- Pharmacological agents for improving sleep quality at high altitude: a systematic review and meta-analysis of randomized controlled trials. [Review]
- SMSleep Med 2018 Aug 16; 51:105-114
- Several hypnotic agents commonly recommended for improving sleep at sea level are discouraged at high altitude. We aimed to evaluate the efficacy and safety of drugs prescribed for improving sleep qu...
Several hypnotic agents commonly recommended for improving sleep at sea level are discouraged at high altitude. We aimed to evaluate the efficacy and safety of drugs prescribed for improving sleep quality in patients with acute exposure to high altitudes by conducting a systematic review and meta-analysis. An electronic search was executed for randomized controlled trials comparing drug treatments with placebo and no-treatment conditions, which used objective sleep parameters or subjective sleep quality evaluations. Eight studies (152 participants) were included in the meta-analysis and involved trials using acetazolamide, temazepam, zolpidem, zaleplon, and theophylline. Generally, the nonbenzodiazepines were reported to be superior and safe in improving sleep quality. Participants who were administered zaleplon or zolpidem reported a significant improvement in subjective sleep quality. As measured by polysomnography, both zaleplon and zolpidem improved the total sleep time, sleep efficiency index, and stage 4 sleep duration, whereas they decreased the wake-after-sleep onset without impairing ventilation. In contrast, temazepam was not superior to placebo in terms of quicker onset of sleep and better sleep quality. On the other hand, acetazolamide and theophylline both reduced the sleep efficiency index. The present results favored zaleplon and zolpidem in improving both the objective and subjective quality of sleep without impairing ventilation.
- Local Delivery of a Zoledronate Solution Improves Osseointegration of Titanium Implants in a Rat Distal Femur Model. [Journal Article]
- JOJ Orthop Res 2018 Aug 17
- CONCLUSIONS: Intramedullary injection of local bisphosphonate solutions could be implemented to improve osseointegration in cementless arthroplasty. This article is protected by copyright. All rights reserved.
- Local inhibition of carbonic anhydrase does not decrease sweat rate. [Journal Article]
- JBJ Basic Clin Physiol Pharmacol 2018 Aug 13
- CONCLUSIONS: The most important finding of the current study was that iontophoresis of acetazolamide did not significantly decrease sweat rate during exercise in the heat. Such results suggest that in past studies it was systemic dehydration, and not CA inhibition at the level of the sweat gland, that caused the reported decreased sweat rate.
- Flow Resistance along the Rat Renal Tubule. [Journal Article]
- AJAm J Physiol Renal Physiol 2018 Aug 08
- The Reynolds number in the renal tubule is extremely low, consistent with laminar flow. Consequently, luminal flow can be described by the Hagen-Poiseuille laminar flow equation. This equation calcul...
The Reynolds number in the renal tubule is extremely low, consistent with laminar flow. Consequently, luminal flow can be described by the Hagen-Poiseuille laminar flow equation. This equation calculates the volumetric flow rate from values of the axial pressure gradient and flow resistance, which is dependent on the length and diameter of each renal tubule segment. Our goal was to calculate the pressure drop along each segment of the renal tubule and determine the points of highest resistance. When the Hagen-Poiseuille equation was used for rat superficial nephrons based on known flow rates, tubule lengths, and diameters for each renal tubule segment, it was found that maximum pressure drop occurred in two segments: the thin descending limbs of Henle and the inner medullary collecting ducts. The high resistance in the thin descending limbs is due to their small diameters. The steep pressure drop observed in the inner medullary collecting ducts is due to the convergent structure of the tubules, which channels flow into fewer and fewer tubules toward the papillary tip. For short-looped nephrons, the calculated glomerular capsular pressure matched measured values, even with the high collecting duct flow rates seen in water diuresis, providing that tubule compliance was taken into account. In long-looped nephrons, the greater length of thin limb segments is compensated for by a larger luminal diameter. Simulation of the effect of proximal diuretics, viz. acetazolamide or SGLT2-inhibitors, predicts a substantial back pressure in Bowman's capsule, which may contribute to observed decreases in glomerular filtration rate.
- Effectiveness of a lightweight portable auto-CPAP device for the treatment of sleep apnea during high altitude stages of the Dakar Rally: a case report. [Journal Article]
- SSSleep Sci 2018 Mar-Apr; 11(2):123-126
- Sleep-related breathing disturbances are exacerbated at altitude in patients with Obstructive Sleep Apnea (OSA). The objective of this case report was to determine if a portable auto-CPAP device effe...
Sleep-related breathing disturbances are exacerbated at altitude in patients with Obstructive Sleep Apnea (OSA). The objective of this case report was to determine if a portable auto-CPAP device effectively treated sleep apnea across different altitudes. We report the severity of sleep apnea from 60 to 12,000 feet high in a man with severe OSA (Apnea Hypopnea Index at diagnosis = 60 events/hour) during the 2017 Dakar rally over the Andes mountains. The man was equipped with a lightweight portable auto-CPAP device with a narrow window [6-8 cmH2O]. Pressures delivered and corresponding residual events were assessed at different altitudes. The 95th percentile pressure reached the maximal set pressure at the highest altitudes, and residual AHI increased from 5 events/hour to 45 events/hour at the highest altitudes. Potential mechanisms behind the development of central apnea, and optimal clinical management at altitude are discussed in the light of the findings.
- Acetazolamide can cause acute hypercrystalluria. [Letter]
- BMJBMJ 2018 Aug 06; 362:k3400
- The Relationship Between Optic Disc Volume, Area, And Frisén Score In Patients With Idiopathic Intracranial Hypertension. [Journal Article]
- AJAm J Ophthalmol 2018 Aug 03
- CONCLUSIONS: Frisén score fails to reflect the photographic area and OCT volume of papilledema after treatment with acetazolamide. Clinicians should use caution when using the Frisén scale to monitor the effect of treatment on papilledema over time.
- Acetazolamide alleviates sequelae of hyperglycemic intracerebral hemorrhage by suppressing astrocytic reactive oxygen species. [Journal Article]
- FRFree Radic Res 2018 Aug 06; :1-11
- Hyperglycemia is associated with the poor outcome after intracerebral hemorrhage (ICH). Acetazolamide (AZA), a kind of carbonic anhydrogenase (CA) inhibitor, its effectiveness in ICH had been reporte...
Hyperglycemia is associated with the poor outcome after intracerebral hemorrhage (ICH). Acetazolamide (AZA), a kind of carbonic anhydrogenase (CA) inhibitor, its effectiveness in ICH had been reported. However, the connections between AZA and ICH especially in hyperglycemia condition had never been defined. In this study, adult Sprague Dawley rats were administered with vehicle or streptozotocin (STZ) to render them into normoglycemic (NG) or hyperglycemic (HG), respectively. Collagenase was then injected into the striatum. The NG or HG ICH rats treated with vehicle control or 5 mg/kg AZA (oral gavage) underwent hemorrhagic area assessments on the first, fourth, and seventh day after ICH. The coverage of pericytes was examined by immunohistochemistry. Reactive oxygen species (ROS) levels were assessed in mouse astrocyte cell line treated with vehicle or 20 µmol/L of AZA in culture media according to two different glucose concentrations. AZA reduced the hematoma size, improved neurobehavioral functions, suppressed astrocytic ROS production in vitro, and preserved cerebral pericytes coverage, which are even more remarkable in hyperglycemic conditions. The present study indicates that AZA may alleviate some sequelae after ICH, especially in poorer prognostic hyperglycemic rats through the suppression of astrocytic ROS production.
- Headaches Due to Low and High Intracranial Pressure. [Journal Article]
- CContinuum (Minneap Minn) 2018; 24(4, Headache):1066-1091
- CONCLUSIONS: Significant overlap is seen in the symptoms of high and low CSF pressure disorders and in those of primary headache disorders. Neurologists are frequently challenged by patients with headaches who lack the typical clinical signs or imaging features of the pseudotumor cerebri syndrome or spontaneous intracranial hypotension. Even when characteristic symptoms and signs are initially present, the typical features of both syndromes tend to lessen or resolve over time; consider these diagnoses in patients with long-standing "chronic migraine" who do not improve with conventional headache treatment. While the diagnostic criteria for pseudotumor cerebri syndrome accurately identify most patients with the disorder, at least 25% of patients with spontaneous intracranial hypotension have normal imaging and over half have a normal lumbar puncture opening pressure. Detailed history taking will often give clues that suggest a CSF pressure disorder. That said, misdiagnosis can lead to significant patient morbidity and inappropriate therapy.
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- Epidemiology of traumatic brain injury-associated epilepsy and early use of anti-epilepsy drugs: An analysis of insurance claims data, 2004-2014. [Journal Article]
- EREpilepsy Res 2018 Jul 23; 146:41-49
- CONCLUSIONS: The probability of developing PTE increased within the study period. The risk of developing PTE significantly increased with age, early seizure and TBI severity. Most of the individuals did not receive AED after TBI. There was no evidence suggesting AEDs helped to prevent PTE with the possible exception of acetazolamide. However, further studies may be needed to test the efficacy of acetazolamide in preventing PTE.