Epidemiology of restless legs symptoms in adults.

BACKGROUND: Restless legs syndrome (RLS) is a disorder characterized by sleep-disrupting unpleasant leg sensations, often accompanied by daytime behavioral problems. Treatment for this condition is available, but it is suspected that most instances of RLS remain undiagnosed. The goal of this investigation was to assess the prevalence and health status correlates of restless legs symptoms (hereinafter referred to as restless legs) in the general population. METHODS: A question reflecting the clinical features of RLS was added to the 1996 Kentucky Behavioral Risk Factor Surveillance Survey. Data on the frequency of experiencing restless legs, self-rated general and mental health status, demographics, and behavioral risk factors were collected by telephone interview from 1803 men and women, 18 years and older. RESULTS: Experiencing restless legs 5 or more nights per month was reported by 3% of participants aged 18 to 29 years, 10% of those aged 30 to 79 years, and 19% of those 80 years and older. The age-adjusted prevalence for Kentucky adults is 10.0%; prevalence did not vary significantly by sex. The adjusted odds ratios (95% confidence intervals) for restless legs and diminished general health and poor mental health status were 2.4 (1.4-4.0) and 3.1 (2.0-4.6), respectively. Restless legs were significantly associated with increased age and body mass index, lower income, smoking, lack of exercise, low alcohol consumption, and diabetes. CONCLUSIONS: The prevalence of restless legs in the general adult population is high. Restless legs may be associated with decreased well-being, emphasizing the need for further research and greater medical recognition of this condition.

c-fos expression in noradrenergic A2 neurons of the rat during the estrous cycle and after steroid hormone treatments.

The expression of the proto-oncogene product fos in noradrenergic neurons of the A2 cell group was studied with immunohistochemistry during the estrous cycle of the rat and after ovariectomy and estrogen treatments. During the estrous cycle the percentage of fos-positive norepinephrine containing neurons was highest at proestrus (39%), followed by estrus (36%) while during diestrus only 4% of the A2 neurons contained immunoreactive fos protein in their nuclei. Ovariectomy caused a further decrease in the number of fos-positive A2 neurons (2%) while long-term estradiol administration partially reversed the effects of ovarian steroid removal (19%). However, 3 h after a single subcutaneous injection of estradiol into ovariectomised rats, 79% of the noradrenergic neurons in the A2 area showed fos immunoreactivity in their nuclei. The results indicate that fos-expression in the noradrenergic neurons in the A2 region varies depending upon the circulating estradiol levels. Since norepinephrine stimulates gonadotropin releasing hormone (GnRH) secretion from the median eminence during proestrus and the GnRH neurons do not contain estrogen receptors, it is suggested that the A2 region is, at least in part, responsible for conveying the estrogen signal to the GnRH neurons.

Investigations of the regulation of specific 2-[125I]iodomelatonin binding sites in Siberian hamsters by endogenous and exogenous melatonin.

These studies used quantitative in vitro autoradiography to investigate whether endogenous or exogenous melatonin modulate specific 2-[125I]iodomelatonin binding sites in the pars tuberalis or suprachiasmatic nuclei of Siberian hamsters. Saturation analyses were conducted on tissue sections from hamsters that were pinealectomized, exposed to constant illumination (72 h), or injected with melatonin, and from hamsters that were treated as controls. High affinity (Kd approximately 20-75 pM) specific 2-[125I]iodomelatonin binding sites were detected in the suprachiasmatic nuclei and pars tuberalis of all animals. Neither pinealectomy nor constant illumination significantly affected either the affinity or the density of the specific 2-[125I]iodomelatonin binding sites in either region. Melatonin injections led to a decrease in specific 2-[125I]iodomelatonin binding to the pars tuberalis at 3-4 h after the last injection. However, washing the sections before incubation with 2-[125I]iodomelatonin eliminated this effect, suggesting that melatonin was occupying the binding sites rather than decreasing their actual number. Furthermore, when hamsters were sacrificed 18 h after the last melatonin injection, no effect of melatonin on either the affinity or density of specific 2-[125I]iodomelatonin sites was observed. These data suggest that 2-[125I]iodomelatonin binding sites in Siberian hamsters are not regulated by changes in circulating melatonin levels.

Optimizing cerebral perfusion pressure during fiberoptic bronchoscopy in severe head injury: effect of hyperventilation.

The aim of this study was to evaluate if Hyperventilation (HV) could avoid the Intracranial Pressure (ICP) peak that occurs during Fiberoptic Bronchoscopy (FB) in severely head injured patients. A Cerebral Perfusion Pressure (CPP) > 75 mmHg was maintained in 34 patients, with a subgroup randomized to receive controlled HV during FB. Measurements were done before the procedure, during maximum ICP values and 30 minutes after FB. The HV group had minor ICP values after FB, without differences in CPP and ICP peak values.

Comparison of diazepam and flurazepam in the treatment of insomnia in general practice.

In a double-blind crossover study in general practice, flurazepam was shown to be significantly better (p less than 0.001) than diazepam in treating sleep disturbance. Fewer patients reported side-effects on flurazepam.

Effects of aging on photoperiodic responsiveness and specific 2-[125I]-iodomelatonin binding sites in the pars tuberalis and suprachiasmatic nuclei of Siberian hamsters.

Siberian hamsters undergo reproductive quiescence during exposure to a short day photoperiod, but this response appears to diminish with age. This study investigated whether age-related losses in photoperiodic responsiveness may be related to decreases in specific 2-[125I]-iodomelatonin binding sites in the suprachiasmatic nuclei or pars tuberalis. Adult male Siberian hamsters (group 1: 3-6 months of age and group 2: 9-12 months of age) were exposed to short photoperiod (10 hr of light/day) for 10 weeks. Profound testicular regression was evident in the majority of the hamsters in group 1, but in only a few of the hamsters in group 2. There were no significant differences between the groups in the density or affinity of the specific 2-[125I]-iodomelatonin binding sites in either the suprachiasmatic nuclei or the pars tuberalis. These findings suggest that the failure of older hamsters to respond to short photoperiod is not caused by a loss of specific 2-[125I]-iodomelatonin binding sites in the suprachiasmatic nuclei or pars tuberalis.

Discrete thalamic lesions attenuate winter adaptations and increase body weight.

The midline thalamus (e.g., the paraventricular thalamic nuclei and the reuniens nucleus) of Siberian hamsters and other mammals has been reported to contain specific binding sites for melatonin, a hormone that is essential for photoperiodically induced winter adaptations such as reproductive quiescence, loss of body weight, daily torpor, and the winter molt. The first experiment investigated whether the midline thalamus is necessary for these winter adaptations. Adult Siberian hamsters received discrete neurotoxic lesions of the paraventricular thalamic nuclei or the reuniens nucleus while under pentobarbital sodium-induced anesthesia. After recovery, the hamsters were monitored for winter adaptations while they were exposed to short photoperiods (10 h light/day) for 12 wk at 22 degrees C then for 60 days at 7 degrees C. Lesions of the reuniens nucleus, but not of the paraventricular thalamic nuclei, significantly inhibited short photoperiod-induced loss of body weight and tended to increase food consumption and decrease daily torpor. The second experiment showed that lesions of the reuniens nucleus increased body weight gain compared with that in controls during exposure to long photoperiods at 22 degrees C for 16 wk. In summary, these findings show that the reuniens nucleus is an important site for regulation of body weight and suggest that lesions of the reuniens nucleus may attenuate winter metabolic adaptations by causing an increase in body weight.

Antiatherogenic properties of calcium antagonists.

Atherosclerosis results from multiple factors, and involves several mechanisms including endothelial monocyte and smooth muscle cell changes, cholesterol accumulation, lumen stenosis, necrosis, mineralization, plaque hemorrhage, rupture, and thromboembolism. Calcium antagonists have been shown in hypercholesterolemic animal models to reduce atherosclerosis. This effect cannot be explained on the basis of changes in blood pressure, therefore suggesting that calcium channel antagonists have a direct effect on arterial wall processes associated with plaque evolution. The antiatherosclerosis properties of calcium antagonists have been tested in human subjects and suggest that these compounds inhibit new lesion development. Recent developments in B-mode ultrasonography allow investigators to detect and monitor atherosclerosis noninvasively. This method is being used in several trials within the U.S. and Europe to evaluate treatment effects on carotid atherosclerosis. Carotid artery disease is associated with transient ischemic attacks, ischemic cerebral infarction, and with risk for coronary artery disease. B-mode ultrasonography is a powerful method for monitoring atherosclerosis progression. The combination of this technology with calcium antagonist treatment will allow evaluation of the efficacy of intervention on the arterial wall during the asymptomatic stages of atherosclerosis evolution.

Yolk polypeptide gene expression in cultured Drosophila cells.

The transfer of chimaeric plasmids to Drosophila melanogaster cell lines has been examined as a system for investigation of the hormonal regulation of the genes coding for D. melanogaster yolk polypeptide 1 (YP1) and Locusta migratoria vitellogenin B (VgB). Constructs containing promoters and putative 5'-regulatory sequences from these genes, ligated to bacterial chloramphenicol acetyltransferase (CAT) coding DNA, were transfected into Drosophila Kc (Kc-H) and S3 cells, and transient expression of CAT was assayed. Activity was expressed both from the homologous promoter of pYP1CAT and from the heterologous locust promoter of pVgCAT at comparable levels. In S3 cells, with calcium phosphate-mediated transfer of pYP1CAT there was a twofold induction of CAT activity after the addition of 10(-6) M ecdysterone, but no hormonal stimulation was noted when the polycation polybrene was used to achieve transfection. For Kc cells, calcium phosphate was ineffective for transfection, and after transfection with polybrene neither pYP1CAT nor pVgCAT was induced by the juvenile hormone (JH) analog methoprene. It is concluded that S3 cells may be useful for investigating the molecular basis of gene regulation by ecdysteroids, but conditions suitable for the analysis of JH action have not yet been established.

Nursing in the aftermath of disaster : Orplanage relief work in Romania

Disaster relief workers experience psychological and physical needs as a direct consequence of their disaster involvement. While this impact has been acknowledged, relatively little is known about the nature of the psychosocial demands generated by prolonged exposure. Developing both comprehensive preparatory and support programmes for relief workers will require that the nature of these demands, their impact on personnel, and their implications for disaster management are documented (AU)