Association Between Sleep Duration and Atrial Fibrillation: A Narrative Review.

Sleep duration is a substantial risk factor for several cardiovascular diseases, including atrial fibrillation (AF). Despite much research, the precise nature of the relationship between the amount of sleep and AF remains unclear. This narrative review explores the relationship between AF and sleep duration, looking at genetic, mechanistic, and epidemiological data to explain this association. A U-shaped association (nonlinear relationship or curvilinear association) between sleep duration and AF has been seen, where longer and shorter sleep duration, more or less than seven to eight hours, have been associated with increased AF risk. Multiple mechanisms such as autonomic dysfunction, inflammation, and structural atrial remodeling have been proposed linking sleep disturbances to AF. Moreover, confounding factors such as individual lifestyle, comorbidities, and sleep quality could affect this association. Additionally, the interpretation of study results is further impacted by methodological limitations, including self-reported sleep duration and observational study designs. It is imperative to comprehend the complex relationship between sleep duration and AF to develop effective preventive and therapeutic methods. The main goals of future research should focus on prospective cohort studies with objective sleep metrics, exploring the mechanistic pathways, and comprehensive confounder adjustments that link sleep disturbances to AF. In summary, addressing sleep disturbances may represent one of the novel approaches to AF prevention and management, with potential implications for improving cardiovascular health and reducing AF-related morbidity and mortality.

Cross-Sectional Study to Evaluate Disparity in Healthcare Access for Patients With a Headache Having Cigna or Medicaid Insurance.

INTRODUCTION: This study aims to study the disparity in Cigna and Medicaid insurance holders, to secure an appointment for a patient with a headache for two days unrelieved by over-the-counter medication. METHODOLOGY: This is a cross-sectional "secret shopper" type study, assessing the three most populated cities in seven states with the lowest Medicaid coverage and Internal Medicine specialists within a 10-mile radius, with a minimum rating of 3 stars and a willingness to accept new patients. RESULTS: There was a statistically significant difference in the average waiting period for those with Medicaid and Cigna in the states of Missouri, Nebraska, and Utah, as well as the total average for all seven states. Moreover, there were more healthcare providers who accepted Medicaid rather than Cigna in New Hampshire; whereas in Wyoming, the numbers for Medicaid and Cigna were almost equal. CONCLUSIONS: The significant Medicaid-Cigna acceptance rate disparities should be corrected to ensure higher healthcare access.

CSF-1R inhibitor PLX3397 attenuates peripheral and brain chronic GVHD and improves functional outcomes in mice.

Graft-versus-host disease (GVHD) is a serious complication of otherwise curative allogeneic haematopoietic stem cell transplants. Chronic GVHD induces pathological changes in peripheral organs as well as the brain and is a frequent cause of late morbidity and death after bone-marrow transplantation. In the periphery, bone-marrow-derived macrophages are key drivers of pathology, but recent evidence suggests that these cells also infiltrate into cGVHD-affected brains. Microglia are also persistently activated in the cGVHD-affected brain. To understand the involvement of these myeloid cell populations in the development and/or progression of cGVHD pathology, we here utilized the blood-brain-barrier permeable colony stimulating factor-1 receptor (CSF-1R) inhibitor PLX3397 (pexidartinib) at varying doses to pharmacologically deplete both cell types. We demonstrate that PLX3397 treatment during the development of cGVHD (i.e., 30 days post-transplant) improves disease symptoms, reducing both the clinical scores and histopathology of multiple cGVHD target organs, including the sequestration of T cells in cGVHD-affected skin tissue. Cognitive impairments associated with cGVHD and neuroinflammation were also attenuated by PLX3397 treatment. PLX3397 treatment prior to the onset of cGVHD (i.e., immediately post-transplant) did not change in clinical scores or histopathology. Overall, our data demonstrate significant benefits of using PLX3397 for the treatment of cGVHD and associated organ pathologies in both the periphery and brain, highlighting the therapeutic potential of pexidartinib for this condition.

Prosocial behavior, psychological well-being, positive and negative affect among young adults: A cross-sectional study.

Background: Prosocial behaviors are considered important moral and social behavior. Various researchers have found that prosocial behavior increases well-being; research is scarce on the effects of prosocial behavior on psychological well-being, positive and negative affect among adults. Aim: The present study investigated the relationship between prosocial behavior, psychological well-being, and positive and negative affect on adults. Materials and Methods: The study included 80 adults (19-25 years) males and females. Snowball and incidental sampling method is used for data collection. The tools used for the study are the Prosocial Personality Battery, Ryff's psychological well-being scale, and the positive and negative affect scale. Results: A positive correlation was found between prosocial behavior and psychological well-being (0.396 which is significant at 0.01 level). A positive correlation was also observed between prosocial behavior and positive affect (0.274 which is significant at 0.01 level). A negative correlation was found between prosocial behavior and negative affect (-0.191 which is significant at 0.05 level). Conclusion: People involved in Prosocial behavior showed a positive correlation with Psychological well-being and positive affect and a negative correlation with negative affects.

Donor bone marrow-derived macrophage MHC II drives neuroinflammation and altered behavior during chronic GVHD in mice.

Graft-versus-host disease (GVHD) remains the leading cause of nonrelapse mortality after allogeneic stem cell transplantation for hematological malignancies. Manifestations of GVHD in the central nervous system (CNS) present as neurocognitive dysfunction in up to 60% of patients; however, the mechanisms driving chronic GVHD (cGVHD) in the CNS are yet to be elucidated. Our studies of murine cGVHD revealed behavioral deficits associated with broad neuroinflammation and persistent Ifng upregulation. By flow cytometry, we observed a proportional shift in the donor-derived T-cell population in the cGVHD brain from early CD8 dominance to later CD4 sequestration. RNA sequencing of the hippocampus identified perturbations to structural and functional synapse-related gene expression, together with the upregulation of genes associated with interferon-γ responses and antigen presentation. Neuroinflammation in the cortex of mice and humans during acute GVHD was recently shown to be mediated by resident microglia-derived tumor necrosis factor. In contrast, infiltration of proinflammatory major histocompatibility complex (MHC) class II+ donor bone marrow (BM)-derived macrophages (BMDMs) was identified as a distinguishing feature of CNS cGVHD. Donor BMDMs, which composed up to 50% of the CNS myeloid population, exhibited a transcriptional signature distinct from resident microglia. Recipients of MHC class II knockout BM grafts exhibited attenuated neuroinflammation and behavior comparable to controls, suggestive of a critical role of donor BMDM MHC class II expression in CNS cGVHD. Our identification of disease mediators distinct from those in the acute phase indicates the necessity to pursue alternative therapeutic targets for late-stage neurological manifestations.

DCC regulates astroglial development essential for telencephalic morphogenesis and corpus callosum formation.

The forebrain hemispheres are predominantly separated during embryogenesis by the interhemispheric fissure (IHF). Radial astroglia remodel the IHF to form a continuous substrate between the hemispheres for midline crossing of the corpus callosum (CC) and hippocampal commissure (HC). Deleted in colorectal carcinoma (DCC) and netrin 1 (NTN1) are molecules that have an evolutionarily conserved function in commissural axon guidance. The CC and HC are absent in Dcc and Ntn1 knockout mice, while other commissures are only partially affected, suggesting an additional aetiology in forebrain commissure formation. Here, we find that these molecules play a critical role in regulating astroglial development and IHF remodelling during CC and HC formation. Human subjects with DCC mutations display disrupted IHF remodelling associated with CC and HC malformations. Thus, axon guidance molecules such as DCC and NTN1 first regulate the formation of a midline substrate for dorsal commissures prior to their role in regulating axonal growth and guidance across it.

Selective Ablation of BDNF from Microglia Reveals Novel Roles in Self-Renewal and Hippocampal Neurogenesis.

Microglia, the resident immune cells of the CNS, have emerged as key regulators of neural precursor cell activity in the adult brain. However, the microglia-derived factors that mediate these effects remain largely unknown. In the present study, we investigated a role for microglial brain-derived neurotrophic factor (BDNF), a neurotrophic factor with well known effects on neuronal survival and plasticity. Surprisingly, we found that selective genetic ablation of BDNF from microglia increased the production of newborn neurons under both physiological and inflammatory conditions (e.g., LPS-induced infection and traumatic brain injury). Genetic ablation of BDNF from microglia otherwise also interfered with self-renewal/proliferation, reducing their overall density. In conclusion, we identify microglial BDNF as an important factor regulating microglia population dynamics and states, which in turn influences neurogenesis under both homeostatic and pathologic conditions.SIGNIFICANCE STATEMENT (1) Microglial BDNF contributes to self-renewal and density of microglia in the brain. (2) Selective ablation of BDNF in microglia stimulates neural precursor proliferation. (3) Loss of microglial BDNF augments working memory following traumatic brain injury. (4) Benefits of repopulating microglia on brain injury are not mediated via microglial BDNF.

Clinical Validation of Integrated Point-of-Care Devices for the Management of Non-Communicable Diseases.

Non-communicable diseases are the leading cause of death and disability across India, including in the poorest states. Effective disease management, particularly for cardiovascular diseases, requires the tracking of several biochemical and physiological parameters over an extended period of time. Currently, patients must go to diagnostic laboratories and doctors' clinics or invest in individual point-of-care devices for measuring the required parameters. The cost and inconvenience of current options lead to inconsistent monitoring, which contribute to suboptimal outcomes. Furthermore, managing multiple individual point-of-devices is challenging and helps track some parameters to the exclusion of others. To address these issues, HealthCubed, a primary care technology company, has designed integrated devices that measure blood glucose, hemoglobin, cholesterol, uric acid, blood pressure, capillary oxygen saturation and pulse rate. Here we report data from clinical studies undertaken in healthy subjects establishing the validity of an integrated device for monitoring multiple parameters.