Search

Repetitive surges in heart rate (HR) at respiratory event termination underpin the altered autonomic HR control associated with sleep disordered breathing (SDB). As children born preterm are at greater risk of adverse cardiovascular outcomes, we aimed to determine whether the HR response to obstructive respiratory events was elevated compared to term-born children.Fifty children (3-12 years) born preterm, were matched for SDB severity, age and gender with term born children. Multilevel modelling determined the effect of preterm birth and arousal on HR changes between a 10s baseline to the latter half of respiratory events and 15s post event during NREM and REM.1203 events were analysed (NREM: term 380; preterm 383; REM: term 207; preterm 233). During NREM fewer events terminated in arousal in the preterm compared with term group (preterm 68%; term 84%; χThe greater magnitude of surges in HR following respiratory events terminating with arousal in preterm born children, although small, occur repeatedly throughout the night and may contribute to adverse cardiovascular outcomes, although further studies are required.

Objectives Adherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. Methods Children aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. Results A total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. Conclusion Despite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.

The concept of personalised medicine is likely to revolutionise the treatment of adult obstructive sleep apnoea as a result of recent advances in the understanding of disease heterogeneity by identifying clinical phenotypes, pathophysiological endotypes, biomarkers and treatable traits. Children with the condition show a similar level of heterogeneity and paediatric obstructive sleep apnoea would also benefit from a more targeted approach to diagnosis and management. This review aims to summarise the adult literature on the phenotypes and endotypes of obstructive sleep apnoea and assess whether a similar approach may also be suitable to guide the development of new diagnostic and management approaches for paediatric obstructive sleep apnoea.

In adults there is a distinct gender difference in the prevalence and severity of sleep disordered breathing (SDB), however there have been limited studies examining the effects of gender in children with SDB. We aimed to compare the effects of gender on severity of SDB, blood pressure, sleep and respiratory characteristics, quality of life, behavior and executive function.We included 533 children aged 3-18 years, who underwent standard pediatric overnight polysomnography (PSG) between 2004 and 2016. Blood pressure was recorded prior to each study. Quality of life, behavior and executive function were assessed with parental questionnaires. Children were grouped by gender and SDB severity based on their obstructive apnea hypopnea index (OAHI) into non-snoring controls, Primary Snoring (PS) (OAHI≤1 event/h), Mild obstructive sleep apnea (OSA) (OAHI1-≤5 events/h) and moderate/severe (MS) OSA (OAHI5 events/h) and data compared with 2-way ANOVA.A total of 298 boys and 235 girls were studied. There were no differences in age, BMI z-score, SDB severity sleep characteristics or blood pressure between genders. Diastolic blood pressure was elevated in females with MS OSA compared to males (P 0.05). Quality of life, behavior and executive function scores were all elevated in the SDB groups compared to controls. Females with MS OSA exhibited more internalizing behavioral problems compared to males (59.2 ± 2.4 vs. 51.4 ± 2.3, P 0.05).In contrast to studies in adults, we identified no gender differences in the severity or consequences of SDB in children, other than females with moderate-severe OSA exhibiting more internalizing problems and higher diastolic blood pressure.

Highlights • Diagnosis of haemorrhage in adrenal masses is more common, due to use of CT. • We present 13 cases either spontaneous or after blunt abdominal trauma. • Emergency operation is rarely warranted, due to possibility of pheochromocytoma. • Haemorrhage should raise the high likelihood of undiagnosed metastatic disease., Introduction Adrenal haemorrhage in the context of a pre-existing adrenal mass is a rare, underestimated and potentially fatal surgical emergency. It is a rare cause of acute abdominal pain. Presentation of cases Data from 13 patients with adrenal haemorrhage in a pre-existing adrenal mass were prospectively collected during a 9 year period from a single institution. All patients underwent CT imaging which formed the basis of diagnosis and a complete endocrinological evaluation. Seven out of 13 patients underwent an elective surgical procedure and 2 patients underwent emergency laparotomy. Five out of 13 patients were diagnosed with metastatic disease. One patient was diagnosed with pheochromocytoma. Discussion The likelihood of an undiagnosed pheochromocytoma renders emergency surgery extremely precarious. Complete patient evaluation includes testing for hormonally active adrenal tumors and malignancy. Emergency surgery is reserved for cases where conservative management fails. Conclusion Haemorrhage of an adrenal mass constitutes a diagnostic and therapeutic challenge. Most patients respond well to initial resuscitation efforts. When feasible, patients should undergo a complete hormonal and oncologic evaluation before surgical intervention is considered.

Down syndrome (DS), the most common human chromosomal malformation, has an estimated annual incidence of one in 1000 live births worldwide. Sleep problems are common in children with DS, reported by parents in up to 65% of school-aged children, significantly higher rates than in typically developing (TD) children. Problems include difficulty in sleep initiation and maintenance together with obstructive sleep apnoea (OSA) which affects up to over 90%, of DS children compared with 1-5% in the general paediatric population. Any sleep problem has the potential to exert significant negative effects on daytime behaviour, learning and quality of life in TD children and there is now a growing body of evidence that children with DS are similarly affected. In addition to adverse effects on daytime functioning, OSA has adverse effects on the cardiovascular system and this is a particularly significant issue given the high rates of hypertension and premature cardiac disease in people with DS. This review discusses the effects of sleep problems and OSA on daytime functioning and cardiovascular function in children with DS and evidence of the effectiveness of treatment in improving outcomes and quality of life for these children.

Background We aimed to investigate the relationship between sleep quality, mood and health-related quality of life (HRQOL) in children with CF and controls. Methods Children (7–12years) and adolescents (13–18years) with CF and controls completed sleep evaluation: overnight oximetry and 14days of actigraphy. Age-appropriate questionnaires assessed mood (Children's Depression Inventory; CDI or Beck's Depression Inventory), HRQOL (CF Questionnaire-Revised; CFQ-R or PedsQL), and sleepiness (Pediatric Daytime Sleepiness Scale). Results 87 CF and 55 controls recruited. Children with CF had poorer sleep quality, more sleepiness and lower mood than controls, with a negative correlation between mood score and sleep efficiency. Sleepiness score was predictive of mood score and multiple CFQ-R domains. Adolescents with CF also demonstrated poorer sleep and more sleepiness than controls, but no difference in mood. Reduced sleep quality predicted lower CFQ-R scores. No correlation between sleep, mood or HRQOL in controls. Conclusions In children and adolescents with CF, impaired sleep quality is associated with lower mood and HRQOL in an age-specific manner. Future research will aid understanding of effective strategies for prevention and treatment of mood disorders and sleep disturbance in children with CF.

Background Sleep disturbance is common in children with cystic fibrosis (CF) however there are limited studies investigating the causes for poor sleep quality. In a cross sectional observational study we aimed to evaluate the clinical correlates of sleep disturbance in this population. Methods Children with CF (7-18years) free from pulmonary exacerbation completed medical review, overnight oximetry, the OSA-18 and 14days of actigraphy recordings with a sleep diary. Results In addition to FEV1 Conclusions Reduced sleep quality in children with CF is related to lung health and co-morbidities. However, family characteristics and poor sleep hygiene in the child were also associated with sleep disturbance. Optimal management of CF would seem to be the primary intervention to alleviate children's sleep disturbance, however our data raises additional targets for attempts to improve sleep.

Background In both adults and children, obstructive sleep apnea (OSA) has significant adverse cardiovascular consequences. In adults, sleeping position has a marked effect on the severity of OSA; however, the limited number of studies conducted in children have reported conflicting findings. We aimed to evaluate the effect of sleeping position on OSA severity and the cardiovascular consequences in preschool-aged children. Methods This was a retrospective analysis of children (3–5 years of age) diagnosed with OSA (n = 75) and nonsnoring controls (n = 25). Sleeping position was classified as supine, semi-supine, left lateral, right lateral, prone, and semi-prone by using video recordings during one night of attended polysomnography. OSA severity and cardiovascular parameters were compared between the positions. Results All children spent significantly more sleep time in the supine position than in any other position. The obstructive apnea-hypopnea index was higher in the supine position than in the other sleeping positions during NREM (p Conclusions This study identified that preschool-aged children, whether nonsnoring controls or children with OSA, predominately sleep in the supine position, and OSA was more severe in the supine position. We suggest that to avoid the supine sleep position, positional therapy has the potential to ameliorate OSA severity, and the known cardiovascular consequences.

To measure sleep patterns and quality, objectively and subjectively, in clinically stable children with cystic fibrosis (CF) and healthy control children, and to examine the relationship between sleep quality and disease severity.Clinically stable children with CF and healthy control children (7-18 years of age) were recruited. Sleep patterns and quality were measured at home with actigraphy (14 days). Overnight peripheral capillary oxygen saturation was measured via the use of pulse oximetry. Daytime sleepiness was evaluated by the Pediatric Daytime Sleepiness Scale (PDSS) and subjective sleep quality by the Sleep Disturbance Scale for Children and Obstructive Sleep Apnea-18.A total of 87 children with CF and 55 control children were recruited with no differences in age or sex. Children with CF had significantly lower total sleep time and sleep efficiency than control children due to frequent awakenings and more wake after sleep onset. In children with CF, forced expiratory volume in 1 second and overnight peripheral capillary oxygen saturation nadir correlated positively with total sleep time and sleep efficiency and negatively with frequency of awakenings and wake after sleep onset. Patients with CF had significantly greater Sleep Disturbance Scale for Children (45 vs 35; P .001), Obstructive Sleep Apnea-18 (35 vs 24; P .001), and PDSS scores (14 vs 11; P .001). There was a negative correlation between PDSS and forced expiratory volume in 1 second (r = -0.23; P .05).Even in periods of clinical stability, children with CF get less sleep than their peers due to more time in wakefulness during the night rather than less time spent in bed. Objective measures of sleep disturbance and subjective daytime sleepiness were related to disease severity. In contrast, parents of children with CF report high levels of sleep disturbance unrelated to disease severity.

Background In 2012 clinical management of children having adenotonsillectomy (AT) for suspected obstructive sleep apnea (OSA) at our tertiary centre changed based on previous research: children with severe obstructive sleep apnea (OSA) at increased risk of post-operative respiratory adverse events (AE) identified using home overnight oximetry or polysomnography (PSG) were managed post-operatively in a high nurse/patient ratio unit in the ward (high acuity unit, HAU) rather than in the intensive care unit (ICU) as previously. Objectives To examine the post-operative respiratory AE post AT in HAU. Methods A retrospective audit was performed of children having AT on the HAU list from Oct 2012–Sept 2014, identifying clinical information, pre-operative testing for OSA and post-operative course. Results 343 children underwent elective adenotonsillectomy at our tertiary centre in the study period, of whom 79 had surgery on the HAU list (16F; median age 4.2 year (range 1.2–14.7); median weight-for-age centile 77.9% (IQR 44–98.7%)). 75 had moderate/severe OSA by oximetry ( n = 44) or PSG ( n = 31) criteria. 77 of 79 children had oxygen therapy in the recovery room (median 20 min, IQR 15–40 min). 18 (23%) had at least one AE outside the recovery room, which were observed ( n = 2) or treated with oxygen therapy ( n = 14) or repositioning ( n = 2). Obesity increased the risk of an AE (10/25 obese vs 8/54 non obese, p = 0.01), as did the presence of a major comorbidity (5/9 with comorbidity vs 13/70 without, p = 0.03). There were no admissions from the HAU to ICU. 63 patients (83%) stayed only one night in hospital (median 1 d, range 1–5 d). Conclusions In a cohort of children with known moderate-severe OSA, post-operative AE after AT were all managed in the HAU. Post-operative care in HAU provides safe and effective care for high-risk children post-AT, minimizing admissions to ICU.

Background Laparoscopic mini-gastric bypass (LMGB) is a relatively new bariatric procedure; published studies are accumulating in various settings. The objective of this study was to summarize the available evidence about the efficacy and safety of LMGB. Methods A systematic search in the literature was performed , and PubMed and reference lists were scrutinized (end-of-search date: July 15, 2013). For the assessment of the eligible articles, the Newcastle-Ottawa quality assessment scale was used. Results Ten eligible studies were included in this study, reporting data on 4,899 patients. According to all included studies, LMGB induced substantial weight and body mass index reduction, as well as substantial excess weight loss. Moreover, resolution or improvement in all major associated medical illnesses and improvement in overall Gastrointestinal Quality of Life Index score were recorded. Major bleeding and anastomotic ulcer were the most commonly reported complications. Readmission rate ranged from 0%– 11%, whereas the rate of revision operations ranged from .3%– 6%. The latter were conducted due to a variety of medical reasons such as inadequate or excessive weight loss, malnutrition, and upper gastrointestinal bleeding. Finally, the mortality rate ranged between 0% and .5% among primary LMGB procedures. Conclusion LMGB represents an effective bariatric procedure; its safety and minimal postoperative morbidity seem remarkable. Randomized comparative studies seem mandatory for the further evaluation of LMGB.

Objective To compare symptoms of obstructive sleep apnea (OSA) and polysomnography (PSG) results in children with Down syndrome and typically developing children. Study design A total of 49 children with Down syndrome referred for PSG between 2008 and 2012 were matched with typically developing children of the same sex, age, and OSA severity who had undergone PSG in the same year. A parent completed a sleep symptom questionnaire for each child. Sleep quality and measures of gas exchange were compared between the matched groups. Results The 98 children (46 females, 52 males) had mean age of 6.2 years (range, 0.3-16.9 years). Fourteen children had primary snoring, and 34 had OSA (9 mild, 7 moderate, and 19 severe). Children with Down syndrome had more severe OSA compared with 278 typically developing children referred in 2012. Symptom scores were not different between the matched groups. Those with Down syndrome had a higher average pCO 2 during sleep ( P = .03) and worse McGill oximetry scores. Conclusion Compared with closely matched typically developing children with OSA of comparable severity, children with Down syndrome had a similar symptom profile and slightly worse gas exchange. Referred children with Down syndrome had more severe OSA than referred typically developing children, suggesting a relative reluctance by parents or doctors to investigate symptoms of OSA in children with Down syndrome. These findings highlight the need for formal screening tools for OSA in children with Down syndrome to improve detection of the condition in this high-risk group.

Highlights • Primary malignant hepatic mesothelioma is usually diagnosed postoperatively, as there are no specific radiologic features for this tumor. • The surgeon should be alert in cases of patients with known history of asbestos exposure. • Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy., INTRODUCTION Primary malignant hepatic mesotheliomas are extremely rare. We report the case of a patient with primary intrahepatic malignant mesothelioma who was treated in our department. PRESENTATION OF CASE A 66-year old male patient was admitted to our department for the evaluation of anemia. An abdominal computed tomography scan revealed a large space occupying lesion in the right liver lobe. DISCUSSION The tumor was subsequently resected and a diagnosis of primary intrahepatic malignant mesothelioma was made after pathologic examination. The patient did not receive adjuvant therapy and is currently alive and free of disease, 36 months after the resection. CONCLUSION To our knowledge this is the eighth adult case of primary intrahepatic malignant mesothelioma reported in the literature. These tumors are rarely diagnosed preoperatively. Absence of previous asbestos exposure does not exclude malignant mesothelioma from the differential diagnosis. Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy.

Obstructive sleep apnea (OSA) is associated with autonomic dysfunction in adults and school-aged children; however, this association has not been investigated in preschool children. We aimed to analyze heart rate variability (HRV) and catecholamine levels in preschool children with OSA.One hundred and forty-two snoring children aged 3-5years and 38 nonsnoring control group children underwent overnight polysomnography (PSG). Nocturnal urinary catecholamines were measured in 120 children. Children were grouped according to their obstructive apnea-hypopnea index (OAHI) (control [no snoring], OAHI⩽1event/h; primary snoring, OAHI⩽1event/h; mild OSA OAHI1⩽5events/h; moderate to severe [MS] OSA, OAHI5events/h). The HRV parameters for each child were averaged during rapid eye movement (REM) and non-REM (NREM) sleep.During stable sleep, low-frequency (LF) HRV was similar between groups. High-frequency (HF) HRV was higher in the MS OSA group compared with the control group during all sleep stages (NREM sleep stages 1 and 2 [NREM1/2], 4234±523ms(2) vs 2604±457ms(2); NREM sleep stages 3 and 4 [NREM3/4], 4152±741ms(2) vs 3035±647ms(2); REM, 1836±255ms(2) vs 1456±292ms(2); P.01 for all). The LF/HF ratio was lower in the MS OSA group compared with the control group (NREM1/2, 0.4±0.06 vs 0.7±0.05; NREM3/4, 0.3±0.06 vs 0.4±0.05; REM, 0.8±0.1 vs 1.3±0.1; P.01 for all). Catecholamine levels were not different between groups.In preschool children, OSA is associated with altered HRV, largely due to the HF fluctuations in heart rate (HR) which occur during respiratory events and are still evident during stable sleep. The preschool age may represent a window of opportunity for treatment of OSA before the onset of the severe autonomic dysfunction associated with OSA in adults and older children.

Background: Obstructive sleep apnea (OSA) in adults has been associated with hypertension, low baroreflex sensitivity (BRS), a delayed heart rate response to changing blood pressure (heart period delay [HPD]), and increased blood pressure variability (BPV). Poor BRS may contribute to hypertension by impairing the control of blood pressure (BP), with increased BPV and HPD. Although children with OSA have elevated BP, there are scant data on BRS, BPV, or HPD in this group. Methods: 105 children ages 7–12 years referred for assessment of OSA and 36 nonsnoring controls were studied. Overnight polysomnography (PSG) was performed with continuous BP monitoring. Subjects were assigned to groups according to their obstructive apnea–hypopnea index (OAHI): primary snoring (PS) (OAHI 61 event/h), mild OSA (OAHI > 1–65 events/h) and moderate/severe (MS) OSA (OAHI > 5 events/h). BRS and HPD were calculated using cross spectral analysis and BPV using power spectral analysis. Results: Subjects with OSA had significantly lower BRS (p < .05 for both) and a longer HPD (PS and MS OSA, p < .01; mild OSA, p < .05) response to spontaneous BP changes compared with controls. In all frequencies of BPV, the MS group had higher power compared with the control and PS groups (low frequency [LF], p < .05; high frequency [HF], p < .001). Conclusions: Our study demonstrates reduced BRS, longer HPD, and increased BPV in subjects with OSA compared to controls. This finding suggests that children with OSA have altered baroreflex function. Longitudinal studies are required to ascertain if this dampening of the normal baroreflex response can be reversed with treatment.

Little is known of the long-term prognosis of children treated for sleep disordered breathing (SDB) and even less of children with milder forms of SDB who remain untreated. We aimed to investigate the long-term sleep and respiratory outcomes of children with a range of SDB severities.41 children with SDB and 20 non snoring controls (mean age, 12.9±0.2 y), underwent repeat overnight polysomnography (PSG) 4.0±0.3years after initial diagnosis. SDB severity, presence of snoring, sleep and respiratory parameters, sleep fragmentation index (SFI), the Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC), and obstructive sleep apnea 18-item quality of life questionnaire were re assessed. Children with SDB were grouped into resolved (no snoring and obstructive apnea-hypopnea index [OAHI]1) and unresolved (snoring or an OAHIor =1).At follow-up OAHI was reduced in both SDB groups (p0.05); however, 54% (n=22) of children still continued to snore, having either persistent or new OSA (n=4). In this unresolved group, sleep was significantly disrupted; % nonrapid eye movement stage 1 (NREM1) sleep and SFI were increased (p0.05), and total sleep time (TST) and sleep efficiency were decreased compared to the resolved and control groups (p0.05). Overall, 29% of children were treated, and of these, 67% had resolved SDB. SDB groups had higher PDSS, SDSC, and OSA-18 scores compared to controls at follow-up (p0.01).Our study demonstrated that although SDB improved in the long-term, more than 50% of children had residual SDB (mostly primary snoring) and sleep disturbance. As even mild forms of SDB are known to have adverse cardiovascular, learning, and behavioral outcomes, which have implications for the health of these children.

Childhood sleep disordered breathing (SDB) peaks in the preschool years. We aimed to compare the effects of SDB on polysomnographic characteristics between preschool and school aged children.One hundred and fifty-two preschool (3-5 y) and 105 school-aged (7-12 y) children, referred for assessment of SDB, plus controls (39, 3-5 y and 34, 7-12 y) with no history of snoring underwent overnight polysomnography. Subjects were grouped by their obstructive apnea hypopnea index (AHI) into those with primary snoring, mild obstructive sleep apnea (OSA), and moderate/severe OSA. The effects of SDB severity on sleep architecture and respiratory characteristics were compared between the age cohorts using quantile regression.There was an average reduction in median sleep efficiency of 3.5% (p=0.004) and an average increase in median WASO of 2% (p=0.08) between the age cohorts across the severity groups, with sleep efficiency falling and WASO increasing with increasing SDB severity in the school-aged, but not the preschool, cohort. There was an average difference in median central AHI of 0.6 events/h (p0.001) between the age cohorts across the severity groups, with the 3-5 y old cohort but not the 7-12 y old cohort having more central apneas with increasing SDB severity.We have demonstrated clinically important, age-related differences in sleep architecture in children with SDB. Preschool children with SDB maintain sleep efficiency and awaken fewer times throughout the night than do school aged children with a comparable severity of SDB, but experience more central apneas. This may have implications for the outcomes and treatment of SDB in children of different ages.

Sleep-disordered breathing (SDB) has been associated with impaired cognitive and behavioral function in school children; however, there have been limited studies in preschool children when the incidence of the disorder peaks. Thus, the aim of this study was to compare cognitive and behavioral functions of preschool children with SDB to those of non-snoring control children.A clinical sample of 3-5 year-old children (primary snoring [PS], n=60; mild obstructive sleep apnea syndrome [OSAS], n=32; moderate/severe [MS] OSAS, n=24) and a community sample of non-snoring control children (n=37) were studied with overnight polysomnography. Cognitive performance and behavioral information were collected.Children with PS and mild OSAS had poorer behavior than controls on numerous measures (p.05-p.001), and on some measures they had poorer behavior than the MS OSAS group (p.05). In contrast, all groups performed similarly on cognitive assessment. Outcomes related more to sleep than respiratory measures.SDB of any severity was associated with poorer behavior but not cognitive performance. The lack of significant cognitive impairment in this age group may have identified a "window of opportunity" where early treatment may prevent deficits arising later in childhood.

Sleep-disordered breathing in children is most prevalent in the pre-school years and has been associated with sleep fragmentation and hypoxia. We aimed to compare the sleep and spontaneous arousal characteristics of 3-5-year-old children with obstructive sleep apnoea (OSA) with that of non-snoring control children, and to further characterise the arousal responses to obstructive respiratory events.A total of 73 children (48 male) underwent overnight polysomnography: 51 for assessment of snoring who were subsequently diagnosed with OSA (obstructive apnoea hypopnoea index (OAHI)1 event per h) and 22 control children recruited from the community (OAHI ≤ 1 and no history of snoring).The OSA group had poorer sleep efficiency (p0.05), spent a smaller proportion of their sleep period time in rapid eye movement (REM) (p0.05), and had significantly fewer spontaneous arousals (p0.001) compared with controls. One-quarter of the children with OSA had a sleep pressure score above the cut-off point for increased sleep pressure. In children with OSA, 62% of obstructive respiratory events terminated in a cortical arousal and 21% in a sub-cortical arousal. A significantly higher proportion of obstructive respiratory events terminated in a cortical arousal during non-REM (NREM) compared with REM (p0.001).These findings suggest that in pre-school children OSA has a profound effect on sleep and arousal patterns. Given that these children are at a critical period for brain development, the impact of OSA may have more severe consequences than in older children.

Background Atherosclerotic lesions predominantly localize in areas exposed to distinct hemodynamic conditions. In such lesions, tissue factor (TF) is over-expressed. Therefore, we hypothesized that varying types of mechanical forces may induce different effects on TF expression in endothelial cell, and may also influence the effects of chemical stimuli. Materials and Methods TF RNA expression in human umbilical vein endothelial cells (HUVEC) exposed to mechanical stress in the presence or absence of chemical stimulation with thrombin (Th) was determined. The forces examined were: steady unidirectional laminar flow (LF), pulsatile unidirectional laminar flow (PF), constant oscillatory flow (OF), pulsatile to-fro flow (TFF), and cyclic strain (CS). Results Mechanical stimulation of HUVEC with LF for 2 h induced an 8.7 ± 0.7-fold increase in TF RNA expression, while PF induced 4.7 ± 0.9 and TFF induced 8.6 ± 1.7-fold, respectively. These responses were significantly higher than static controls. Exposure to OF or CS did not result in any significant increase, whereas chemical stimulation with Th led to significant TF expression (4.9 ± 0.3-fold). The combination of mechanical-chemical stimuli induced significantly higher TF expression than mechanical stresses alone, and this effect was synergistic. Combination of LF+Th for 2 h induced significantly increased TF expression (16.6 ± 1.7-fold), as did PF+Th (14.8 ± 2.4) and TFF+Th (17.4 ± 1.0). Furthermore, after 6 h exposure, only TFF demonstrated significantly higher TF expression both with and without Th. Conclusions While uniform laminar flow resulted in transient TF expression, disturbed flow induced sustained amplification of TF expression. Further investigation is needed to elucidate the mechanism of localized atherosclerosis in areas exposed to disturbed flow.

Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured questionnaire assessing change in their child's quality of life (QOL) and OSA symptoms after treatment, or between 6 months ago and the present time for controls. Fifty-one children were eligible, of whom 19 (37%) completed questionnaires: treatment group, n = 10 (adenotonsillectomy 7, CPAP 3); and controls, n = 9. The treatment group showed an improvement in OSA symptoms compared to controls, especially sleep disturbance (p = 0.005), daytime functioning (p = 0.03) and caregiver concern (p = 0.03). Parental QOL score improved by a mean of 18% in the treatment group (p = 0.06 for a difference from controls). Treatment of OSA in children with cerebral palsy leads to significant benefit in some aspects of health and QOL.

Non-nutritive swallowing occurs frequently during sleep in infants and is vital for fluid clearance and airway protection. Swallowing has also been shown to be associated with prolonged apnea in some clinical populations. What is not known is whether swallowing contributes to apnea or may instead help resolve these clinically significant events. We studied the temporal relationships between swallowing, respiratory pauses and arousal in six preterm infants at term using multi-channel polysomnography and a pharyngeal pressure transducer. Results revealed that swallows occurred more frequently during respiratory pauses and arousal than during control periods. They did not trigger the respiratory pause, however, as most swallows (66%) occurred after respiratory pause onset and were often tightly linked to arousal from sleep. Swallows not associated with respiratory pauses (other than the respiratory inhibition to accommodate swallowing) and arousal occurred consistently during the expiratory phase of the breathing cycle. Results suggest that swallowing and associated arousal serve an airway protective role during sleep and medically stable preterm infants exhibit the mature pattern of respiratory-swallowing coordination by the time they reach term.

N-Methyl-d-aspartate (NMDA)-type glutamate receptors in the hippocampus are important mediators of both memory formation and excitotoxicity. It is thought that glutamatergic neurons of the CA1, CA3 and dentate gyrus regions of the hippocampus contribute differentially to memory formation and are differentially sensitive to excitotoxicity. The subunit and/or splice variant composition of the NMDA receptor controls many aspects of receptor function such as ligand affinity, calcium permeability and channel kinetics, as well as interactions with intracellular anchoring and regulatory proteins. Thus, one possible explanation of the differences in NMDA receptor-dependent processes, such as synaptic plasticity and excitotoxicity, among the hippocampal sub-regions is that they differ in subunit and/or splice variant expression. Here we report that the NMDA receptor subunits NR1 and NR2B, along with the four splice variant cassettes of the NR1 subunit are differentially expressed in the CA1, CA3 and dentate gyrus of the hippocampus. Expression of the AMPA receptor subunits GluR1 and GluR2 also differ. These differences may contribute to functional differences, such as with excitotoxicity and synaptic plasticity, that exist between the sub-regions of the hippocampus.

N-methyl-D-aspartate receptor dysfunction has been strongly suggested to link with the abnormalities seen in fetal alcohol syndrome. Thus, the effects of prenatal ethanol exposure on the total expression of NR1 splice variants and the cell surface expression of both NR1 and NR2 subunits in brain were investigated in rats. Western blot studies of membrane homogenates from cerebral cortices at postnatal days 1 through 21 indicate that prenatal ethanol treatment does not alter total NR1 expression or differential expression of NR1 splice variants during development. However, immunoprecipitation studies using PSD95 suggest that both C2'-terminal variants and NR2A subunits at the cortical postsynaptic membrane of postnatal day 21 were significantly reduced after prenatal ethanol treatment. Moreover, C1-terminal variants were decreased in both pair-fed and ethanol-treated groups, while no significant differences in the levels of total NR1 subunits, NR1 splice variants containing the N- or C2-terminal cassettes, or NR2B subunits were observed. Thus, these results suggest that prenatal exposure to ethanol may influence neuronal function by selective regulation of expression of C2'-terminal variants and NR2A subunits at the cell surface.

To determine the clinical consequences of acquiring Pseudomonas aeruginosa infection during early childhood in children with cystic fibrosis (CF).Prospective, observational cohort study of 56 children with CF identified by newborn screening during 1990-92. Each child underwent an annual bronchial lavage during the first 2 to 3 years of life. Clinical outcome was determined at 7 years of age.P aeruginosa infection was diagnosed in 24 (43%) cohort subjects. Four children died before 7 years of age, all of whom had been infected with a multi-resistant, mucoid strain of P aeruginosa (P =.04). In survivors, P aeruginosa infection was associated with significantly increased morbidity as measured by lower National Institutes of Health scores, greater variability in lung function, increased time in the hospital, and higher rates of recombinant human deoxyribonuclease therapy (P.01). In this young CF cohort, best forced expiratory volume in 1 second was an insensitive measure of increased morbidity.Acquisition of P aeruginosa was common by 7 years of age in this CF birth cohort and was associated with increased morbidity and mortality. An improved disease severity score would improve the evaluation and study of early CF lung disease.

The clusters HRu3W(η5-Cp)(CO)11−x(PPh3)xBH (x=1, 2) have been prepared by reaction of PPh3 with HRu3W(η5-Cp)(CO)11BH after Me3NOMeCN-activation; HRu3W(η5-Cp)(CO)10(PPh3)BH has also been made by the reaction of HRu3(CO)8(PPh3)B2H5 with [(η5-Cp)W(CO)3]2. The cluster-bound hydrogen atoms respond to the charge density changes as PPh3 is introduced into HRu3W(η5-Cp)(CO)11BH, and proton chemical shift correlations are presented for this and related systems. The single crystal structure of HRu3W(η5-Cp)(CO)10(PPh3)BH has been determined.

Deprotonation of [HRu3W(η5-C5H5)(CO)11BH] (1), occurs by loss of a proton bridging a B–H–Ru edge, and the remaining cluster-bound hydrogen atom in [HRu3W(η5-C5H5)(CO)11B]− (2), is fluxional in solution. Anion 2 (isolated as the [(Ph3P)2N]+ salt) reacts with [Ph3PAuCl] to give [HRu3W(η5-C5H5)(CO)11B(AuPPh3)] (3) in high yield. The crystal structure of 3 illustrates that the gold(I) phosphine unit takes the place of the B–Ru bridging proton in 1. Reaction of [(Ph3P)2N][2] with [ClAu(dppf)AuCl] (dppf=1,1′-bis(diphenylphosphino)ferrocene) leads to [{HRu3W(η5-C5H5)(CO)11BAu}2(μ-dppf)] as the dominant product; [HRu3W(η5-C5H5)(CO)11B(AuPPh3)] is formed in low yield and apparently arises from phosphine exchange involving the [(Ph3P)2N]+ cation.

Metal octadecylphosphonate Langmuir–Blodgett (LB) films of a series of divalent and trivalent metals have been prepared and characterized. The films are each shown to be LB analogs of known solid-state metal organophosphonates possessing a two-dimensional ionic–covalent metal phosphonate network. The metal phosphonate lattice crystallizes during the LB deposition process. LB films of octadecylphosphonic acid with Mn 2+ , Mg 2+ , Co 2+ and Cd 2+ form with the stoichiometry M II (O 3 PC 18 H 37 )H 2 O and have metal binding consistent with the analogous M II (O 3 PR)H 2 O layered solids. The Ca 2+ and Ba 2+ films form structures with stoichiometry M II (HO 3 PC 18 H 37 ) 2 , and octadecylphosphonate LB films of La 3+ , Sm 3+ and Gd 3+ form with stoichiometry M III (HO 3 PC 18 H 37 )(O 3 PC 18 H 37 ) and have structures consistent with the analogous M III (HO 3 PR)(O 3 PR) layered solids.

The ruthenaborane anions [Ru3(CO)9BH4]− and [Ru3(CO)9B2H5]− can be used as building blocks to assemble tetraruthenium butterfly clusters incorporating a wingtip Ru(η6-Ar) fragment in place of the isolobal Ru(CO)3 fragment present in the previously reported compound [Ru4H(CO)12BH2]. The syntheses and spectroscopic characterizations of [Ru4H(η6-Ar)(CO)9BH2] (Ar = C6H6, C6H5Me, MeC6H4-4-CHMe2) are reported. A single crystal structure determination of [Ru4H(η6-C6H5Me)(CO)9BH2] confirms the location of the η6-arene ligand in a wingtip site but reveals that the butterfly framework is essentially unperturbed in going from an Ru(CO)3 to Ru(η6-Ar) cluster fragment.

The ATLAS accelerator consists of a HVEC model FN tandem accelerator injecting into a linac of independently-phased niobium superconducting resonators. The accelerator provides beams with masses 6⩽A⩽127 and with energies ranging up to 20 MeV/A for the lightest ions and 4 MeV/A for the heaviest ions. Portions of the linac have been in operation since 1978 and, over the last decade, more than 35000 h of operating experience have been accumulated. The long-term stability of niobium resonators, and their feasibility for use in heavy-ion accelerators is now well established.