Synergic Effects of Cranial Electrotherapy Stimulation with Sleep Hygiene in Patients with Chronic Insomnia

OBJECTIVES: To investigate the therapeutic effect of cranial electrotherapy stimulation (CES) with sleep hygiene in patients with chronic insomnia. METHODS: This study was designed as a prospective, double-blinded, and randomized controlled trial. Twenty-seven patients with chronic insomnia were recruited and randomly allocated to two groups; cranial microcurrent therapy (MC) group and sham group. All patients received sleep hygiene education. Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were measured at baseline (pre-treatment), and 2 weeks and 4 weeks of treatment. RESULTS: In MC group, the PSQI and ISI showed a tendency to decrease consistently until 4 weeks of treatment. In sham group, PSQI and ISI initially decreased during the first 2 weeks, but it increased after 2 weeks of treatment. CONCLUSIONS: This study showed that combination treatment of CES and sleep hygiene is more effective in treating chronic insomnia than sleep hygiene only as demonstrated by improvement and maintenance of sleep score for 1 month.

Acute Effects of Caffeine on Arterial Stiffness in Young Healthy Subjects

BACKGROUND AND OBJECTIVES: Coffee is one of the most popular beverages in the world. Caffeine is one of the substances contained in coffee and it is well known to increase blood pressure and the peripheral vascular resistance, in part because it stimulates the sympathetic nervous system. Arterial stiffness is an important factor for the performance of the cardiovascular system and it is an independent prognosticator of cardiovascular disease. We investigated the acute effect of caffeine on arterial stiffness in young healthy subjects. SUBJECTS AND METHODS: We enrolled 20 young healthy subjects, who were randomly divided two groups. The caffeine group (10 subjects, 4 males, mean age: 23.3+/-1.1 years) received 520 mL caffeinated coffee and the control group (10 subjects, 4 males, mean age: 23.1+/-1.3 years) received 520 mL water. The arterial stiffness was evaluated by the carotid-radial pulse wave velocity and the augmentation index as corrected by heart rate (75 bpm), and all the hemodynamic measurements were obtained at baseline, 30, 60, 120 and 180 minutes after ingestion of the coffee or water. RESULTS: Arterial stiffness measured by carotid-radial pulse wave velocity increased progressively from 9.4+/-1.2 m/sec at baseline to 11.5+/-1.6 m/sec (p<0.05) at 30 minutes after the coffee intake. In addition, peripheral systolic pressure increased progressively from 107.1+/-10.2 mmHg at baseline to 114.4+/-12.9 mmHg (p<0.05) at 60 minutes after the coffee intake. Such changes were not seen in control group. CONCLUSION: Caffeine affects increased the pulse wave velocity and systolic blood pressure. This means that coffee might have an adverse effect on arterial stiffness.

The Relationship of Homocysteine, Vitamin B12, Vitamin B6 and Folate with Ischemic Heart Disease

BACKGROUND AND OBJECTIVES: An elevated serum homocysteine level is a risk factor of atherosclerosis. The relationship between homocysteine and antioxidant vitamins, and other cardiovascular risk factors, and between cardiovascular patients and controls, were evaluated. SUBJECTS AND METHODS: The study population consisted of 146 patients, with objectively first diagnosed ischemic heart disease, and 146 healthy sex and age matched controls. The serum levels of homocysteine, folate, vitamin B12 and vitamin B6 were measured. The correlation between the serum levels of homocysteine and those of folate, vitamin B6 and vitamin B12 were also evaluated. RESULTS: The serum homocysteine concentrations were significantly higher in the cardiovascular patients than in the matched controls (13.35+/-0.51 mmol/l vs. 11.43+/-0.37 mmol/l, p=0.003). However, there was no significant difference between the stable angina, unstable angina and myocardial infarction subgroups. From a multivariate analysis, the elevated homocysteine level was still associated with a low folate level (patient group;r=-0.380, p=0.000, control group;r=-0.229, p=0.000). The measured vitamin B12 level showed no correlation with the homocysteine level in the cardiovascular patients, but did in the controls (R2=0.066, p<0.05). The measured levels of vitamin B6 showed no correlation with the homocysteine level in either group. CONCLUSION: The serum homocysteine level was inversely correlated with the serum folate level; therefore, folic acid supplementation would be expected to improve the endothelial function, and may also reduce cardiovascular events in patients with ischemic heart disease.

Immunohistochemical Study on the Distribution of Estrogen Receptor-alpha in the Hippocampus of the Normal Aged Rat

BACKGROUND: In recent years, estrogen has also been shown to modulate the development and function of the brain, bur not exclusively in areas involved with sexual behavior. Among the most novel and fascinating effects of estrogen are those on cognitive function and memory process and their alterations during aging and neurodegenarative disease like Alzheimer. Estrogen receptors distributed not only in the hypothalamus but many different areas, like cerebral cortex, hippocampus, basal forebrain, midbrain, spinal cord, and the diverse action of estrogen is supported by this fact. Numerous studies suggest thai estrogen may be beneficial in preserving cognitive function, but it is not clear yet. PURPOSE: In this study, we perform the immunohistochemical staining in the hippocampus of normal aged rat, and show the distribution of estrogen receptor compared with the neonatal rat. METHODS: we have used antibodies against a estrogen receptor(ER)-alpha to determine their distribution in neonatal and aged SD rat hippocampus. RESULTS: In neonatal rat hippocampus, ER-alpha immunoreactivity was observed in the nucleus of Purkinje cells, whereas in aged rat hippocampus, ER-a immunoreactivity was found mainly in the cytoplasm of Purkinje cells. CONCLUSION: We showed the age related intracellular differential distribution of ER-alpha immunoreactivity in the rat hippocampus. But, further investigations are required to establish whether functional relations like cognitive ability exist with this different intracellular expression of ER-alpha immunoreactivity.

The Relationship of Left Atrial Volume and Left Ventricular Diastolic Dysfunction

BACKGROUND AND OBJECTIVES: Mitral flow Doppler has been used to evaluate left ventricle (LV) diastolic function by mitral E/A flow ratio, isovolumic relaxation time (IVRT) and deceleration time (DT) of E wave. Such variables can be affected by various factors. The increase in left atrium (LA) afterload and preload is accompanied by increased LA size. So, we investigated the relationship of LA volume and LV diastolic dysfunction. MATERIALS AND METHOD: From January 2000 to July 2000, 39 patients were included in this study. They were classified into normal (M:F=5:6, mean age 54.0+/-11.4 years), impaired relaxation (M:F=5:4, mean age 70.0+/-5.5 years), pseudonormal (M:F=5:3, mean age 68.3+/-13.2 years) and restrictive physiology (M:F=10:1, mean age 65.5+/-12.7 years) according to mitral inflow variables. The LA volume of each groups was measured by Simpson method, M-mode method and arealength method. RESULTS: 1) The LA volumes measured by Simpson method, M-mode method and area-length method were correlated (p<0.001, r=0.925 in Simpson compared with arealength method). 2) The LA volume by Simpson method were found 54.4+/-16.4 cm3 in normal, 57.3+/-9.2 cm3 in impaired relaxation, 81.4+/-28.8 cm3 in pseudonormal and 119.8+/-64.5 cm3 in restrictive physiology. 3) The LA volume were significantly increased in pseudonormal group compared with normal (p<0.05). CONCLUSION: The LA volume is a useful and easy diagnostic stool for evaluating of LV diastolic function.

Remodeling and Changes of Systolic and Diastolic Functions of Left Ventricle after Acute Myocardial Infarction: Comparison according to Killip Class at Admission

BACKGROUND: Infarct size determines left ventricular (LV) systolic and diastolic dysfunctions after acute myocardial infarction, and also may affect the recovery from functional impairment. We studied the differences of LV remodeling and changes of systolic and diastolic functions of LV during two weeks after acute myocardial infarction, according to Killip class at admission. METHODS: Echocardiographic examinations were performed within two days (23.9+/-2.3 hours), and two weeks after the attack in 27 patients with acute myocardial infarction, and the results were compared with those of 19 controls. Patients were divided into two groups according to Killip class at admission; 18 patients in Killip class I (group I) and 9 patients in Killip class II to IV (group II). Group II had larger infarct, reflected by higher levels of peak serum cardiac enzymes. RESULTS: LV systolic function was more depressed in group II. Regional wall motion score index decreased in group I after two weeks, but not in group II. LV systolic and diastolic volume indexes increased after two weeks in group II but not group I. E/A ratio of mitral inflow was less than 1, and isovolumic relaxation time was prolonged in group I immediately after the attack. Group II had E/A>1 and shorter deceleration time (DT) of mitral inflow, and higher peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow than those of controls immediately after the attack. In group II, E/A ratio was greater, DT was shorter, peak systolic/diastolic flow velocity ratio of pulmonary venous flow was less, and AR was higher than those of controls after two weeks. CONCLUSION: Infarct size affected remodeling and changes of systolic and diastolic functions of LV after acute myocardial infarction. In patients with large infarct, LV was dilated and regional wall motion was not improved during two weeks. Restrictive pattern of LV filling, which was more aggravated during two weeks, was noted immediately after the attack. In patients with small infarct, LV was not dilated and regional wall motion was improved during two weeks. LV filling pattern showed relaxation abnormality.

Comparison of inodilator effect of higenamine, YS49, YS51, tetra-hydroisoquinoline analogs, and dobutamine in the rat

Tetrahydroisoquinoline (THI) alkaloids can be considered as cyclized derivatives of simple phenylethylamines. Many of them, especially with 6,7-disubstitution, demonstrate a relatively high affinity for catecholamines. Present study examines the pharmacological action of limited series of THI, using rats' isolated atria and aorta. In addition, a (3H) prazosin displacement binding study with THI compounds was performed, using rat brain homogenates to investigate whether these probes have a-adrenoceptor affinity. We also compared the vascular relaxation potency of these probes with dobutamine. YS 49, YS 51, higenamine and dobutamine, concentration-dependently, relaxed endothelium-denuded rat thoracic aorta precontracted with phenylephrine (PE, 0.1 micrometer) in which pEC50 were 5.56-0.32 and 5.55+/-0.21, 5.99+/- 1.16 and 5.57+/-0.34, respectively. These probes except higenamine also relaxed KCl (65.4 mM)-contracted aorta. In isolated rat atria, all THIs and dobutamine increased heart rate and contractile force. In the presence of propranolol, the concentration response curves of YS 49 and YS 51 shifted to the right and resulted in pA2 values of 8.07+/-0.84 and 7.93+/-0.11, respectively. The slope of each compound was not deviated from unity, indicating that these chemicals are highly competitive at the cardiac beta-adrenoceptors. YS 49 YS 51, and higenamine showed alpha-adrenoceptor affinity in rat brain, in which the dissociation constant (Ki) was 2.75, 2.81, and 1.02 micrometer, respectively. It is concluded, therefore, that THI alkaloids have weak affinity to alpha1-adrenoceptors in rat aorta and brain, respectively, while these probes show relatively high affinity for cardiac beta-adrenoceptors. Thus, these chemicals may be useful in the treatment of congestive heart failure.