor during Mch inhalation, whereas work/effort (72%) was the highest during sCPET.

In conclusion, obstruction/hyperinflation and work rate are highly reliable predictors of Borg rating of dyspnoea during methacholine inhalation and short cardiopulmonary exercise testing, respectively. Regardless of the global score of intensity dyspnoea, different descriptors may be selected by patients during short cardiopulmonary exercise testing and methacholine inhalation. Various qualities of dyspnoea result from different pathophysiological abnormalities.
Continuous positive airway pressure treatment for sleep apnoea: compliance increases with time in continuing users
Authors: Sucena M. , Liistro G. , Aubert G. , Rodenstein D. O. , Pieters T.
Published: April 2006

Continuous positive airway pressure (CPAP) remains the best treatment for sleep apnoea syndrome (SAS). In the 1990s, many authors reported on daily compliance, but all of the studies utilised relatively short periods of follow-up that did not exceed a few years.

The mean annual rate of CPAP use in patients with SAS was prospectively recorded. In the current study, the results are presented along with compliance data from patients who started CPAP between 1991 and 1998 and were still using it by the end of 2003. The cohort was chosen in order to obtain ≥5 yrs of follow-up for each patient. In total, there were 204 patients. For the whole group, mean±sdcompliance reached 321±90 and 393±84 min after 1 and 10 yrs, respectively.

There was no significant change in the first 2 yrs, with a significant increase from the third year onwards. Compliance, or its evolution over time, was not correlated either to the baseline polysomnographical data (except slightly for the CPAP pressure), to the difference of these data before and under CPAP therapy, to the age of retirement or to changes in the marital status.

In conclusion, very long-term compliance with continuous positive airway pressure increases by a mean of 8 min·day−1per year of follow-up in patients with sleep apnoea syndrome.
Do respiratory symptoms predict job choices in teenagers?
Authors: Radon K. , Huemmer S. , Dressel H. , Windstetter D. , Weinmayr G. , Weiland S. , Riu E. , Vogelberg C. , Leupold W. , von Mutius E. , Goldberg M. , Nowak D.
Published: April 2006

Existing guidelines advise adolescents with asthma and allergies against high-risk occupations. The aim of the current authors' analyses was to investigate the resulting self-selection in a prospective cohort study.

The participants of Phase II of the International Study of Asthma and Allergies in Childhood in Germany (aged 9–11 yrs at baseline) were re-contacted after 7 yrs (response rate was 77%) and were asked to complete a questionnaire, which included items on atopic diseases. The subjects were also asked about the type of job they would like to have in the future (preferred job choice). Exposure to agents with potential asthma risk was evaluated using a job exposure matrix. The analyses were restricted to those in school-based vocational training programmes without occupational exposures.

A total of 33% of subjects chose jobs with high asthma risk, 23% selected low asthma risk jobs and the remaining adolescents indicated jobs without known asthma risk (reference category). There were no statistically significant associations between asthma, allergic rhinitis or atopic dermatitis and selecting jobs with asthma risk. Participants with allergic rhinitis tended to select high risk jobs less frequently.

In conclusion, self-selection into low risk jobs seems to play a minor role in teenagers with asthma or allergies.
The neutrophilic and fibrinolytic response to talc can predict the outcome of pleurodesis
Authors: Psathakis K. , Calderón-Osuna E. , Romero-Romero B. , Martin-Juan J. , Romero-Falcón A. , Rodriguez-Panadero F.
Published: April 2006

It was hypothesised that monitoring neutrophil andd-dimer (DD) levels into the pleural fluid, after talc instillation, could predict the outcome of pleurodesis.

The current authors investigated a total of 168 patients with malignant pleural effusion, who were treated with talc poudrage. According to the outcome the patients were categorised into one of two groups, either successful or failed pleurodesis. In all cases, pleural fluid neutrophils and DDswere determined on serial measurements at 0, 3, 24 and 48 h after the procedure. The time course of these parameters was assessed in both groups and the time point at which they could better predict the outcome was further explored.

Neutrophils rose rapidly after talc poudrage in both groups, reaching a plateau at 24 h, although in successful pleurodesis this response was significantly higher. DD dropped markedly at 24 h in the group with the successful outcome, but it did not show significant changes in the other group. A cut-off value of 61% for neutrophils and 61 mg·L−1for the DD at 24 h yielded the best prognosis for successful pleurodesis.

The current authors conclude that serial measurements of neutrophil andd-dimer values into the pleural fluid after talc poudrage could be used as predictors of the outcome of pleurodesis.
Crackle-sound recording to monitor airway closure and recruitment in ventilated pigs
Authors: Peták F. , Habre W. , Babik B. , Tolnai J. , Hantos Z.
Published: April 2006

It was hypothesised that the recruitment of atelectatic lung areas is signified by changes in the airway and tissue mechanics, and by the appearance of crackle activity attributed to the sudden reopening of collapsed airways. The authors also assumed that the acoustic activity is an earlier indicator of lung recruitment than the change in the overall mechanical state of the lungs.

Six thoracotomised and mechanically ventilated mini-pigs were studied. Low-frequency pulmonary impedance was measured at end-expiratory pauses at transpulmonary pressures of 4 and 1 hPa to estimate airway resistance (Raw) and the coefficient of lung tissue elastance (H), and tracheal sounds were recorded during subsequent slow inflations to 30 hPa, in the control state and following increasing doses ofi.v.methacholine (Mch).

RawandHwere higher at baseline and increased more in response to Mch at 1 hPa than at 4 hPa. The crackles detected during the subsequent inflations were concentrated around and associated with the development of the lower knee of the pressure–volume curve. The number of crackles increased faster following the Mch doses and reached statistical significance earlier thanRawandH.

Crackle recording during mechanical ventilation can be employed as a simple method with which to monitor lung recruitment–derecruitment.
Outcomes and markers in the assessment of chronic obstructive pulmonary disease
Authors: Jones P. W. , Agusti A. G. N.
Published: April 2006

The clinical presentation of chronic obstructive pulmonary disease (COPD) is highly variable, reflecting the interaction of a complex range of pathological changes including both pulmonary and systemic effects.

The consequences of COPD experienced by the patient (i.e.its outcomes) include: symptoms, weight loss, exercise intolerance, exacerbations, health-related quality of life, health resource use and death. No single measure can reflect the variety of pathological effects or adequately describe the nature or severity of COPD.

Currently, there are few validated markers for assessing COPD and evaluating the effectiveness of treatment. The forced expiratory volume in one second has been used as a global marker of COPD, but it does not fully reflect the burden of COPD on patients. New markers are needed to better characterise the full clinical spectrum of the disease and to guide the development and assessment of new and more effective therapies.

This article considers the distinction between outcomes and markers, the various ways in which markers are used and the need for new markers in the management of chronic obstructive pulmonary disease. The process of marker selection and validation is reviewed and potential new biological, physiological and symptomatic markers for chronic obstructive pulmonary disease are assessed.
Tree-ring evidence of ‘Little Ice Age’ glacier advances in southern Tibet
Authors: Bräuning Achim
Published: April 2006

The history of late Holocene glacier fluctuations in eastern Tibet was studied by determining the ages of trees growing on glacier deposits. Maximum tree ages yield minimum ages of AD 1760 and 1780 for moraine formation at the maximum extent of the ‘Little Ice Age’ glacier advances in two glacier forefields. Subsequent moraines could be dated to the beginning of the nineteenth and the beginning of the twentieth century. Larch trees from a third glacier forefield in southeastern Tibet show evidence of glacier activity from 1580 to 1590, from the end of the eighteenth to the beginning of the nineteenth century and from 1860 to 1880. One glacier at Mt Gyalaperi recently advanced in both 1951 and 1987. Periods of glacier advances can partly be correlated with periods of growth reductions in chronologies of total ring width and maximum latewood density derived from trees growing on slopes above the glacier valleys. Correlation functions with meteorological data suggest that maximum latewood density of subalpine Picea balfouriana, Larix griffithii and Abies delavayi var. motouensis is positively correlated with summer temperature, while ring width of these species and of subalpine Juniperus tibetica is also sensitive to winter conditions prior to the growing season.
A high-resolution record of Holocene rainfall variations from the western Chinese Loess Plateau: antiphase behaviour of the African/Indian and East Asian summer monsoons
Authors: Maher Barbara A. , Hu Mengyu
Published: April 2006

Tropical monsoons are key mechanisms for transfer of heat and moisture to higher latitudes. Here we present a high-resolution, terrestrial proxy summer monsoon record for the southeast Asian monsoon, from a rapidly accumulating Holocene loess/soil sequence in the western Chinese Loess Plateau. We use magnetic and clastic grain size proxies to make quantitative estimates of Holocene rainfall and identify variations in winter monsoon intensity. Our record reveals cyclical millennial and multimillennial rainfall changes. As with the northwest African/southwest Asian monsoon records, a short arid interval at - 12.5 to 11.5 ka BP (the Younger Dryas) and subsequent summer monsoon intensification are recorded. However, at 6 ka BP, the southeast Asian summer monsoon weakened, when the northwest African/ southwest Asian monsoons strengthened, and then, from - 5 ka BP, intensified, when northwest Africa/ southwest Asia became dry. These antiphase monsoonal relationships may reflect competition between sea surface temperature changes and solar forcing. The intensity of the southeast Asian winter monsoon intensified from - 9 ka BP onwards, varying in its phase relationships with summer monsoon intensity. After - 2.25 ka BP, extreme climatic instability is indicated by both climate proxies.
Effects of storminess, sand supply and the North Atlantic Oscillation on sand invasion and coastal dune accretion in western Portugal
Authors: Clarke Michele L. , Rendell Helen M.
Published: April 2006

Holocene forested coastal dunes fringe the Atlantic coast of western Portugal. Mapping of dunes in the field and using air photographs shows a range of forms reflecting dominant northwest and westerly onshore wind regimes. Planting of maritime pine forests in the thirteenth and twentieth centuries was initiated because of sand invasion causing problems for human settlement and agriculture. Early Holocene dunes have a well-developed podsol and date to 9.7 and 8.2 ka, suggesting at least some of these sands may have been emplaced during a global cooling event. Significant transgressive dune accretion at 2.2 and 1.5 ka, implies abundant sand supply and strong onshore winds The most recent dune-building period dates to AD 1770-1905 and coincides with a predominantly negative winter North Atlantic Oscillation index (NAOi). Accretion of dunes along the Portuguese coast appears out of phase with dune development in southwest France, which may reflect different Atlantic storm tracks driven by changes in the dominance and state of the NAOi.
Mid-to late-Holocene hydrological and climatic variability in Disko Bugt, central West Greenland
Authors: Moros Matthias , Jensen Karin G. , Kuijpers Antoon
Published: April 2006

Diatom and lithological analyses were carried out on two sediment cores from Disko Bugt and the adjacent Kangersuneq Fjord, West Greenland, in order to investigate mid-to late-Holocene (6.9-0.7 kyr BP) hydrographic and climatic variability. While the Disko Bugt record is found to reflect mainly West Greenland Current (WGC) fluctuations that can be linked to North Atlantic circulation variability, the fjord record appears to be more representative of local climate conditions. The records demonstrate that the period of investigation was marked by a late-Holocene Thermal Maximum beginning at c. 4.8 kyr and ending between 3.5 and 3.1 kyr BP, encompassing a colder period between c. 4.0 and 3.8 kyr BP. An episode of higher surface-water temperature is also indicated in Disko Bugt between 2.2 and 1.5 kyr BP. In contrast, the record from Kangersuneq Fjord suggests persisting cooler (summer) surface waters for this interval, interpreted to be attributable to increased meltwater outflow. The warming episode recognized in Disko Bugt corresponds to a reported interval of increased influence of Atlantic waters in the East Greenland Current, which suggests an active North Atlantic current system with enhanced Irminger Current transport also affecting the WGC. Within the later part of the Disko Bugt record ending at c. 0.7 kyr BP ( c. AD 1300) no evidence could be found for a significant Mediaeval warming. When comparing the timing of various environmental changes with past shifts in human settlement in the Disko Bugt area, an apparent link exists between changes in hunting tradition and sea ice conditions.
Past changes in the Scots pine forest line and climate in Finnish Lapland: a study based on megafossils, lake sediments, and GIS-based vegetation and climate data
Authors: Kultti Seija , Mikkola Kari , Virtanenj Tarmo , Timonen Mauri , Eronen Matti
Published: April 2006

Subfossil samples of Scots pine (Pinus sylvestris) and evidence of pine stomata and pollen accumulation rates from previously studied lakes located beyond the present pine forest line in Finnish Lapland were used to reconstruct the extent of the past forest line and the corresponding minimum shift in mean July temperatures, compared with the present. The location of the present pine forest line follows the c. + 12.2C mean July temperature isoline (1961-1990). When minimum shifts in mean July temperatures during the Holocene were studied, the estimated glacio-isostatic land uplift and its regional differences were taken into account. Results indicate that pine reached its maximum distribution between 8300 and 4000 cal. yr BP. The inferred minimum shift in mean July temperature was at that time c. +2.5. Until 3000 cal. yr BP, the results indicate a shift of c. + 1°C. Between 2538 and 1721 cal. yr BP, evidence for a wider distribution of pine in Finnish Lapland is lacking. During the ‘Mediaeval Warm Period’ the reconstructed minimum shift in mean July temperature was +0.5. The record of subfossil pines beyond the present pine treeline ceases during the initiation of the ‘Little Ice Age’, c. 700 years ago.
Prehistoric and Roman gullying in the European oess belt: a case study from central Belgium
Authors: Vanwalleghem T. , Bork H. R. , Poesen J. , Dotterweich M. , Schmidtchen G. , Deckers J. , Scheers S. , Martens M.
Published: April 2006

In contrast with the understanding of present-day soil erosion processes, knowledge on past soil erosion phenomena is still rather limited. Although some studies report on severe gully erosion phases during the fourteenth and eighteenth centuries, almost no evidence is available that documents earlier gully erosion phases. This study investigates the development and age of two old, permanent gullies that are conserved in the ancient Meerdaal forest in central Belgium. The development history of both gullies is very similar. In the first gully, archaeological evidence was found indicating an erosion phase during Roman times, followed by a partial infilling of the gully. In the second gully, radiocarbon dating provided evidence of the same Roman activity phase (cal. yr 46 BC-AD 78), but also of an earlier incision phase during the Middle Bronze Age (cal. yr 1743-1602, 1568-1533 BC). Also here, the erosion phase was followed by a partial infilling. This limited infilling indicates that the catchment of the gullies was reforested quite rapidly, hereby cutting off all runoff and sediment production. This has led to a unique situation in the Meerdaal forest, with the conservation of about 43 similar, large gullies in an area of about 17 km2. This area has a high geovalue, as the studied gullies are among the oldest and best conserved gullies in northwestern Europe.
Soil and sedimentary charcoal evidence for Holocene forest fires in an inland temperate rainforest, east-central British Columbia, Canada
Authors: Sanborn Paul , Geertsema Marten , Jull A. J. Timothy , Hawkes Brad
Published: April 2006

Accelerator radiocarbon dating of 147 charcoal samples recovered from colluvial and alluvial fan deposits at 29 sites was used to reconstruct the Holocene fire history of an inland temperate rainforest watershed in east-central British Columbia (BC), Canada. Radiocarbon dates ranged from 182 to 9558 cal. yr BP, with prominent peaks in the probability distribution of calibrated dates at e. 7100, 3900, 2300, 1600 and 250-1000 cal. yr BP. The inferred median fire return interval (FRI) was 800-1200 cal. yr, depending on the extent of inbuilt age errors resulting from charring of wood pre-dating actual fire ages. This FRI is likely an overestimate, as less severe events may not have created sufficient erosion and slope instability to preserve a record of charcoal in buried soils and slope deposits. Median time since fire was 467 cal. yr based on ages of the uppermost charcoal found at each site, but the severity of heart-rots in the dominant redcedars (Thuja plicata Donn ex D. Don) prevented independent confirmation of stand ages by dendrochronology. Sites with multiple charcoal-containing layers having similar radiocarbon ages can be explained with reference to contemporary post-fire mass-wasting processes. Peaks in fire-related sedimentation probability coincided broadly with periods of higher fire frequency c. 600-1000, 1300-2400 and 3500-4500 cal. yr BP inferred from sedimentary charcoal records at subalpine sites in southwestern BC. Correspondence with fire records from more distant sites in northwestern North America was less clear.
Holocene river floods in the upper Glomma catchment, southern Norway: a high-resolution multiproxy record from lacustrine sediments
Authors: Bøe Anne-Grete , Dahl Svein Olaf , Lie Øyvind , Nesje Atle
Published: April 2006

The Glomma catchment in east-central southern Norway has a discharge dominated by a general spring-flood regime with episodic large river floods In this study, the instrumental records (from AD 1871) and documentary evidence (back to the seventeenth century) have been extended for about 10 000 years by reconstructing episodes of palaeofloods as recorded by sedimentological depositional indicators. A record of Holocene flood events has been established based on a lake-fill sedimentary succession in a small basin in the upper Glomma catchment. The flood events as deposited in Lake Butjonna are discrete, sharp-bounded, normal graded units of silt-sized sediments characterized by low organic and water content. The reconstruction of individual palaeofloods is based on loss-on-ignition, dry bulk density, grain-size analyses and several mineral magnetic analyses: initial susceptibility, bulk susceptibility (X), anhysteretic remanent magnetization (ARM) and isothermal remanent magnetization (IRM). Based on 13 14C AMS dates, the age-depth model covers the Holocene from c. 9800 cal. yr BP until present. About 115 discrete flood events (ranging from 1 to 620 mm in thickness) have been detected. The recurrence interval is about 90 years with an occurrence probability of about 1%. Important results include: (1) a weak increasing trend of higher river flood activity toward the end of the Holocene; (2) an early-Holocene calm (low or no river flood activity) period with subsequent onset of flood activity around 7600 cal. yr BP; (3) a pronounced and well-defined river flood event correlated to the ‘Stor-Ofsen’ disaster that occurred in July AD 1789; (4) enhanced southerly winds that bring moist air from the Atlantic Ocean apparently lead to periods of higher river flood frequency.
Optical dating of Holocene dune sands from the Hulun Buir Desert, northeastern China
Authors: Li Sheng-Hua , Sun Jimin
Published: April 2006

Aeolian deposits from the Hulun Buir Desert of northeastern China are studied with optically stimulated luminescence dating methods to establish the chronology of dune building phases and climatic changes since the last deglaciation. Our results indicate that wet climate, marked by dune stabilization and soil development in the Hulun Buir Desert, commenced at-11 ka ago, and this early episode of dune stabilization lasted until 4.4 ka ago. This optimum climate between -11 and -4.4 ka ago is mostly the response to the strengthened monsoon circulation and increased precipitation in the Northern Hemisphere. The environment generally became arid after - 4.4 ka ago, but the dry climate was interrupted by three phases of weak soil development occurring at - 1.8-1.4, - 1.2-1.0 and - 0.84-0.5 ka ago, respectively. Such short events of dune stabilization were associated with the warm and humid climate in historical time. However, the present dune mobilization in the Hulun Buir Desert is mainly the result of poor land-use practices (land cultivation and overgrazing) since about 300 years ago.
Gastroparesis with multiple sclerosis
Authors: Raghav S , Kipp D , Watson J , Spring W
Published: April 2006

Symptomatology in multiple sclerosis (MS) depends on the areas of demyelination which can be situated anywhere in the white matter of central nervous system (CNS). Upper gastrointestinal tract symptoms are rarely reported. We recently saw a patient with MS who had disabling gastroparesis and dysphagia.
Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis
Authors: Rasova K , Havrdova E , Brandejsky P , Zálišová M , Foubikova B , Martinkova P
Published: April 2006

Purpose The aim of this study was to compare the effect of four different programmes on spiroergometric, spirometric and clinical parameters in multiple sclerosis (MS) patients.

Methods One hundred and twelve MS patients were divided into four groups. The first group underwent neurophysiologically based physiotherapy, the second aerobic training, the third combined therapy (neurophysiologically based physiotherapy and aerobic training) and the fourth did not change any habits. Seventeen patients did not finish the study. Patients were examined on impairment (Expanded Disability Status Scale), disability (Barthel Index), handicap (Environment Status Scale), quality of life (Multiple Sclerosis Quality of Life), fatigue (Modified Fatigue Impact Scale), depression (Beck Depression Inventory Score), respiratory function (spirometric parameters on spirometry) and physical fitness (spiroergometric parameters on a bicycle ergometer).

Results The patients who participated in one of our training programmes showed a significant improvement of the examined parameters in comparison to those who did not change their present habits. Each of the four training programmes had a different impact on the parameters, which means that each of them had a different effect. The neurophysiologically based physiotherapy had the greatest impact on impairment, and the aerobic training on spirometric and spiroergometric parameters. All methods (the neurophysiologically based physiotherapy, the aerobic training and the combined programme) had an impact on fatigue.
The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients
Authors: Storr L K , Sørensen P S , Ravnborg M
Published: April 2006

Objective To evaluate the short-term efficacy of multidisciplinary, inpatient rehabilitation of multiple sclerosis (MS) patients.

Methods A double-blind, randomized, parallel group design was used. The intervention group were offered comprehensive, multidisciplinary inpatient rehabilitation at the Haslev MS Hospital for an average of 35.5 days, while the control group received no treatment related to the study. All patients were examined in their homes twice with a 10-week interval. The rehabilitation of the intervention group started 2-3 weeks after the first examination and ended 2-3 weeks before the second examination. Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Expanded Disability Status Scale. Disability was assessed by means of Guy’s Neurological Disability Scale. Two specific scales were used to assess upper limb function and ambulation: The Nine-Hole Peg Test and timed 10-metre walking. Patients’ own perception of bodily pain, bladder symptoms, spasticity, fatigue, impaired walking and transfers were recorded using visual analogue scales. Finally, quality of life was assessed using the Life Appreciation and Satisfaction Questionnaire and the Functional Assessment in Multiple Sclerosis.

Patients Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls.

Results We found no statistically significant differences between the two groups in any of the outcome measures.

Conclusion Although the study was underpowered, the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation, which is liable to confounding factors such as variation in the indication for treatment, in the placebo effect, and in the reliability and responsiveness of the outcome measures.
Multiple sclerosis patients with and without sexual dysfunction: are there any differences?
Authors: Demirkiran M. , Sarica Y. , Uguz S. , Yerdelen D. , Aslan K.
Published: April 2006

Objective Sexual dysfunction (SD) severely affects the quality of life in patients with multiple sclerosis (MS). The aim of this study is to investigate the type and frequency of sexual complaints in MS patients, to analyse their relationship to various clinical and psychosocial variables and to clarify the differences between MS patients with and without SD.

Methods Thirty-five relapsing-remitting (RR), nine secondary progressive and seven primary progressive MS patients were included in this study. A structured face-to-face interview regarding sexual function and other physical problems which may interfere with sexual functioning was administered to each patient. They also filled out Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), which includes items for primary (direct physical), secondary (indirect physical) and tertiary (psychosocial) causes of SD. Disability, cognitive functions and psychological functioning were also evaluated.

Results Forty-one patients (80.4%) reported primary SD; decreased libido was the most frequent complaint (80.5%). These patients were older and more disabled, however 39% had low disability scores. SD was a common problem for both men and women. Patients with RRMS were affected less in all items of primary SD. Several items of secondary SD-problems with memory and concentration, bladder symptoms, bowel symptoms-showed correlation with different items of primary SD; these were altered genital sensation, decreased libido, increased time for arousal, decreased lubrication/difficulties with erection. Total MSISQ-19 scores were correlated with disease duration, age, disability, disease course, Beck depression scale, temporary and long-standing anxiety and low level of education.

Conclusion SD is an underestimated, common symptom of MS. It may occur in MS even in the absence of severe disability. Physicians’ awareness of this problem may help to bring about appropriate treatments and management, and improve the quality of life for these patients.
Anorectal dysfunction in multiple sclerosis
Authors: Munteis E , Andreu M , Téllez M J , Mon D , Ois A , Roquer J
Published: April 2006

Objective To ascertain the prevalence of anorectal dysfunction (ARD) in patients with multiple sclerosis (MS) and its relationship with MS clinical characteristics.

Methods Prospective transversal study in 193 patients with MS. All patients fulfilled a protocol that included: demographic variables, clinical characteristics of MS and the presence of ARD and urinary dysfunction (UD).

Results One hundred and ninety-three patients: 66.8% women, an average age of 42.8 (12.1) years; 67.8% of patients had relapsing-remitting MS, 21.2% a secondary progressive and 10.9% a primary progressive form. The average duration of MS was 10.7 (9.4) years and the EDSS 2.8 (2.3). ARD was present in 93 patients (48.2%), and UD in 50.2%. ARD associated to UD was present in 35.7% of cases. The univariate study revealed that patients with ARD were older (p<0.001), had greater disability (p<0.0001), longer disease duration (p<0.001) and a greater association with UD (p<0.0001). ARD was more frequent in progressive forms (p<0.0001). The logistic regression analysis showed that female sex ( P=0.015), EDSS ( P=0.002) and UD ( P=0.003) were independent factors related to ARD.

Conclusion ARD is a highly prevalent disorder in MS. Female sex, EDSS and UD are independent predictors of ARD development.
Survival, and time to an advanced disease state or progression, of untreated patients with moderately severe multiple sclerosis in a multicenter observational database: relevance for design of a clinical trial for high dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation
Authors: Daumer M , Griffith L M , Meister W , Nash R A , Wolinsky J S
Published: April 2006

Despite prolonged survival, patients with multiple sclerosis (MS) experience considerable morbidity, which adversely impacts quality of life. To assess the risk-benefit of a clinical trial of high dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation for MS, we sought to determine the natural history of the disease in a comparison group of untreated patients. We identified 285 individuals with 2132 combined observation years (median: 5.6 years; 5th to 95th percentile: 1-21 years), with Expanded Disability Status Scale (EDSS) scores of 3.0-5.5 at baseline observation. Disease-related mortality was zero at five years, 5.4% at 10 years, and 22% at 15 years (40 patients contributing to the data point; 95% confidence interval: 4-32%). Risk for progression to advanced disability, defined as an EDSS score of 8, was very low for the subgroup with a baseline EDSS score of 3-3.5; however, for those with a baseline EDSS score of 4-5.5, 3% had advanced disability after two years, 5% after three years, 6% after four years, 12% after five years, and 40% after 10 years. The estimated probability of disease progression, defined as an increase in EDSS score by ≥ 1.0 sustained for at least 180 days, was 5% after one year, 14% after two years, 22% after three years, 38% after five years, 57% after 10 years, and-80% after 20 years of observation. The relevance of these features to the design of the clinical trial is discussed.
Cognitive and motor function in people with multiple sclerosis in Stockholm County
Authors: Einarsson U , Gottberg K , von Koch L , Fredrikson S , Ytterberg C , Jin Y P , Andersson M , Holmqvist L Widén
Published: April 2006

The aim of this study was to analyse cognitive and motor function in a population-based sample of people with multiple sclerosis (PwMS), taking into account both disease-related data and sociodemographic factors. Data were collected from 166 PwMS during home visits. Cognitive function was assessed by the Mini-Mental State Examination (MMSE), the Free Recall and Recognition of 12 Random Words Test (FRR12RWT), and the Symbol Digit Modalities Test (SDMT); manual dexterity by the Nine-Hole Peg Test (NHPT); global motor capacity by the Lindmark Motor Capacity Assessment; and walking capacity by a timed 10-metre walk. On cognitive tests, 55% (MMSE), 84% (FRR12RWT), and 45% (SDMT) of PwMS scored within the normal range; 27% of PwMS displayed normal manual dexterity, 9% had a maximal motor-capacity score, and 8% walked at normal speed. Factors associated with normal cognitive function were lower disability and higher education; lower disability and current employment were predictive of capacity to perform the NHPT and to walk 10 metres. In conclusion, cognitive function was normal in approximately half of the PwMS investigated, while a minority displayed normal manual dexterity and normal walking capacity. Thus, both disease severity and socio-demographic factors appear to influence cognitive and motor function in MS.
Idiopathic acute transverse myelitis: a clinical study and prognostic markers in 45 cases
Authors: Bruna J , Martínez-Yélamos S , Martínez-Yélamos A , Rubio F , Arbizu T
Published: April 2006

Objective The Transverse Myelitis Consortium Working Group has proposed new diagnostic criteria for idiopathic acute transverse myelitis (ATM). We reviewed patients admitted to our center diagnosed with myelitis with two objectives: (i) to evaluate the usefulness of these criteria in distinguishing between myelitis as the first episode of multiple sclerosis (MS) and idiopathic ATM; and (ii) to analyse the clinical and laboratory variables that may be used as functional prognostic markers.

Methods We selected patients who met the criteria. We recorded clinical epidemiological data, patients treated with methylprednisolone, maximal disability reached and disability at final follow-up. We also recorded cerebrospinal fluid (CSF) data and the number of levels affected in the spinal magnetic resonance imaging (MRI).

Results Twenty-four patients fulfilled the criteria for definite ATM and 21 for possible ATM. Five patients converted to MS. Mean follow-up time was 3.5 years. There was an association between younger patients and female patients with conversion to MS. The highest Rankin score reached and increased CSF glucose levels were associated with a poor outcome. In multivariate analysis, only the admission Rankin score was associated with outcome.

Conclusions (i) About 10% of patients who met the criteria may convert to MS; and (ii) admission Rankin score was the only independent prognostic factor found.
Interferon beta-1b (Betaseron®/Betaferon®) is well tolerated at a dose of 500 mg: interferon dose escalation assessment of safety (IDEAS)
Authors: Gottesman M H , Friedman-Urevich S
Published: April 2006

The approved interferon beta-1b (Betaseron®/Betaferon®) dose is 250 mg (8 MIU) administered subcutaneously (sc) every other day (eod). Clinical trial data suggest a dose-response effect for interferon beta in multiple sclerosis (MS) treatment and a maximum dose has yet to be established. The Interferon Dose Escalation Assessment of Safety (IDEAS) study evaluated the safety and tolerability of interferon beta-1b 500 mg (16 MIU) sc eod with structured dose escalation and adverse event (AE) management in 22 patients (20 interferon beta-1b-treated (SD) and two interferon beta-1b-naïve (ND)) with relapsing-remitting (RR) MS, secondary-progressive (SP) MS, or progressive relapsing MS. IDEAS comprised an eight-week dose escalation period and a 12-week maintenance period, with modification as clinically warranted. Autoinjectors were used for all injections ≥0.4 mL. Clinical laboratory values were monitored monthly. Baseline and exit assessments included the MS Functional Composite score, EDSS, and neutralizing antibody MxA assay. AEs were recorded at every injection. Dose escalation ranged from two to 12 weeks. Some 91% of patients (20/22) achieved the 500-mg dose, and of these 90% (18/20) completed the maintenance phase. There were no differences in response between ND and SD patients. Most common AEs were decreased general well-being, insomnia, and injection site reactions (mostly mild). The 500-mg dose of interferon beta-1b was well tolerated in the short-term with escalation and premedication in these patients, most of whom had previously been receiving 250 mg interferon beta-1b.
Axonal damage markers in the cerebrospinal fluid of patients with clinically isolated syndrome improve predicting conversion to definite multiple sclerosis
Authors: Brettschneider J , Petzold A , Junker A , Tumani H
Published: April 2006

Clinically isolated syndrome (CIS) represents the earliest phase of multiple sclerosis (MS). This study tested whether biomarkers for axonal degeneration can improve upon sensitivity and specificity of magnetic resonance imaging (MRI) parameters in predicting conversion from CIS to MS. Patients with CIS ( n=52), relapsing-remitting MS (RRMS, n=38) and age-matched controls ( n=25) were included. Cerebrospinal fluid (CSF) levels of tau and neurofilaments (NfHSMI35) were measured using ELISA. The MRI T2-lesion load and the Expanded Disability Status Scale (EDSS) were recorded. CSF tau and NfHSMI35 were elevated in CIS compared to controls (p<0.05). RRMS patients with acute relapse had higher NfHSMI35 levels than stable patients. Tau and NfHSMI35 levels correlated with EDSS in CIS and RRMS. In RRMS, the number of T2-lesions correlated with tau levels ( R=0.53, P=0.01). The sensitivity predicting the conversion from CIS to MS was higher for the combination of CSF markers (either tau or NfHSMI35 elevated) than for MRI (40 versus 34%), but could be further increased to 60% if CSF and MRI criteria were combined. Similarly, the combination of tau and NfHSMI35 showed higher specificity (94%) than MRI (82%). Tau and NfHSMI35 are valuable biomarkers for axonal damage in the CIS patients. Predicting conversion from CIS to MS can be improved if CSF markers are combined with MRI.
Human demyelinating disease and the polyomavirus JCV
Authors: Khalili K , White M K
Published: April 2006

Many human neurological diseases involve demyelination of the central and/or peripheral nervous systems. These include the hereditary leukodystrophies -which have a genetic basis; multiple sclerosis (MS) -where the underlying cause of demyelination remains unknown; and progressive multifocal leukoencephalopathy (PML) -where the etiology is well-established as being viral. The human neurotropic polyomavirus -JC virus (JCV) -is the etiologic agent of PML, a fatal demyelinating disease of the central nervous system that occurs mainly in immunosuppressed patients, especially those with HIV/AIDS. JCV belongs to the polyomavirus family of tumor viruses that are characterized by non-enveloped icosahedral capsids containing small, circular, double-stranded DNA genomes. Serological studies have shown that JCV is widespread throughout the human population, but infections are usually restricted by the immune system, particularly cell-mediated immunity, causing the virus to enter a latent phase. An important corollary of this is that situations of severe immunosuppression may permit JCV to replicate and are thus a risk factor for PML.
De-stabilizing and training effects of foot orthoses in multiple sclerosis
Authors: Ramdharry G M , Marsden J F , Day B L , Thompson A J
Published: April 2006

This study evaluates the effects of dynamic foot orthoses (DFO) on walking and balance performance in people with multiple sclerosis (MS). Sixteen ambulant subjects with MS and ten age-matched healthy control subjects were studied on initial receipt of foot orthoses and after four weeks of daily wear. Walking speed, MS Walking Scale-12 (MSWS-12) and standing balance were assessed with and without orthoses at both these times. During standing, stance width and vision were varied, and performance was quantified using the velocity of the centre of pressure (COP), body sway velocity and the mean COP position relative to the shoe.

People with MS walked slower (p<0.001) and showed increased sway when standing (p<0.001). At the first assessment, the foot orthoses caused an increase in sway and a medial and posterior shift of the COP position. At repeat measurement, the DFOs continued to increase sway compared to a shoe only condition. However, MS subjects reported an improvement in the MSWS-12 (p<0.05) and, compared to the initial session, showed decreased sway when eyes were closed both with and without DFOs.

Dynamic foot orthoses may increase sway and change COP position by altering foot alignment and/or plantar afferent stimulation. Improvement in body sway over time may be an overall training effect of the DFOs, as MS subjects adapt to the initial de-stabilization.
The relation between menarche and the age of first symptoms in a multiple sclerosis cohort
Authors: Sloka J S , Pryse-Phillips W EM , Stefanelli M
Published: April 2006

Background Previously, multiple sclerosis (MS) has been thought to be associated with changes in hormone levels. This study investigates the association between the age of menarche and the age of onset of the first symptoms of MS.

Methods A complete list of patients diagnosed with MS in the province of Newfoundland and Labrador was constructed. The age of menarche for our entire relapsing remitting female MS (RRMS) population was requested by mailout survey. Age of symptom onset was ascertained by chart review.

Results A 74% rate of return on the survey results was obtained (150 RRMS patients). A linear regression model demonstrated that the age of first symptoms increased by 1.16 years as the age of menarche increased by one year (R2=0.69, P=0.04). Another analysis showed that the average age of first symptoms for women with reported menarche from 10 to 12 years was 28.96 years compared with 31.83 years for a reported menarche from 13 to 15 years, a significant difference ( P=0.047, t-test).

Conclusions This study suggests that menarche may be related to the pathogenesis of MS.