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Derya Ozturk,1 Adem Melekoglu,1 Ertugrul Altinbilek,1 Mustafa Calik,2 Arzu Kosem,3 Hakan Kilci,4 Naile Fevziye Misirlioglu,5 Hafize Uzun6 1Sisli Hamidiye Etfal Education and Research Hospital, Department of Emergency, &Idot;stanbul, Turkey; 2Gaziosmanpasa Education and Research Hospital, Department of Emergency, &Idot;stanbul, Turkey; 3Ministry of Health Ankara City Hospital, Clinical Biochemistry Laboratory, Ankara, Turkey; 4Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey; 5University of Health Sciences, Gaziosmanpa&scedil;a Training and Research Hospital, Department of Biochemistry, Istanbul, Turkey; 6Istanbul Atlas University, Faculty of Medicine, Department of Medical Biochemistry, Istanbul, TurkeyCorrespondence: Mustafa Calik, Gaziosmanpasa Education and Research Hospital, Emergency Department, &Idot;stanbul, 34255, Turkey, Email drmustafacalik@yahoo.comBackground: An acute ST-elevation myocardial infarction (STEMI) is a serious cardiovascular condition with a high risk of morbidity and mortality. Irisin is adipomyokine that is associated with various health conditions. In post-STEMI, elevated serum irisin levels are associated with more adverse cardiovascular events.Objective: The purpose of this study was to investigate associations between the serum irisin levels and acute MI (AMI) and whether irisin may be a useful biomarker for severity of AMI in patients with STEMI. Possible correlations between serum irisin and cardiac troponin-I (cTi) levels were investigated.Methods: A total of 90 subjects (46 control subjects and 44 STEMI patients) were included in the study. Besides demographic data, presence of diabetes mellitus and hypertension, electrocardiography (ECG) findings, blood biochemistry, cardiac biomarkers (cTi) and serum irisin levels were examined.Results: Significantly lower heart rate (HR) and significantly higher ST-elevation and QTc interval were detected in ECG recordings in STEMI patients (p < 0.05). Serum irisin levels were significantly lower in STEMI patients compared to the control subjects (p < 0.001). The decrease in the serum irisin levels was significantly correlated with the increase in cTi levels, as well as increased QTc (p < 0.05). The sensitivity and specificity of irisin were found to be 93% and 78%, respectively.Conclusion: Decreased irisin levels were found to be highly predictive in STEMI. In patients with STEMI, the serum irisin levels were associated with cTi levels and QTc, suggesting that irisin is a promising biomarker for AMI cases.Keywords: myocardial infarction, cardiovascular diseases, irisin, troponin-I, QT interval, biomarker

Ozlem Ethemoglu,1 Mustafa Calik2 1Department of Neurology, Harran University School of Medicine, Şanlıurfa, Turkey; 2Department of Pediatric Neurology, Harran University School of Medicine, Şanlıurfa, Turkey Objective: The aim of this study was to evaluate blood neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), C-reactive protein (CRP), and albumin levels for their prognostic value in adult Guillain–Barré syndrome (GBS-A) and pediatric Guillain–Barré syndrome (GBS-P) patients. Patients and methods: We retrospectively analyzed the medical records of 68 Guillain–Barré syndrome (GBS) patients (36 adults, 32 children) who were treated as inpatients at Harran University Faculty of Medicine, Neurology and Pediatric Neurology Departments. The pretreatment NLR, PLR, CRP, and albumin levels and Hughes scores at hospital admission, discharge, and third-month control were documented. Results: In GBS-A patients, the mean CRP and NLR levels at admission/discharge and third-month control were significantly higher, and the mean albumin level was significantly lower in the Hughes disabil­ity scale (HDS)≥3 group. In GBS-P group, the mean NLR level at third month was significantly higher in the HDS≥3 group. GBS-A patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than GBS-P patients. Both GBS-A and GBS-P patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than healthy controls. Only the albumin level of the GBS-A group was found to be a significant predictor of prognosis at discharge from hospital. Conclusion: NLR, CRP, and albumin levels in the GBS-A group and NLR levels in the GBS-P group may be helpful in predicting the prognosis of the disease. The albumin level of GBS-A patients is an independent risk factor for prognosis at discharge from hospital. Keywords: Guillain–Barré syndrome, albumin, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, C-reactive protein

Mustafa Calik,1 Dilek Sen Dokumaci,2 Suna Sarikaya,3 Mahmut Demir,4 Ilhan Isik,5 Halil Kazanasmaz,4 Cemil Kaya,4 Hasan Kandemir6 1Department of Pediatric Neurology, 2Department of Radiology, 3Department of Neurology, 4Department of Pediatrics, Harran University School of Medicine, 5Department of Pediatric Neurology, Eyyubiye Training and Research Hospital, 6Department of Child and Adolescent Psychiatry, Harran University School of Medicine, Sanliurfa, Turkey Abstract: Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS). Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05). Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells. Keywords: brain metabolite, children, breath holding, magnetic resonance spectroscopy

Irina Topchiy,1,2,&ast; Anne M Fink,1,2 Katherine A Maki,2,3 Michael W Calik1,2,&ast; 1Center for Sleep and Health Research, University of Illinois Chicago, Chicago, IL, USA; 2Department of Biobehavioral Nursing Science; University of Illinois Chicago, Chicago, IL, USA; 3Translational Biobehavioral and Health Disparities Branch, Clinical Center; National Institutes of Health, Bethesda, MD, USA&ast;These authors contributed equally to this workCorrespondence: Michael W Calik, University of Illinois Chicago, 845 South Damen Avenue (M/C 802), College of Nursing, Room 740, Chicago, IL, 60612, USA, Tel +1 312 413 0581, Email mcalik@uic.eduIntroduction: Current methods of sleep research in rodents involve invasive surgical procedures of EEG and EMG electrodes implantation. Recently, a new method of measuring sleep, PiezoSleep, has been validated against implanted electrodes in mice and rats. PiezoSleep uses a piezoelectric film transducer to detect the rodent’s movements and respiration and employs an algorithm to automatically score sleep. Here, we validate PiezoSleep scoring versus EEG/EMG implanted electrodes sleep scoring in rats.Methods: Adult male Brown Norway and Wistar Kyoto rats were implanted with bilateral stainless-steel screws into the skull for EEG recording and bilateral wire electrodes into the nuchal muscles for EMG assessment. In Brown Norway rats, the EEG/EMG electrode leads were soldered to a miniature connector plug and fixed to the skull. In Wistar Kyoto rats, the EEG/EMG leads were tunneled subcutaneously to a telemetry transmitter implanted in the flank. Rats were allowed to recover from surgery for one week. Brown Norway rats were placed in PiezoSleep cages, and had their headsets connected to cable for recording EEG/EMG signals, which were then manually scored by a human scorer in 10-sec epochs. Wistar Kyoto rats were placed in PiezoSleep cages, and EEG/EMG signals were recorded using a telemetry system (DSI). Sleep was scored automatically in 4-sec epochs using NeuroScore software. PiezoSleep software recorded and scored sleep in the rats.Results: Rats implanted with corded EEG/EMG headsets had 85.6% concurrence of sleep-wake scoring with PiezoSleep. Rats implanted with EEG/EMG telemetry had 80.8% concurrence sleep-wake scoring with PiezoSleep. Sensitivity and specificity rates were similar between the EEG/EMG recording systems. Total sleep time and hourly sleep times did not differ in all three systems. However, automatic sleep detection by NeuroScore classified more sleep during the light period compared to the PiezoSleep.Conclusion: We showed that PiezoSleep system can be a reliable alternative to both automatic and visual EEG/EMG- based sleep-wake scoring in rat.Keywords: piezoelectric, noninvasive sleep scoring, telemetry, automated sleep scoring, EEG/EMG, rat

Michael W Calik1,2 1Department of Biobehavioral Health Science, 2Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL, United States Abstract: Narcolepsy is a neurological disease that affects 1 in 2,000 individuals and is characterized by excessive daytime sleepiness (EDS). In 60–70% of individuals with narcolepsy, it is also characterized by cataplexy or a sudden loss of muscle tone that is triggered by positive or negative emotions. Narcolepsy decreases the quality of life of the afflicted individuals. Currently used drugs treat EDS alone (modafinil/armodafinil, methylphenidate, and amphetamine), cataplexy alone (“off-label” use of antidepressants), or both EDS and cataplexy (sodium oxybate). These drugs have abuse, tolerability, and adherence issues. A greater diversity of drug options is needed to treat narcolepsy. The small molecule drug, pitolisant, acts as an inverse agonist/antagonist at the H3 receptor, thus increasing histaminergic tone in the wake promoting system of the brain. Pitolisant has been studied in animal models of narcolepsy and used in clinical trials as a treatment for narcolepsy. A comprehensive search of online databases (eg, Medline, PubMed, EMBASE, the Cochrane Library Database, Ovid MEDLINE, Europe PubMed Central, EBSCOhost CINAHL, ProQuest Research Library, Google Scholar, and ClinicalTrials.gov) was performed. Nonrandomized and randomized studies were included. This review focuses on the outcomes of four clinical trials of pitolisant to treat narcolepsy. These four trials show that pitolisant is an effective drug to treat EDS and cataplexy in narcolepsy. Keywords: narcolepsy, pitolisant, histamine

Terri E Weaver,1,2 Michael W Calik,1,2 Sarah S Farabi,1,2 Anne M Fink,1,2 Maria T Galang-Boquiren,2,3 Mary C Kapella,1,2 Bharati Prasad,2,4 David W Carley1,21Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago; 2Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, 3Department of Orthodontics, University of Illinois at Chicago College of Dentistry, 4Sleep Center, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USAAbstract: Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.Keywords: obstructive sleep apnea, innovative treatment, continuous positive airway pressure, oral appliance, nerve stimulation