Exploration of Solid-State vs Solution-State Structure in Contact Ion Pair Systems: Synthesis, Characterization, and Solution-State Dynamics of Zinc Diphenyl Phosphate, [Zn{O2P(OPh)2}2], Donor-Base-Supported Complexes.

A family of zinc phosphate complexes supported by nitrogen donor-base ligands have been synthesized, and their molecular structures were identified in both the solid (X-ray crystallography) and solution state (DOSY NMR spectroscopy). [Zn{O2P(OPh)2}2]∞ (1), formed from the reaction of Zn[N(SiMe3)2]2 with HO(O)P(OPh)2 coordinates to donor-base ligands, i.e., pyridine (Py), 4-methylpyridine (4-MePy), 2,2-bipyridine (bipy), tetramethylethylenediamine (TMEDA), pentamethyldiethylenetriamine (PMDETA), and 1,3,5-trimethyl-1,3,5-triazacyclohexane (Me3-TAC), to produce polymeric 1D structures, [(Py)2Zn{O2P(OPh)2}2]∞ (2) and [(4-MePy)2Zn{O2P(OPh)2}2]∞ (3), the bimetalic systems, [(Bipy)Zn{O2P(OPh)2}2]2 (4), [(TMEDA)Zn{O2P(OPh)2}2]2 (5), and [(Me3-TAC)Zn{O2P(OPh)2}2]2 (7), as well as a mono-nuclear zinc bis-diphenylphosphate complex, [(PMDETA)Zn{O2P(OPh)2}2] (6). 1H NMR DOSY has been used to calculate averaged molecular weights of the species. Studies are consistent with the disassembly of polymeric 3 into the bimetallic species [(Me-Py)2·Zn2{O2P(OPh)2}4], where the Me-Py ligand is in rapid exchange with free Me-Py in solution. Further 1H DOSY NMR studies of 4 and 5 reveal that dissolution of the complex results in a monomer dimer equilibrium, i.e., [(Bipy)Zn{O2P(OPh)2}2]2 ⇆ 2[(Bipy)Zn{O2P(OPh)2}2] and [(TMEDA)Zn{O2P(OPh)2}2]2 ⇆ 2[(TMEDA)Zn{O2P(OPh)2}2], respectively, in which the equilibria lie toward formation of the monomer. As part of our studies, variable temperature 1H DOSY experiments (223 to 313 K) were performed upon 5 in d8-tol, which allowed us to approximate the enthalpy [ΔH = -43.2 kJ mol-1 (±3.79)], entropy [ΔS = 109 J mol-1 K-1 (±13.9)], and approximate Gibbs free energy [ΔG = 75.6 kJ mol-1 (±5.62) at 293 K)] of monomer-dimer equilibria. While complex 6 is shown to maintain its monomeric solid-state structure, 1H DOSY experiments of 7 at 298 K reveal two separate normalized diffusion coefficients consistent with the presence of the bimetallic species [(TAC)2-xZn2{O2P(OPh)2}4], (x = 1 or 0) and free TAC ligand.

Lithium, Tin(II), and Zinc Amino-Boryloxy Complexes: Synthesis and Characterization.

Analogous to the ubiquitous alkoxide ligand, metal boroxide and boryloxy complexes are an underexplored class of hard anionic O- ligand. A new series of amine-stabilized Li, Sn(II), and Zn boryloxy complexes, comprising electron-rich tetrahedral boron centers have been synthesized and characterized. All complexes have been characterized by one-dimensional (1D), two-dimensional (2D), and DOSY NMR, which are consistent with the solid-state structures unambiguously determined via single-crystal X-ray diffraction. Electron-rich µ2- (Sn and Zn) and µ3- (Li) boryloxy binding modes are observed. Compounds 6-9 are the first complexes of this class, with the chelating bis- and tris-phenol ligands providing a scaffold that can be easily functionalized and provides access to the boronic acid pro-ligand, hence allowing facile direct synthesis of the resulting compounds. Computational quantum chemical studies suggest a significant enhancement of the π-donor ability of the amine-stabilized boryloxy ligand because of electron donation from the amine functionality into the p-orbital of the boron atom.

Tin(II) Ureide Complexes: Synthesis, Structural Chemistry, and Evaluation as SnO Precursors.

In an attempt to tailor precursors for application in the deposition of phase pure SnO, we have evaluated a series of tin (1-6) ureide complexes. The complexes were successfully synthesized by employing N,N'-trialkyl-functionalized ureide ligands, in which features such as stability, volatility, and decomposition could be modified with variation of the substituents on the ureide ligand in an attempt to find the complex with the ideal electronic, steric, or coordinative properties, which determine the fate of the final products. The tin(II) ureide complexes 1-6 were synthesized by direct reaction [Sn{NMe2}2] with aryl and alkyl isocyanates in a 1:2 molar ratio. All the complexes were characterized by NMR spectroscopy as well as elemental analysis and, where applicable, thermogravimetric (TG) analysis. The single-crystal X-ray diffraction studies of 2, 3, 4, and 6 revealed that the complexes crystallize in the monoclinic space group P2(1)/n (2 and 4) or in the triclinic space group P-1 (3 and 6) as monomers. Reaction with phenyl isocyanate results in the formation of the bimetallic species 5, which crystallizes in the triclinic space group P-1, a consequence of incomplete insertion into the Sn-NMe2 bonds, versus mesityl isocyanate, which produces a monomeric double insertion product, 6, under the same conditions, indicating a difference in reactivity between phenyl isocyanate and mesityl isocyanate with respect to insertion into Sn-NMe2 bonds. The metal centers in these complexes are all four-coordinate, displaying either distorted trigonal bipyramidal or trigonal bipyramidal geometries. The steric influence of the imido-ligand substituent has a clear effect on the coordination mode of the ureide ligands, with complexes 2 and 6, which contain the cyclohexyl and mesityl ligands, displaying κ2-O,N coordination modes, whereas κ2-N,N' coordination modes are observed for the sterically bulkier tert-butyl and adamantyl derivatives, 3 and 4. The thermogravimetric analysis of the complexes 3 and 4 exhibited excellent physicochemical properties with clean single-step curves and low residual masses in their TG analyses suggesting their potential utility of these systems as MOCVD and ALD precursors.

Synthetic, Structural, and Computational Studies on Heavier Tetragen and Chalcogen Triazenide Complexes.

The syntheses of the triazenide complexes [{N(NDipp)2}2M] (Dipp = 2,6-di-isopropylphenyl; M = Ge(II) (1), Sn(II) (2), Pb(II) (3), and Te(II) (5)) are described for the first time. These compounds have been characterized by single-crystal X-ray diffraction and heteronuclear NMR spectroscopy. Density functional theory calculations were employed to confirm the presence and nature of the stereochemically active lone pairs in 1-5, alongside the Gibbs energy changes for their general synthesis, which enable the rationalization of observed reactivities.

Aerosol-Assisted Chemical Vapor Deposition of ZnS from Thioureide Single Source Precursors.

A family of 12 zinc(II) thoureide complexes, of the general form [{L}ZnMe], [{L}Zn{N(SiMe3)2}], and [{L}2Zn], have been synthesized by direct reaction of the thiourea pro-ligands iPrN(H)CS(NMe2) H[L1], CyN(H)CS(NMe2) H[L3], tBuN(H)CS(NMe2) H[L2], and MesN(H)CS(NMe2) H[L4] with either ZnMe2 (1:1) or Zn{N(SiMe3)2}2 (1:1 and 2:1) and characterized by elemental analysis, NMR spectroscopy, and thermogravimetric analysis (TGA). The molecular structures of complexes [{L1}ZnMe]2 (1), [{L2}ZnMe]2] (2), [{L3}ZnMe]∞ (3), [{L4}ZnMe]2] (4), [{L1}Zn{N(SiMe3)2}]2 (5), [{L2}Zn{N(SiMe3)2}]2 (6), [{L3}Zn{N(SiMe3)2}]2] (7), [{L4}Zn{N(SiMe3)2}]2] (8), [{L1}2Zn]2 (9), and [{L4}2Zn]2 (12) have been unambiguously determined using single crystal X-ray diffraction studies. Thermogravimetric analysis has been used to assess the viability of complexes 1-12 as single source precursors for the formation of ZnS. On the basis of TGA data compound 9 was investigated for its utility as a single source precursor to deposit ZnS films on silica-coated glass and crystalline silicon substrates at 150, 200, 250, and 300 °C using an aerosol assisted chemical vapor deposition (AACVD) method. The resultant films were confirmed to be hexagonal-ZnS by Raman spectroscopy and PXRD, and the surface morphologies were examined by SEM and AFM analysis. Thin films deposited from (9) at 250 and 300 °C were found to be comprised of more densely packed and more highly crystalline ZnS than films deposited at lower temperatures. The electronic properties of the ZnS thin films were deduced by UV-Vis spectroscopy to be very similar and displayed absorption behavior and band gap (Eg = 3.711-3.772 eV) values between those expected for bulk cubic-ZnS (Eg = 3.54 eV) and hexagonal-ZnS (Eg = 3.91 eV).

Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis.

In Arizona, USA, primary pulmonary coccidioidomycosis accounts for 15%-29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate coccidioidomycosis during 2010-2012, we conducted a prospective 24-week study of patients with primary pulmonary coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.

Green Alternatives to Zinc Dialkyldithiophosphates: Vanadium Oxide-Based Additives.

A functionalized vanadyl(IV) acetylacetonate (acac) complex has been found to be a superior and highly effective antiwear agent, affording remarkable wear protection, compared to the current industry standard, zinc dialkyldithiophosphates (ZDDPs). Analysis of vanadium speciation and the depth profile of the active tribofilms by a combination of X-ray absorption near-edge structure (XANES), X-ray photoelectron spectroscopy (XPS), and near-edge X-ray absorption fine structure (NEXAFS) analyses indicated a mixed-valence oxide composite, comprising V(III), V(IV), and V(V) species. A marked difference in composition between the bulk and the surfaces of the tribofilms was found. The vanadyl(VI) acac precursor has the potential to reduce or even replace ZDDP, which would represent a paradigm shift in the antiwear agent design. A major benefit relative to ZDDPs is the absence of S and P moieties, eliminating the potential for forming noxious and environmentally harmful byproducts of these elements.

Evidence for liver injury in the setting of obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) are both strongly associated with obesity. Whether OSA is an independent risk factor for liver injury is uncertain. OBJECTIVE: To assess the hypothesis that OSA is associated with liver injury independent of obesity. MATERIALS AND METHODS: We reviewed the histories of 73 consecutive patients referred to a hospital-based sleep lab because of suspected OSA. OSA was determined to be present if the apnea-hypopnea index was > 10. Obesity was defined as a BMI ≥ 30 kg/m 2 . Patients were included for analysis if they had aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels obtained within 60 days of sleep study. Patients with evidence of viral hepatitis, autoimmune-, metabolic- or established alcoholic-liver disease were excluded. Patients who reported alcohol intake equivalent to a dose ≥ 20 g/day were also excluded. 53 of 73 patients met study criteria. Patients were subdivided for analysis into groups meeting or not meeting OSA and obesity criteria, and having or not having elevated aminotransferase levels. RESULTS: 35/53 patients (66%) had OSA. 31/53 (58%) patients were obese. 15 (28%) and 12 (23%) patients had elevated AST and ALT, respectively. Mean age, gender distribution, mean BMI and percentage with either diabetes or hyperlipidemia were not significantly different in those with or without OSA. Elevated ALT was found in 11/35 (31%) patients with OSA, compared to 1/18 patients without OSA (p = 0.041). Frequency of elevated AST [obese 11/31 (35%); non-obese 4/22 (18%)] or ALT [obese 10/31 (32%); non-obese 2/22 (9%)] was not significantly different in the obese and non-obese cohorts. CONCLUSIONS: OSA may be a risk factor for liver injury independent of obesity. The prevalence and nature of liver disease in the setting of OSA should be determined with larger, prospective studies. The impact of OSA treatment, if any, on liver injury should be similarly evaluated.

Evaluation of auto bi-level algorithm to treat pressure intolerance in obstructive sleep apnea.

PURPOSE: The objective of this study was to evaluate whether a new auto-adjusting bi-level algorithm was comparable to a standard method for prescribing bi-level therapy. METHODS: This study was a prospective randomized, double-blinded crossover evaluation of the equivalency of the auto-adjusting bi-level mode (VAuto™) compared to standard bi-level mode, using a pre-determined difference in Apnea-Hypopnea Index (AHI) of five events per hour. Data were obtained during sleep studies performed on two separate nights. Twenty-two subjects met the entry criteria and were enrolled in the study at four investigational sites in the USA. RESULTS: Mean AHI for the auto-adjusting bi-level mode was 6.2 ± 5.4 events per hour and for the standard bi-level mode 8.3 ± 5.8 events per hour. The AHI for the two modes were clinically equivalent. The difference in median pressure between these two modes was -3.8 cm H(2)O ± 3.6 (p = 0.0008) in favor of the auto-adjusting bi-level mode. In addition, the maximum pressure was significantly higher in the auto-adjusting bi-level mode (16.0 cm H(2)O vs. 14.1 cm H(2)O, p = 0.02). CONCLUSIONS: Our results demonstrated that the auto-adjusting bi-level mode normalized AHI comparable to the standard bi-level mode. The results of this study have several significant implications for the clinical management of sleep apnea. Obstructive sleep apnea (OSA) is a common condition and is associated with untoward complications. Non-compliance with positive airway pressure (PAP) limits the efficacy of the PAP therapy. The auto-adjusting bi-level mode provides a potentially reliable alternative for sleep clinicians faced with prescribing bi-level PAP for non-compliant patients. This study documents that this type of auto-adjusting device provides effective treatment of OSA.

Evaluation of Sn(II) aminoalkoxide precursors for atomic layer deposition of SnO thin films.

We have successfully prepared and structurally characterized a family of eight tin(II) heteroleptic complexes, [Sn(NR2)(ON)]x (NR2 = NMe2 (1a-d) or N(SiMe3)2 (2a-d); x = 1 or 2) and four homoleptic systems, [Sn(κ2-ON)2] (3a-d) from a series of aminoalcohols and fluorinated aminoalcohols (H{ON}) having a different number of methyl/trifluoromethyl substituents at the α-carbon atom, [HOC(R1)(R2)CH2NMe2] (R1 = R2 = H (H{dmae}) (a); R1 = H, R2 = Me (H{dmap}) (b); R1 = R2 = Me (H{dmamp}) (c); R1 = R2 = CF3 (H{Fdmamp}) (d)). The synthetic route used reactions of either [Sn{N(SiMe3)2}2] or [Sn(NMe2)2] with one or two equivalents of the aminoalcohols (a-d) in dry aprotic solvents leading to elimination of amines and formation of the Sn(II) species 1a-d, 2a-d and 3a-d respectively. All complexes were thoroughly characterized by NMR spectroscopy (1H, 13C, 19F, and 119Sn) as well as single-crystal X-ray diffraction studies. In all case the solid state molecular structures of the complexes have been unambiguously established: the solid state structures 1a-b and 1c are dimeric with central {Sn2N2} cores resulting from bridging {µ2-NMe2} units, in which the Sn(II) atoms are four-coordinate. In contrast, the solid state structures of complexes 1c and 2a-c possess similarly dimeric structures, with four-coordinate Sn(II) atoms, in which the oxygen atoms of the {ON} ligand bridge two Sn(II) centres to form dimers with a central {Sn2O2} core. Uniquely in this study, 2d, [Sn(κ2-O,N-OCMe2CH2NMe2){N(SiMe3)2}] is monomeric with a three coordinate Sn(II) centre. The homoleptic complexes 3a-d are all isostructural with monomeric four-coordinate structures with disphenoidal geometries. Solution state NMR studies reveal complicated ligand exchange processes in the case of the heteroleptic complexes 1a-d and 2a-d. Contrastingly, the homoleptic systems 3a-d show no such behaviour. While complexes 1a-d and 2a-d displayed either poor thermal stability or multistep thermal decomposition processes, the thermal behaviour of the homoleptic complexes, 3a-d, was investigated in order to determine the effects, if any, of the degree of fluorination and asymmetry of the aminoalkoxide ligands on the suitability of these complexes as ALD precursors for the deposition of SnO thin films.

The utility of Coccidioides polymerase chain reaction testing in the clinical setting.

Coccidioidomycosis, the fungal infection caused by dimorphic Coccidioides sp., is typically diagnosed by histopathologic identification of spherules in affected secretions and tissues or by culture. These tests are reliable but time-intensive, delaying diagnosis and treatment. To evaluate a polymerase chain reaction (PCR) test developed to detect Coccidioides sp. in clinical specimens, we conducted a retrospective chart review of all patients (N = 145) who underwent Coccidioides PCR at our institution between April 27, 2007, and May 6, 2008, abstracting clinical, microbiologic, serologic, radiographic, treatment, and follow-up data. One hundred fifty-eight PCR tests (153 respiratory; 5 cerebrospinal fluid) produced 5 positive and 153 negative findings. Five of nine patients (56%) with confirmed or highly probable pulmonary coccidioidomycosis had a positive PCR on respiratory specimens, and four of nine (44%) had a positive culture. Among two patients with coccidioidal meningitis, none had a positive PCR, whereas Coccidioides sp. in fungal culture grew for one of two. Among six asymptomatic patients with probable coccidioidomycosis, none had a positive culture or PCR. Compared with culture of respiratory specimens, PCR demonstrated a sensitivity, specificity, positive predictive value, and negative predictive value of 75, 99, 60, and 99%, respectively. Coccidioides PCR appears accurate in identifying negative results, and its sensitivity is similar to that of fungal culture.

Examining the Utility of a Novel Neurologic Test in Patients With Obstructive Sleep Apnea: A Pilot Study.

Purpose: To test the association between participant King-Devick Test (KDT) times and obstructive sleep apnea (OSA) severity and evaluate for improvement after continuous positive airway pressure (CPAP) treatment. Methods: Study dates January 30 to July 31, 2018. Patients were referred for initial evaluation of sleep disordered breathing concerns. OSA severities were defined by Apnea Hypopnea Index (AHI) results, with ≥15 considered at least moderate OSA. The KDT is an objective physical measure of brain function. We estimated correlation between KDT time and AHI and compared mean KDT time between patients with and without moderate OSA. For the OSA subgroup, we evaluated for potential improvement in KDT after CPAP. Results: We enrolled 60 participants, of whom 35 (58.3%) had OSA with an AHI ≥15. Initial analyses noted no significant KDT time differences between patients based on OSA severity. However, after excluding 3 participants who had baseline neurologic illness, adjusted analyses demonstrated that mean KDT time was significantly prolonged for patients with moderate or greater OSA (AHI ≥15) as compared to those with mild or no sleep apnea (AHI <15); 63.4 seconds (95% CI 58.9-67.8) versus 55.7 seconds (95% CI 50.2-61.1), P = .03. CPAP-treated subjects demonstrated significantly improved KDT test times; 63.5 seconds mean pretreatment versus 55.6 posttreatment; -6.6 seconds mean difference, 95%CI (-12.0, -1.13), P = .02. Conclusion: Neurologic abnormalities in patients with OSA are potentially demonstrable utilizing this objective physical measure. Significant improvement is achieved in patients after CPAP treatment.

Subpectoral implantation of the hypoglossal nerve stimulator: An effective technical modification.

Upper airway stimulation is now a well-established treatment option for selected patients with obstructive sleep apnea. The implanted pulse generator of this system activates the hypoglossal nerve and is routinely placed in a subcutaneous pocket overlying the pectoralis muscle. This case report describes a patient with a history of bilateral mastectomy and radiation for breast cancer who required explantation due to device exposure and infection. The patient was successfully reimplanted by placing the implantable pulse generator deep to the pectoralis major muscle. Clinical circumstances involving the chest wall may warrant subpectoral placement of the implanted pulse generator. Laryngoscope, 129:2420-2423, 2019.

Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing.

STUDY OBJECTIVES: Scleroderma is associated with abnormal skin thickening, interstitial lung disease, pulmonary hypertension, and abnormalities of the upper airway. These changes can cause cardiopulmonary complications, potentially including sleep-disordered breathing. The objective of this study is to examine the risk of sleep-disordered breathing in patients with scleroderma. METHODS: We retrospectively identified patients with documented scleroderma. We abstracted data from their electronic health records, including findings from antibody tests, serial pulmonary function tests, transthoracic echocardiography, high-resolution computed tomography, and overnight forehead oximetry. RESULTS: We identified 171 patients with scleroderma. Mean age at the time of initial consult was 56.5 years (range, 18-96 years), and 150 (86.7%) were women. Scleroderma was categorized as limited disease for 108 (62.4%), diffuse disease for 59 (34.1%), and mixed connective tissue disease for 6 (3.5%). Fifty-four patients (31.2%) had abnormal overnight forehead oximetry results, defined as an oxygen desaturation index greater than 5 or a baseline mean arterial oxygen saturation level less than 90%. CONCLUSIONS: Cardiopulmonary complications are common in patients with scleroderma, one of which may be sleep-disordered breathing. In our cohort, approximately one-third of individuals with scleroderma had evidence of sleep-disordered breathing. Moreover, the rate of sleep-disordered breathing in our population of scleroderma patients was twice the rate of pulmonary hypertension and was approximately the same as the rate of interstitial lung disease. Future prospective studies are needed to further assess the role of sleep-disordered breathing in scleroderma clinical outcomes.

Coccidioidomycosis.

Coccidioidomycosis is a common infectious disease in the southwestern United States. Although Coccidioides species are not endemic in other areas of the country, the rapid population growth in the southwestern United States in recent decades and the increase in tourism mean that many people travel to the Southwest and return home before developing the clinical syndrome of coccidioidomycosis. In this respect, coccidioidomycosis is a disease of national importance. It can occur in various manifestations: acute pneumonia, chronic progressive pneumonia, pulmonary nodules and cavities, extrapulmonary nonmeningeal disease, and meningitis. The diagnosis is often made on the basis of serologic findings. Treatment is usually with an azole or amphotericin B, depending on the clinical manifestations and the immune status of the host. We discuss the most common clinical manifestations, the best way to make the diagnosis, and the treatment of common infections.

Obstructive sleep apnea: A better Dx model for primary care.

This study identified a method that provides a truer assessment of disease probability than has been achieved with history and physical exam evaluation.

Synthesis, characterisation and thermal properties of Sn(ii) pyrrolide complexes.

SnO is a rare example of a stable p-type semiconductor material. Here, we describe the synthesis and characterisation of a family of Sn(ii) pyrrolide complexes for future application in the MOCVD and ALD of tin containing thin films. Reaction of the Sn(ii) amide complex, [{(Me3Si)2N}2Sn], with the N,N-bidentate pyrrole pro-ligand, L1H, forms the hetero- and homoleptic complexes [{L1}Sn{N(SiMe3)2}] (1) and [{L1}2Sn] (2), respectively, bearing the 2-dimethylaminomethyl-pyrrolide ligand (L1). Reaction of [{(Me3Si)2N)}2Sn] with the pyrrole-aldimine pro-ligands, L2H-L7H, results in the exclusive formation of the homoleptic bis-pyrrolide complexes [{L2-7}2Sn] (3-8). All complexes have been characterised by elemental analysis and NMR spectroscopy, and the molecular structures of complexes 1-5 and 8 are determined by single crystal X-ray diffraction. TG analysis and isothermal TG analysis have been used to evaluate the potential utility of these systems as MOCVD and ALD precursors.

"Idiopathic" rapid-eye-movement (REM) sleep behavior disorder is associated with future development of neurodegenerative diseases.

OBJECTIVE: To determine whether a diagnosis of idiopathic rapid-eye-movement sleep behavior disorder (RBD) is associated with a future risk of development of neurodegenerative diseases. METHODS: We addressed the objective through development of a structured critically appraised topic that included a clinical scenario, structured question, search strategy, critical appraisal, results, summary of best evidence, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarians, and clinical content experts. RESULTS: A retrospective study of 44 consecutive patients diagnosed with idiopathic RBD demonstrated that 20 patients (45%) developed a neurologic disorder, most commonly Parkinson disease or Lewy body dementia, after a mean of 11.5 years from reported symptom onset and 5.1 years after RBD diagnosis. CONCLUSION: Currently available evidence is limited to cross-sectional and retrospective analyses of patients with RBD. Although ascertainment biases and the retrospective nature of the available evidence limits quantitative analyses, the diagnosis of idiopathic RBD portends a risk of greater than 45% for future development of a clinically defined neurodegenerative disease. This finding has significant implications for clinical neurologic and sleep disorder practice and neurodegenerative disease research.

Gambling and increased sexual desire with dopaminergic medications in restless legs syndrome.

OBJECTIVES: Do patients with restless legs syndrome (RLS) report gambling or other abnormal behaviors as previously reported in Parkinson disease. METHODS: This survey study was sent to 261 idiopathic RLS patients, and it included the Gambling Symptoms Assessment Scale, Altman Self-Rating Mania Scale, and questions pertaining to sexual activity and novelty-seeking behaviors. RESULTS: Ninety-nine patients responded to the survey, and 77 were actively taking 1 or more dopaminergic medications. Of the 70 respondents who answered the gambling questions, 5 (7%) noted a change in gambling, with 4 (6%; 95% confidence interval, 2%-14%) stating that increased urges and time spent gambling occurred specifically after the use of dopaminergic medications (2 on pramipexole, 1 on ropinirole, and 1 on levodopa and pramipexole). Increased sexual desire was reported by 4 (5%) of the 77 respondents, 3 (4%; 95% confidence interval, 1%-11%) reported that this occurred specifically after the use of dopaminergic medications (1 on pramipexole, 1 on ropinirole, and 1 on levodopa). One patient reported both an increase in gambling and sexual habits. CONCLUSIONS: This exploratory survey study revealed the development of gambling and/or increased sexuality in patients with RLS. These data raise the possibility that, as in Parkinson disease, RLS patients should be cautioned about potential behaviors that may occur with the use of dopaminergic medications. Further prospective studies are needed to assess the relationship between these medications and compulsive behaviors associated with the treatment of RLS.