Dual-floor Burr Hole Technique Optimized for Modern Burr Hole Caps with an Internal Electrode Locking Mechanism.

Insertion of a deep brain stimulating electrode is a commonly performed procedure. Burr hole caps play an important role in this procedure by immobilizing this electrode; however, burr hole caps could form scalp bumps, which can create further complications. The dual-floor burr hole technique could prevent the formation of scalp bumps. This technique has previously been used with older versions of burr hole caps and has proved to be successful. In recent years, modern burr hole caps with an internal electrode locking mechanism have become the mainstay for this procedure. However, modern burr hole caps differ considerably in diameter and shape from older burr hole caps. In the present study, a dual-floor burr hole technique was performed using modern burr hole caps. To accommodate the increase in diameters and changes in the shape of modern burr hole caps, a perforator with a 30-mm diameter was used for shaving the bone, and the bone shaving depth was altered. This surgical technique was applied to 23 consecutive deep brain stimulation surgeries without complications and was thus positively optimized for modern burr hole caps.

Augmented Reality in Stereotactic Neurosurgery: Current Status and Issues.

Stereotactic neurosurgery is an established technique, but it has several limitations. In frame-based stereotaxy using a stereotactic frame, frame setting errors may decrease the accuracy of the procedure. Frameless stereotaxy using neuronavigation requires surgeons to shift their view from the surgical field to the navigation display and to advance the needle while assuming a physically uncomfortable position. To overcome these limitations, several researchers have applied augmented reality in stereotactic neurosurgery. Augmented reality enables surgeons to visualize the information regarding the target and preplanned trajectory superimposed over the actual surgical field. In frame-based stereotaxy, a researcher applies tablet computer-based augmented reality to check for the setting errors of the stereotactic frame, thereby improving the safety of the procedure. Several researchers have reported performing frameless stereotaxy guided by head-mounted-display-based augmented reality that enables surgeons to advance the needle at a more natural posture. These studies have shown that augmented reality can address the limitations of stereotactic neurosurgery. Conversely, they have also revealed the limited accuracy of current augmented reality systems for small targets, which indicates that further development of augmented reality systems is needed.

Prevalence and risk factors of poor subjective sleep quality in elite judo athletes.

This study aimed to determine the prevalence and risk factors of poor subjective sleep quality in elite judo athletes. A subjective cross-sectional questionnaire survey was conducted with 106 elite judo athletes who participated in the training camp of the Japanese national team. Eighty-six respondents (men: 52.3%; average age: 22.9 ± 3.1 years) with complete responses were included in the analysis (valid response rate: 81.1%). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The prevalence of poor sleep quality (PSQI score ≥ 5.5), the mean PSQI score, and subscale scores were investigated. Relationships between poor sleep quality and attributes, lifestyle habits, competition-based activities, and psychological distress were explored using Fisher's exact tests and multivariate logistic regression analysis. Thirty-five respondents (40.7%) reported poor sleep quality. The percentage and subscale scores of the respondents for sleep latency, sleep duration, and daytime dysfunction were higher than those of the population of Japanese national-level athletes. The mean PSQI score of the respondents was similar to that of some elite athlete populations but higher than those of others. Multivariate logistic regression analysis revealed that psychological distress was associated with poor sleep quality. In conclusion, the prevalence of poor subjective sleep quality in elite judo athletes was suggested to be similar or higher among elite athlete population. Sleep latency, sleep duration, and daytime dysfunction status were worse in elite judo athletes than in Japanese national-level athletes. Psychological distress was a risk factor for poor subjective sleep quality in elite judo athletes. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-023-00444-6.

Relationships between sleep efficiency and lifestyle evaluated by objective sleep assessment: SLeep Epidemiology Project at University of Tsukuba.

Objectively measured sleep efficiency has recently been shown to be associated with health problems. Although several factors have previously been reported to be associated with sleep efficiency, most of these studies were conducted on older or younger adults, and the factors associated with sleep efficiency in healthy workers remain unknown. The aim of this study was to investigate the relationship between sleep efficiency and lifestyle factors using sleep measurement data recorded by an activity meter worn by workers. In total, 693 workers (male, 43.6%; mean age, 42.7 ± 11.3 years) were recruited from five offices in 2017. Sleep was measured over the period of 1 week by actigraphy. Workers' attributes, lifestyle habits, and occupational stress were identified using a questionnaire, and the association of sleep efficiency with lifestyle, occupational stress, and attributes was explored by logistic regression analysis. A logistic regression analysis using attributes and occupational stress as adjustment variables revealed that "longer sleeping hours on weekends than on weekdays" [odds ratios (OR), 0.66; 95% confidence interval (CI), 0.47-0.94], "water ingestion at bedtime" [OR, 2.09; 95% CI, 1.28-3.41], and "smartphone use at bedtime" [OR, 1.90; 95% CI, 1.28-2.83] were associated with decreased sleep efficiency. This study found that lifestyle habits were associated with sleep efficiency among workers. It is necessary to verify whether intervention in these lifestyle habits would contribute to the improvement of sleep efficiency in future studies.

Shock Waves Enhance Expression of Glycosphingolipid Tumor Antigen on Renal Cell Carcinoma: Dynamics of Physically Unmasking Hidden Intracellular Markers Independent of Gene-Signaling Pathways.

Antigens associated with tumors have proven valuable in cancer immunotherapy. Their insufficient expression in the majority of tumors, however, limits their potential value as therapeutic markers. Aiming for a noninvasive approach applicable in clinical practice, we investigated the possibility of using focused shock waves to induce membrane expression of hidden intracellular tumor markers. Here, we studied the in vitro effect of a thousand focused shock waves at 16 MPa overpressure on the membrane expression of a cytosolic glycosphingolipid, monosialosyl-galactosyl-globoside (MSGG). Double-staining flow cytometry with propidium-iodide and monoclonal antibody RM1 revealed an immediate increase in MSGG expression on renal carcinoma cells (18% ± 0.5%) that reached its peak value (20.73% ± 0.4%) within one hour after the shock waves. The results of immunoelectron microscopy confirmed the incorporation of MSGG into newly formed cytosolic vesicles and their integration with the cell membrane. Based on the enzymatic nature of MSGG production that is not controlled directly by genes, the immediate upregulation of MSGG membrane expression implies that a chain of mechanochemical events affecting subcellular structures are responsible for the shock-wave-induced antigenic modification. Physically unmasking hidden tumor antigens and enhancing their expression by focused shock waves presents a potential noninvasive method of boosting tumor immunogenicity as a theranostic strategy in cancer immunotherapy.

Morning preference is associated with subjective happiness among Japanese female workers: A moderation analysis by sleep characteristics from the SLEPT study.

Research on mental health in working populations has predominantly focussed on negative outcomes, while studies on the positive aspects of life remain very limited, especially in Japan. Although morningness has recently been considered a factor for being happy, the role of sleep characteristics as it relates to the association between morningness and happiness has not been substantiated. The aim of this study is to investigate the associations between diurnal preference and level of subjective happiness in healthy, full-time, daytime workers in Japan. We also tested the moderation effect of sleep parameters on the relationship between diurnal preference and subjective happiness. This is an exploratory analysis from the cross-sectional data of the SLeep Epidemiology Project at the University of Tsukuba (SLEPT Study). Subjective happiness was evaluated using a single-item question. Diurnal preference was assessed using the Morningness-Eveningness Questionnaire (MEQ), in which higher scores indicate greater tendency to have morning preference. The participants underwent assessment of sleep parameters for 7 consecutive days using a waist-worn actigraphy device and kept a sleep diary. Sleep parameters investigated were subjective sleep quality, sleep disturbance, daytime sleepiness, weekend oversleep, total sleep time, sleep onset time, wake time, and sleep efficiency. A total of 205 males (average 42.6 ± 10.4 years) and 272 females (41.1 ± 9.8 years) were eligible for analysis. Hierarchical liner regression analysis was used to show the relationships of subjective happiness with MEQ score, and the sleep parameters. Further, moderation analysis was conducted by adding the interaction between MEQ score and the sleep parameters. After adjusting for age, psychological distress, self-rated health, and occupational stress, we found that subjective happiness was significantly associated with higher MEQ score and sleep efficiency but only in female. The moderating role of sleep parameters was not found. We discussed the implications of the obtained results and a possible strategy to maintain and improve subjective happiness of female workers who have evening preference.

Evaluation of augmented-reality based navigation for brain tumor surgery.

To date, several researchers have introduced augmented reality navigation (ARN) into neurological surgery. While its application in brain tumor surgery seems promising, reports on its utility have been limited, thus warranting further evaluation. To clarify the stages and approaches in which ARN is useful and assess the effect of presurgical discussion with surgeons, we assessed usefulness using a hand-held ARN system we had developed, which displays three-dimensional (3D) virtual structures overlaid on a real-time image of the surgical field via a tablet PC monitor. The system was tested in 20 patients undergoing various procedures, with the first 10 consecutive cases being unselected and the following 10 cases being selected, for whom 3D models were prepared per the surgeons' request. Thereafter, the surgeons ranked its usefulness during each stage of surgery. Consequently, case selection and presurgical discussions with surgeons considerably improved the usefulness, with the "useful" gradings improving from 50% to 88% across all surgical stages. Accordingly, usefulness improved from 50% to 90%, 67% to 100%, and 40% to 80% during the skin incision and craniotomy, dura incision, and intradural procedure stages, respectively. ARN was useful for superficial tumor resection, but less so for deep-seated tumor resection, except when using the transcortical and interhemispheric approaches. In conclusion, a tablet-type ARN can be useful during skin incisions, craniotomy and dura incisions, superficial tumor resections, and transcortical and interhemispheric approaches for deep-seated tumors. Case selection and presurgical discussions with surgeons were essential for the efficacy of ARN.

Metabolic flexibility during sleep.

Known as metabolic flexibility, oxidized substrate is selected in response to changes in the nutritional state. Sleep imposes an extended duration of fasting, and oxidized substrates during sleep were assumed to progressively shift from carbohydrate to fat, thereby gradually decreasing the respiratory quotient (RQ). Contrary to this assumption, whole-room indirect calorimetry with improved time resolution revealed that RQ re-ascended prior to awakening, and nadir of RQ in non-obese young adults occurred earlier in women than men after bedtime. The transient decrease in RQ during sleep was blunted in metabolically inflexible men with smaller amplitude of diurnal rhythm in RQ. Similarly, the effect of 10 years difference in age on RQ became significant during sleep; the decrease in RQ during sleep was blunted in older subjects. Inter-individual difference in RQ become apparent during sleep, and it might serve as a window to gain insight into the early-stage pathogenesis of metabolic inflexibility.

The abrupt shift to slower frequencies after arousal from sleep in healthy young adults.

STUDY OBJECTIVES: Postarousal hypersynchrony (PAH) is an atypical arousal pattern in children's electroencephalography. PAH is an abrupt shift to slower frequencies in arousal-related responses, appearing as slow-wave clusters. In contrast, the prevalence of PAH in healthy young adults is still unknown. Here, we examined the prevalence and characteristics of PAH in healthy young participants. METHODS: Thirty healthy young participants underwent 1 night of polysomnography (13 females, 22.8 ± 2.0 years [mean ± standard deviation]). We examined the prevalence of PAH as a function of sleep stage, sleep cycle, and time course (the first or the second half). The correlation between PAH and sleep variables was examined. The percent of total sleep time in the N3 stage (%N3) was compared for each sleep cycle and time course. RESULTS: Twenty-eight out of 30 participants exhibited PAH (4.6 ± 4.8 times per night). PAH increased significantly during the first sleep cycle and the first half-sleep period. It was observed only in nonrapid eye movement and not in rapid eye movement sleep. The number of PAHs correlated with the number of arousals and arousal indices. The %N3 increased in the first half-sleep and the first sleep cycle. CONCLUSIONS: PAH was relatively common in healthy young participants. Since PAH occurred in a state with a high prevalence of %N3, the first sleep cycle, or the first half-sleep, we suggest that PAH may be affected by the sleep homeostasis process. Since PAH occurred only in non-rapid eye movement sleep and correlated with arousal increment, it may have the function of suppressing non-rapid eye movement sleep's cortical arousal. CITATION: Suzuki Y, Kawana F, Satoh M, Abe T. The abrupt shift to slower frequencies after arousal from sleep in healthy young adults. J Clin Sleep Med. 2021;17(12):2373-2381.

Effect of a single bout of morning or afternoon exercise on glucose fluctuation in young healthy men.

The timing of exercise plays an important role in the effect of the exercise on physiological functions, such as substrate oxidation and circadian rhythm. Exercise exerts different effects on the glycemic response to exercise and meal intake depending on when the exercise performed. Here, we comprehensively investigated the effects of the timing (morning or afternoon) of exercise on glucose fluctuation on the basis of several indices: glycemic variability over 24 h (24-h SD), J-index, mean amplitude of glucose excursions (MAGE), continuous overall net glycemic action (CONGA), and detrended fluctuation analysis (DFA). Eleven young men participated in 3 trials in a repeated measures design in which they performed a single bout of exercise at 60% of their maximal oxygen uptake for 1 h beginning either at 7:00 (morning exercise), 16:00 (afternoon exercise), or no exercise (control). Glucose levels were measured using a continuous glucose monitoring system (CGMs). Glucose fluctuation was slightly less stable when exercise was performed in the afternoon than in the morning, indicated by higher CONGA at 2 h and α2 in DFA in the afternoon exercise trial than in the control trial. Additionally, decreased stability in glucose fluctuation in the afternoon exercise trial was supported by the descending values of the other glucose fluctuation indices in order from the afternoon exercise, morning exercise, and control trials. Meal tolerance following exercise was decreased after both exercise trials. Glucose levels during exercise were decreased only in the afternoon exercise trial, resulting in less stable glucose fluctuations over 24 h.

Exercise improves the quality of slow-wave sleep by increasing slow-wave stability.

Exercise can improve sleep by reducing sleep latency and increasing slow-wave sleep (SWS). Some studies, however, report adverse effects of exercise on sleep architecture, possibly due to a wide variety of experimental conditions used. We examined the effect of exercise on quality of sleep using standardized exercise parameters and novel analytical methods. In a cross-over intervention study we examined the effect of 60 min of vigorous exercise at 60% [Formula: see text]max on the metabolic state, assessed by core body temperature and indirect calorimetry, and on sleep quality during subsequent sleep, assessed by self-reported quality of sleep and polysomnography. In a novel approach, envelope analysis was performed to assess SWS stability. Exercise increased energy expenditure throughout the following sleep phase. The subjective assessment of sleep quality was not improved by exercise. Polysomnography revealed a shorter rapid eye movement latency and reduced time spent in SWS. Detailed analysis of the sleep electro-encephalogram showed significantly increased delta power in SWS (N3) together with increased SWS stability in early sleep phases, based on delta wave envelope analysis. Although vigorous exercise does not lead to a subjective improvement in sleep quality, sleep function is improved on the basis of its effect on objective EEG parameters.

Protein intake in inhabitants with regular exercise is associated with sleep quality: Results of the Shika study.

STUDY OBJECTIVES: Although associations between sleep quality and environmental factors and nutrient intake have been reported, interactions between these factors have not been elucidated in detail. Therefore, this cross-sectional study examined the effects of regular exercise and nutrient intake on sleep quality using the Pittsburgh Sleep Quality Index (PSQI), which is the most frequently used index for sleep evaluation. METHODS: The participants included 378 individuals aged 40 years or older living in Shika Town, Ishikawa Prefecture. Of these individuals, 185 met the inclusion criteria. The participants completed a self-administered questionnaire assessing lifestyle habits and frequency and duration of exercise, the PSQI, and the brief-type self-administered diet history questionnaire (BDHQ) on nutrient intake. RESULTS: A two-way analysis of covariance on regular exercise and PSQI scores indicated that protein intake (17.13% of energy) was significantly higher in the regular exercise and PSQI ≤10 groups than in the non-regular exercise or PSQI ≥11 groups (p = 0.002). In a multiple logistic regression analysis with PSQI scores (≤10 and ≥11), protein intake was a significant independent variable in any of the models adjusted for confounding factors such as age, sex, body mass index, current smoker, and current drinker (OR: 1.357, 95% CI: 1.081, 1.704, p = 0.009) in the regular exercise group but not in the non-regular exercise group.Conclusions We identified a positive relationship between sleep quality and protein intake in the regular exercise group. These findings suggest that regular exercise at least twice a week for 30 minutes or longer combined with high protein intake contributes to good sleep quality.

Distinct effects of low-intensity physical activity in the evening on sleep quality in older women: A comparison of exercise and housework.

BACKGROUND: The effects of intensity, type, and time of day of physical activity on sleep are not well understood. An appropriate increase in core body temperature, due to physical activity during daytime, aids sleep in older adults. Our previous study showed that evening exercise has more positive effects on sleep quality in older adults when compared with morning exercise. However, older adults who do not exercise form a large part of the population. This study aimed to examine the distinct effects of low-intensity exercise and housework during the evening on sleep quality in older women. METHODS: This randomized crossover study included 10 healthy older women aged 65-79 years. The participants engaged in low-intensity physical activity for 30 min, either aerobic exercise (70 steps per minute), housework (at the same intensity), or remained sedentary (control) 3 h before bedtime. Sleep was recorded polysomnographically, and self-reported sleep quality was assessed the next morning using the Oguri-Shirakawa-Azumi sleep inventory, Middle-Aged and Aged version (OSA-MA) questionnaire. RESULTS: Compared with the control trial, core body temperature was significantly elevated in participants after each activity trial (0.5 ± 0.4 and 0.4 ± 0.4 °C for housework and aerobic exercise, respectively). There was a significant difference in sleep latency (14.2 ± 19.1, 9.9 ± 15.6, and 4.2 ± 3.5 min for control, housework, and aerobic exercise, respectively; ANOVA P = 0.011) among the trials. The delta power density after aerobic exercise was significantly higher than that after the control trial. We observed an increase of 53% and 15% in delta power during the 1st hour of sleep as a result of aerobic exercise and housework, respectively. The total score on OSA-MA was significantly higher after aerobic exercise (91.0 ± 5.4, 88.1 ± 6.9, and 108.6 ± 5.9 points for control, housework, and exercise, respectively). CONCLUSIONS: Engaging in low-intensity aerobic exercise in the evening improved polysomnographic and self-reported sleep quality. Although housework increased core body temperature to the same level as that observed after aerobic exercise, self-reported sleep quality after housework was lower than that after aerobic exercise.

Skipping Breakfast for 6 Days Delayed the Circadian Rhythm of the Body Temperature without Altering Clock Gene Expression in Human Leukocytes.

Breakfast is often described as "the most important meal of the day" and human studies have revealed that post-prandial responses are dependent on meal timing, but little is known of the effects of meal timing per se on human circadian rhythms. We evaluated the effects of skipping breakfast for 6 days on core body temperature, dim light melatonin onset, heart rate variability, and clock gene expression in 10 healthy young men, with a repeated-measures design. Subjects were provided an isocaloric diet three times daily (3M) or two times daily (2M, i.e., breakfast skipping condition) over 6 days. Compared with the 3M condition, the diurnal rhythm of the core body temperature in the 2M condition was delayed by 42.0 ± 16.2 min (p = 0.038). On the other hand, dim light melatonin onset, heart rate variability, and clock gene expression were not affected in the 2M condition. Skipping breakfast for 6 days caused a phase delay in the core body temperature in healthy young men, even though the sleep-wake cycle remained unchanged. Chronic effects of skipping breakfast on circadian rhythms remain to be studied.

Effect of a single bout of exercise on clock gene expression in human leukocyte.

Mammals have circadian clocks, which consist of the central clock in the suprachiasmatic nucleus and the peripheral clocks in the peripheral tissues. The effect of exercise on phase of peripheral clocks have been reported in rodents but not in humans. Continuous sampling is necessary to assess the phase of the circadian rhythm of peripheral clock gene expressions. It has been assumed that the expression of the genes in leukocyte may be "an accessible window to the multiorgan transcriptome." The present study aimed to examine whether exercise affects the level and phase of clock gene expression in human leukocytes. Eleven young men participated in three trials, in which they performed a single bout of exercise at 60% V̇o2max for 1 h beginning either at 0700 (morning exercise) or 1600 (afternoon exercise) or no exercise (control). Blood samples were collected at 0600, 0900, 1200, 1500, 1800, 2100, and 2300 and at 0600 the next morning, to assess diurnal changes of clock gene expression in leukocytes. Brain and muscle ARNT-like protein 1 (Bmal1) expression level increased after morning and afternoon exercise, and Cryptochrome 1 (Cry1) expression level increased after morning exercise. Compared with control trial, acrophase of Bmal1 expression tended to be earlier in morning exercise trial and later in afternoon exercise trial. Acrophase of Cry1 expression was earlier in morning exercise trial but not affected by afternoon exercise. Circadian locomotor output cycles kaput (Clock), Period 1-3 (Per1-3), and Cry2 expression levels and those acrophases were not affected by exercise. The present results suggest a potential role of a single bout of exercise to modify peripheral clocks in humans.NEW & NOTEWORTHY The present study showed that a single bout of exercise affected peripheral clock gene expression in human leukocytes and the effect of exercise depended on when it was performed. Brain and muscle ARNT-like protein 1 (Bmal1) expression was increased after exercises performed in the morning and afternoon. Cryptochrome 1 (Cry1) expression was also increased after the morning exercise. The effect of exercise on acrophase of Bmal1 depended on the time of the exercise: advanced after morning exercise and delayed after afternoon exercise.

Changes in sleeping energy metabolism and thermoregulation during menstrual cycle.

Women with ovulatory menstrual cycles show an increase in body temperature in the luteal phase, compared with follicular phase, particularly during the night. Several, albeit not all, studies reported higher energy expenditure in the luteal phase compared with follicular phase. Q10 of biological reactions lies between 2.0 and 3.0, predicting a 7-12% increase in energy expenditure when body temperature rises by 1°C. In this study, temperature dependence of energy expenditure was assessed by comparing changes in sleeping energy expenditure and thermoregulation with menstrual cycle in 9 young females. Energy expenditure was measured using a metabolic chamber, in which sleep was recorded polysomnographically, and core body temperature and skin temperature were continuously monitored. Distal-to-proximal skin temperature gradient was assessed as an index of heat dissipation. In the luteal phase, a significant increase in average core body temperature (+0.27°C) and energy expenditure (+6.9%) were observed. Heat dissipation was suppressed during the first 2 hr of sleep in the luteal phase, compared with follicular phase. Rise in basal body temperature in the luteal phase was accompanied by increased energy expenditure and suppressed heat dissipation. The 6.9% increase in metabolic rate would require a Q10 of 12.4 to be attributable solely to temperature (+0.27°C), suggesting that energy expenditure in the luteal phase is enhanced through the mechanism, dependent and independent of luteal-phase rise in body temperature presumably reflects other effects of the sex hormones.

Nerve Stimulation for the Treatment of Obstructive Sleep Apnea.

Purpose: This review will trace the elements of neurostimulation for obstructive sleep apnea and details on its implementation, efficacy and safety, immediate clinical outcomes, and future prospects. Methods: The literature on upper airway neurostimulation was surveyed from July, 2013, to July 2019, with a focus on the components of devices, evidence for clinical utility, and adverse events. Results: Current technology is focused on the hypoglossal nerve stimulation (HNS). The most long-term experience is with the Inspire Medical System (Maple Grove, MN USA) which has both FDA and European regulatory approval. Given the inclusion criteria (BMI <35, ideally <32), AHI 15-65/h, and a favorable anterior-posterior velopharyngeal collapse pattern on DISE), across many centers ~65% of patients who are intolerant to primary therapy achieve clinical success (AHI <20/h with a reduction of <50% in AHI), and more have symptomatic relief. Adverse events are generally mild, often self-limited, with occasional need for uncomplicated surgical adjustments or replacement of the implantable generator. Three other devices are in various phases of development, each with a differences in nerve electrodes, implantable components, power sources, proprietary programming, and activation patterns. Conclusions: HNS is not considered a first-line treatment option. HNS therapy, however, should be considered as one alternative therapeutic option for patients meeting the inclusion criteria when more traditional therapeutic options have been considered.

Distinct effects of orexin receptor antagonist and GABAA agonist on sleep and physical/cognitive functions after forced awakening.

The majority of patients with insomnia are treated with hypnotic agents. In the present study, we evaluated the side-effect profile of an orexin receptor antagonist and γ-aminobutyric acid A (GABAA) receptor agonist on physical/cognitive functions upon forced awakening. This double-blind, randomized, placebo-controlled, cross-over study was conducted on 30 healthy male subjects. Fifteen minutes before bedtime, the subjects took a pill of suvorexant (20 mg), brotizolam (0.25 mg), or placebo and were forced awake 90 min thereafter. Physical- and cognitive-function tests were performed before taking the pill, after forced awakening, and the next morning. Polysomnographic recordings revealed that the efficacies of the hypnotic agents in prolonging total sleep time (∼30 min) and increasing sleep efficiency (∼6%) were comparable. When the subjects were allowed to go back to sleep after the forced awakening, the sleep latency was shorter under the influence of hypnotic agents (∼2 min) compared to the placebo trial (24 min), and the rapid eye movement latency was significantly shorter under suvorexant (98.8, 81.7, and 48.8 min for placebo, brotizolam, and suvorexant, respectively). Although brotizolam significantly impaired the overall physical/cognitive performance (sum of z score) compared with placebo upon forced awakening, there was no significant difference in the total z score of performance between suvorexant and placebo. Notably, the score for static balance with the eyes open was higher under suvorexant compared to brotizolam administration. The energy expenditure was lower under suvorexant and brotizolam compared with the placebo. The effect size of brotizolam (d = 0.24) to reduce the energy expenditure was larger than that of suvorexant (d < 0.01).

Application of Augmented Reality to Stereotactic Biopsy.

Both frame-based stereotaxy and frameless stereotaxy are established surgical procedures. However, they each have their respective disadvantages when used in the biopsy of a deep-seated lesion. To overcome the drawbacks associated with these procedures, we evaluated the feasibility of applying augmented reality (AR) to stereotactic biopsy. We applied our trans-visible navigator (TVN) to frame-based stereotactic biopsy in five cases of deep-seated lesions. This navigation system uses the AR concept, allowing surgeons to view three-dimensional virtual models of anatomical structures superimposed over the surgical field on a tablet personal computer. Using TVN, we could easily confirm a clear trajectory avoiding the important structures as well as the target point's location in the lesion. Use of the stereotactic apparatus allowed the surgeon to easily advance the biopsy probe to the target point. Consequently, a satisfactory histopathological diagnosis without complication was achieved in all cases. In conclusion, applying AR to stereotactic biopsy is feasible and may improve the safety of the procedure.

Effect of skipping breakfast for 6 days on energy metabolism and diurnal rhythm of blood glucose in young healthy Japanese males.

BACKGROUND: Skipping breakfast has become a common trend that may lead to obesity and type 2 diabetes. Previous studies, which imposed a single incidence of breakfast skipping, did not observe any decrease in 24-h energy expenditure. Furthermore, the effects of breakfast skipping on diurnal blood glucose profiles over 24 h are contradictory. OBJECTIVE: The aim of this study was to clarify the influence of 6 consecutive days of breakfast skipping and sedentary behavior on energy metabolism and glycemic control. METHODS: Ten young men participated in 2 trials (with or without breakfast) that lasted for 6 consecutive days, and the 2 trials were conducted 1 wk apart with a repeated-measures design. During the meal intervention, each subject's blood glucose was measured using the continuous glucose monitoring system. If breakfast was skipped, subjects ate large meals at lunch and dinner such that the 24-h energy intake was identical to that of the 3-meal condition. At 2200 on the fifth day, the subjects entered a room-sized respiratory chamber, where they remained for 33 h, and were instructed to carry out sedentary behavior. RESULTS: The glucose levels were similar between the 2 meal conditions during the first 5 d of meal intervention, but the blood glucose at 2300 was higher in the breakfast-skipping condition than in the 3-meal condition. Breakfast skipping elevated postprandial glycemic response after lunch on the first day of meal intervention. On the sixth day, there were no significant differences in 24-h energy expenditure and substrate oxidation. When subjects remained in a metabolic chamber, the level of physical activity significantly decreased, glycemic stability slightly deteriorated, and mean blood glucose over 24 h was higher in the breakfast-skipping trial than in the 3-meal trial. CONCLUSIONS: Sedentary lifestyle and repeated breakfast skipping caused abnormal glucose fluctuations, whereas 24-h energy metabolism remained unaffected. Clinical Trial Registry: This trial was registered at http://www.umin.ac.jp/english/ as UMIN000032346.