Sleep restriction increases the neuronal response to unhealthy food in normal-weight individuals.

CONTEXT: Sleep restriction alters responses to food. However, the underlying neural mechanisms for this effect are not well understood. OBJECTIVE: The purpose of this study was to determine whether there is a neural system that is preferentially activated in response to unhealthy compared with healthy foods. PARTICIPANTS: Twenty-five normal-weight individuals, who normally slept 7-9 h per night, completed both phases of this randomized controlled study. INTERVENTION: Each participant was tested after a period of five nights of either 4 or 9 h in bed. Functional magnetic resonance imaging (fMRI) was performed in the fasted state, presenting healthy and unhealthy food stimuli and objects in a block design. Neuronal responses to unhealthy, relative to healthy food stimuli after each sleep period were assessed and compared. RESULTS: After a period of restricted sleep, viewing unhealthy foods led to greater activation in the superior and middle temporal gyri, middle and superior frontal gyri, left inferior parietal lobule, orbitofrontal cortex, and right insula compared with healthy foods. These same stimuli presented after a period of habitual sleep did not produce marked activity patterns specific to unhealthy foods. Further, food intake during restricted sleep increased in association with a relative decrease in brain oxygenation level-dependent (BOLD) activity observed in the right insula. CONCLUSION: This inverse relationship between insula activity and food intake and enhanced activation in brain reward and food-sensitive centers in response to unhealthy foods provides a model of neuronal mechanisms relating short sleep duration to obesity.

Postprandial thermogenesis and substrate oxidation are unaffected by sleep restriction.

BACKGROUND/OBJECTIVES: The extent to which alterations in energy expenditure (EE) in response to sleep restriction contribute to the short sleep-obesity relationship is not clearly defined. Short sleep may induce changes in resting metabolic rate (RMR), thermic effect of food (TEF) and postprandial substrate oxidation. SUBJECTS/METHODS: Ten females (age and body mass index: 22-43 years and 23.4-28 kg m(-2)) completed a randomized, crossover study assessing the effects of short (4 h per night) and habitual (8 h per night) sleep duration on fasting and postprandial RMR and respiratory quotient (RQ). Measurements were taken after three nights using whole-room indirect calorimetry. The TEF was assessed over a 6-h period following consumption of a high-fat liquid meal. RESULTS: Short versus habitual sleep did not affect RMR (1.01±0.05 and 0.97±0.04 kcal min(-1); P=0.23). Fasting RQ was significantly lower after short versus habitual sleep (0.84±0.01 and 0.88±0.01; P=0.028). Postprandial EE (short: 1.13±0.04 and habitual: 1.10±0.04, P=0.09) and RQ (short: 0.88±0.01 and habitual: 0.88±0.01, P=0.50) after the high-fat meal were not different between conditions. TEF was similar between conditions (0.24±0.02 kcal min(-1) in both; P=0.98), as was the ~6-h incremental area under the curve (1.16±0.10 and 1.17±0.09 kcal min(-1) × 356 min after short and habitual sleep, respectively; P=0.92). CONCLUSIONS: Current findings observed in non-obese healthy premenopausal women do not support the hypothesis that alterations in TEF and postprandial substrate oxidation are major contributors to the higher rate of obesity observed in short sleepers. In exploring a role of sleep duration on EE, research should focus on potential alterations in physical activity to explain the increased obesity risk in short sleepers.

A sipometer for measuring motivation to consume and reward value of foods and beverages in humans: Description and proof of principle.

New methods, derived from animal work, for measuring food reward value (i.e. reinforcing value of food), and motivation (i.e. strength of desire) to consume, in humans are described and validated. A sipping device (sipometer) was developed that permits access to a liquid food or beverage on two reward schedules: continuous reinforcement (CR) and progressively increasing time spent exerting pressure on a straw (PR-schedule). In addition, a pictorial scale showing a cup, from which the 'amount wanted' could be marked was used to pre-test potential consumption. Intake, time spent sipping, breakpoint, and pressure exerted were the main dependent variables measured. Three pilot experiments were conducted. In Experiment 1, participants (n=8) consumed yogurt shakes after a 1-h or 21-h food deprivation period on both schedules. In Experiment 2, participants (n=8) sham-consumed (i.e. spit out) sweet and non-sweet beverages, utilizing both schedules. In Experiment 3, sham-consuming sweet and non-sweet beverages on both schedules and working for shake on the PR schedule were repeated, after three nights of either habitual sleep or short sleep duration (n=7) in a crossover design. In Experiment 1, participants sipped longer after 21-h vs. 1-h of food deprivation (13±3.0 vs. 8.0±2.1s; p=0.04), on the PR schedule. In Experiment 2, sham-intake (p=0.01) and sipping time (p=0.04) were greater for sweet than non-sweet beverages on the PR schedule and a similar, though not conventionally significant, effect was observed for exerted pressure (p=0.09). In both Experiment 2 and Experiment 3 after habitual sleep, on the PR schedule, cumulative pressure difference between sweet and non-sweet beverage increased with difference in amount wanted in the taste test. In contrast, after short sleep participants were less willing to work for sweet taste as their wanting increased, suggesting that sleep deprivation raises desire, but lowers behavioral output. Taken together these results demonstrate that the sipometer and associated ratings are reliable and useful measures of motivation to consume and reward value in humans. Participants were more motivated to obtain access to sweet beverages, especially when these were better liked than to obtain access to non-sweet beverages.

Physicians' attitudes towards androgen replacement therapy for male and female sexual dysfunction.

Androgen deficiency syndrome is a commonly diagnosed condition. The aim of this study was to investigate common clinical practices of specialists in the field of sexual medicine regarding androgen replacement treatment for men and women. Attendees of the 16th Annual Congress of the European Society of Sexual Medicine held in January 2014 in Istanbul, Turkey, were asked to participate in a survey during the congress days. A 24-item self-report, closed-question questionnaire was distributed. Three sections were accessed: sociodemographic data, professional background and personal practice patterns regarding androgen substitution in men and women. A total of 133 physicians (mean age 47 years; range 25-79) completed the survey. Responses were inconsistent regarding the lab tests used for primary evaluation of male androgen deficiency. The majority of participants (62%) recommended testosterone replacement therapy for symptomatic men with testosterone levels <8 nmol l(-1) (231 ng dl(-1)). Similarly, most physicians (88%) recognized a correlation between libido and testosterone levels in women. Only 42% and 53% reported they would prescribe testosterone to women with low libido, premenopausal and postmenopausal, respectively. This survey showed discrepancies among physicians regarding testosterone replacement therapy for men and women.

Migraine prevalence. A review of population-based studies.

Obtaining accurate and reliable information on the prevalence of migraine is essential to understanding the burden it places on society. Although the epidemiology of headache has been described in more than 50 population-based studies, only 24 of these have described the gender- and age-specific prevalence of migraine. Essentially five different case definitions have been used in these studies. Variation in the prevalence of migraine among studies is largely due to differences in case definition and in the age and gender distribution of study populations. Among four recent studies that used the diagnostic criteria of the International Headache Society (IHS), a coherent picture emerges. The prevalence of migraine is approximately 6% among men and 15 to 17% among women. Prevalence varies by age, increasing to about age 40 years and declining thereafter in both men and women. The gender ratio also appears to vary by age, increasing from menarche to about age 42 years and declining thereafter. Although the use of the IHS criteria has resulted in a more coherent picture across population-based studies, efforts must be made to assess the reliability and validity of these criteria in population-based samples.

Migraine heterogeneity. Disability, pain intensity, and attack frequency and duration.

Data from population-based studies are summarized to characterize the full range and variability of the impact migraine has on the individual. Despite differences in methods and data collection in population-based studies describing disability, pain intensity, and attack frequency as well as the duration of migraine and other headaches, several patterns emerge. On average, migraine headaches are more disabling, more painful, and longer in duration than other types of headaches. Females report more pain and disability with headache than do males. Although disability measurements are important in demonstrating the effect of headache on both the individual and society, actual measurements often fall short. Most studies use only workdays lost as the sole measure of disability. Most migraineurs do not miss work while experiencing a headache; instead, they attempt to function on the job, with considerably reduced effectiveness. Computing only workdays lost does not account for impairment at work nor does it show the impact of migraine on other aspects of life. In addition, evidence suggests the presence of a pain intensity threshold for disability. Headache-related pain intensity below the threshold is not associated with disability. Despite the threshold of pain intensity for disability, a significant proportion of migraine sufferers report levels of pain intensity above the threshold in the absence of work-related disability. The grading of headache severity should be a composite that would permit a more complete image of the heterogeneity of migraine's effects and a more accurate idea of the need for healthcare services. This composite should include two areas: (1) more complete measures of life impact, encompassing daily activities in a number of domains, including work, family, and social activities; and (2) an assessment of pain intensity and attack frequency.

Pediatric migraine and the International Headache Society (IHS) criteria.

BACKGROUND: The optimal criteria for the diagnosis of migraine without aura in children are controversial. One strategy for assessing the validity of diagnostic criteria is to compare them with expert clinical diagnoses. OBJECTIVE: To study the agreement between clinical headache diagnoses assigned by pediatric neurologists and symptom-based diagnoses using the International Headache Society (IHS) criteria as well as alternative case definitions. METHODS: We reviewed the records of 253 children and adolescents consecutively evaluated by pediatric neurologists at the Montefiore Headache Unit. Clinical diagnoses assigned by the physicians were used as the gold standard in evaluating the validity of the IHS criteria for the diagnosis of migraine without aura. Alternative symptom-based diagnoses were compared with the clinical gold standard. RESULTS: Detailed headache histories were abstracted from charts of 253 children; 167 children had complete data on all features required for IHS diagnosis. Eighty-eight (52.7%) children received a diagnosis of migraine without aura. Using the clinical diagnosis as the gold standard, the IHS criteria had a sensitivity of 27.3% and a specificity of 92.4%. The poor sensitivity of the IHS definition is a consequence of the rarity of certain features in children clinically diagnosed with migraine: duration of 2 hours or longer (55.7%), unilateral pain (34.1%), vomiting (47.7%), and phonophobia (27.3%). Based on these findings we suggested a definition for pediatric migraine headache without aura that is less complex, more sensitive (71.6%), and almost as specific as the IHS criteria. CONCLUSIONS: The IHS criteria for migraine without aura have poor sensitivity but high specificity using a clinical diagnosis as the gold standard. The IHS criteria should be modified to better reflect current pediatric clinical practice.

Longitudinal study of brainstem auditory evoked responses in 87 normal human subjects.

We evaluated the reproducibility of brainstem auditory evoked responses (BAERs) in 87 normal individuals in a longitudinal study by estimating the correlation coefficients and variability of the interpeak intervals and the V/I amplitude ratio between trials on the same day and between sessions spaced 2 years apart. The highest correlation coefficients occur for the I-V interpeak interval between trials on the same day. The coefficients for the I-III and III-V intervals are lower, due to the variability of wave III. The correlations between ears done on the same day are lower still and are similar to measures obtained from the same ear at a 2-year interval. BAERs are more variable than previously believed between ears and over time, but not in a manner that is clinically significant and can be used longitudinally as a measure of neurologic disease. Finally, we provide the sample size required to detect a significant change in interpeak intervals.

Hemicrania continua is not that rare.

BACKGROUND: Hemicrania continua is an indomethacin-responsive headache disorder characterized by a continuous, moderate to severe, unilateral headache. More than 90 cases of hemicrania continua have been reported, but there is still uncertainty about its clinical features. METHODS: The authors compared 34 new cases (24 women, 10 men) with previously reported cases. All the patients met Goadsby and Lipton's proposed criteria. The authors compared baseline (continuous background headache) and exacerbation (attacks of severe periods of headaches). RESULTS: The baseline headache was typically mild to moderate in intensity and usually not associated with severe disability. In contrast, the headache exacerbations were severe and associated with photophobia, phonophobia, nausea, and disability. At least one autonomic symptom was present in 25 patients (74%). Jabs and jolts were present in 14 patients (41%). The mean indomethacin dose was 136.7 +/- 60 mg (range 25 to 225 mg). Twenty-four patients (70.6%) met International Headache Society criteria for migraine in their exacerbation period. Occipital tenderness was observed in 23 patients (67.6%). The temporal pattern was remitting in four patients (11.8%), continuous from onset in 18 (52.9%), and continuous evolving from remitting in 12 (35.3%). CONCLUSION: Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.

Physician consultation for headache pain and history of panic: results from a population-based study.

In a population-based telephone interview survey of 10,169 respondents aged 12-29 years in Washington County, Maryland, data were collected on history of panic attacks, on the most recent headache and associated symptoms in the 2 weeks before the interview, and on physician consultation for headache-related problems. Of those who had a headache in the previous 12 months, 14.2% of females and 5.8% of males consulted a physician for headache. The proportion who recently consulted a physician increased with age among females but not among males. An unexpectedly high proportion of those who recently sought physician care for their headache problem had a history of panic. In particular, among those who sought care, 15% of females and 12.8% of males ages 24-29 had a history of panic disorder. Overall, females with panic disorder who had recently seen a physician for headache exhibited the most frequent, severe, and complex headaches. In particular, headaches were of considerably longer duration, more severe, and greater than 50% of these females had five or more headaches in a 4-week period. A very high proportion experienced disability (up to 46.7%) from their headache. Males with a history of panic who did or did not seek physician care differed only in that a considerably higher proportion of the former group (up to 45%) had frequent headaches. Overall, 11.8% of the total population had a migraine headache in the 2 weeks before the interview. In contrast, 21.8% of those who sought physician care and 36% of those with panic disorder who sought physician care had a migraine headache.

Population variation in migraine prevalence: a meta-analysis.

A meta-analysis of published studies was conducted to identify factors which explained variation in estimates of migraine prevalence. Twenty-four population based studies contributed a total of 168 gender and age specific estimates of migraine prevalence. In linear regression analysis, 70.6% of the variation in these prevalence estimates was explained by gender, age (AGE+AGE2), a binary variable for case definition, and an interaction term between age and the case definition. Initially, we identified five groups of case definitions among the 24 studies. Only the definition of Waters (any 2 of warning, nausea, or unilateral pain) was associated with statistically significant differences in prevalence estimates among studies; accordingly the other 4 groups were combined. Several other factors were examined as predictors of migraine prevalence including the method of selecting the study population, the source of the population, the response rate and whether diagnoses were confirmed by a clinical assessment. None of these factors substantially increased explained variance. We conclude that after taking sociodemographic factors and case definition into account, estimates of migraine prevalence are remarkably stable among studies.

Effectiveness of erythromycin in the treatment of acute bronchitis.

BACKGROUND: Clinical trials have not shown a consistent benefit of treating bronchitis with antibiotics. Many physicians, however, treat acute bronchitis with antibiotics because of the possibility of Mycoplasma pneumoniae or other pathogens. The objectives of this study were to determine the effectiveness of erythromycin treatment in patients with acute bronchitis and to determine whether a newly developed rapid M pneumoniae antibody test is useful in predicting which patients will respond to therapy. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial at three primary care centers in North Carolina. A convenience sample of 140 patients presenting with acute bronchitis were tested for M pneumoniae, 91 of whom were treated with either erythromycin 250 mg four times daily for 10 days or an identical-appearing placebo. RESULTS: Patients treated with erythromycin missed an average of only 0.81 +/- 1.1 days of work compared with 2.16 +/- 3.2 days for placebo-treated patients (P < .02). There were no significant differences in cough, use of cough medicine, general feeling of well-being, or chest congestion between the erythromycin and placebo groups. Twenty-five percent of the patients tested positive for M pneumoniae. There were no differences in response to erythromycin based on whether the patient had a positive test for M pneumoniae. CONCLUSIONS: Erythromycin is effective in significantly reducing lost time from work, but it is not effective in reducing cough or other symptoms in patients with acute bronchitis, regardless of the outcome of the M pneumoniae antibody test.

Hepatopancreatic multi-transcript expression patterns in the crayfish Cherax quadricarinatus during the moult cycle.

Alterations of hepatopancreatic multi-transcript expression patterns, related to induced moult cycle, were identified in male Cherax quadricarinatus through cDNA microarray hybridizations of hepatopancreatic transcript populations. Moult was induced by X-organ sinus gland extirpation or by repeated injections of 20-hydroxyecdysone. Manipulated males were sacrificed at premoult or early postmoult, and a reference population was sacrificed at intermoult. Differentially expressed genes among the four combinations of two induction methods and two moult stages were identified. Biologically interesting clusters revealing concurrently changing transcript expressions across treatments were selected, characterized by a general shift of expression throughout premoult and early postmoult vs. intermoult, or by different premoult vs. postmoult expressions. A number of genes were differentially expressed in 20-hydroxyecdysone-injected crayfish vs. X-organ sinus gland extirpated males.

The significance of serum progesterone levels on the day of hCG administration on IVF pregnancy rates.

The aim of the present study was to evaluate the relationship between serum progesterone level on the day of human chorionic gonadotropin (hCG) administration (day 0) and pregnancy rate among patients undergoing in vitro fertilization and embryo transfer. Serum progesterone levels were analyzed retrospectively in 160 cycles. In 56 women ovarian stimulation was induced by gonadotropins only (group A). In 104 cases a gonadotropin releasing hormone (GnRH) analog was given prior to gonadotropin administration (group B). At least three embryos were transferred in all cases. A significantly (p < 0.01) higher serum progesterone level (> or = 1 ng/ml) on day 0 was observed in the 43 patients of group A who did not conceive compared with the 13 who conceived. No significant difference in serum progesterone levels on day 0 was found between the 37 patients of group B who conceived and the 67 who did not. The pregnancy rate (0.36) in group B was significantly (p < 0.05) higher than that in group A (0.23). However, the pregnancy rate (0.35) in patients in group A with low progesterone levels (< or = 1 ng/ml) was not significantly lower than that in group B. We demonstrated that elevated progesterone levels (> or = 1 ng/ml) on day 0 in patients receiving stimulation with gonadotropin only, might be detrimental to pregnancy. In view of these results, we suggest that early oocyte retrieval should be considered in patients whose progesterone level on the day of hCG administration exceeds 1 ng/ml following stimulation with gonadotropin only.

Reliability of dermatology teleconsultations with the use of teleconferencing technology.

BACKGROUND: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation. OBJECTIVE: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system. METHODS: Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis. RESULTS: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians. CONCLUSION: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.

Cardiac risk factors and the use of triptans: a survey study.

OBJECTIVE: To describe current practice in triptan use. BACKGROUND: Triptans are effective migraine treatments that cause chest symptoms in some patients. True cardiac ischemia is rare. Design.-Headache specialists and family practitioners completed questionnaires regarding the times when triptans are contraindicated, obtaining electrocardiograms (ECGs), and giving the first dose in the office. RESULTS: Sixty-five headache specialists and 67 family practitioners responded. Headache specialists saw an average of 36.3 patients with headache per week. Family practitioners saw an average of 7.2. Family practitioners and headache specialists had similar opinions regarding the age at which triptans were contraindicated with various numbers of risk factors. Sixty-one percent of headache specialists and 50% of family practitioners would not use a triptan at any age for patients with more than three risk factors (P = NS). Ten percent of headache specialists obtained an ECG for all patients being prescribed triptans, while no family practitioners did (P =. 008). Ten percent of both family practitioners and headache specialists never obtained an ECG, even with multiple cardiac risk factors. Headache specialists obtained ECGs more often than family practitioners (P <.002 for one to three risk factors). Family practitioners were more likely to give the first dose of the triptan in the office regardless of cardiovascular risk (58% versus 20%, P <. 001). Forty-five percent of headache specialists and 2% of family practitioners never gave the first dose in the office (P <.001). Family practitioners gave the first dose in the office more readily than headache specialists in patients with no risk factors (P =.001), but not for one or more risk factors. CONCLUSIONS: No consensus exists among family practitioners or headache specialists about when to avoid using a triptan due to excessive cardiac risk factors, when to obtain an ECG prior to using a triptan, and when to give the first dose of a triptan in the office. Headache specialists are more likely to obtain ECGs, whereas family practitioners are more likely to give the first dose of a triptan in the office.

Topiramate: a case series study in migraine prophylaxis.

We reviewed the electronic records of 74 migraine patients treated with topiramate for more than 6 weeks. Twenty-four patients had episodic migraine and 50 had chronic (transformed) migraine. Most (81%) started treatment at 25 mg per day and reached a dose of 100 mg twice a day (mean dose on the last follow-up visit was 208 mg). The mean headache frequency decreased from 20.6 days to 13.6 days per month (P<0.0001) for all headaches (9.9-5.1 (P<0.0001) and 25.7-17.7 (P<0.001) for episodic migraine and chronic migraine, respectively). The percentage of patients whose headache frequency was reduced by > or =50% was 44.6% for all patients; 58.3 for episodic migraine and 38.0 for chronic migraine. For all patients mean headache severity (10-point scale) was reduced from 6.2 to 4.8 (P<0.0001). Patients on monotherapy (20%) and polytherapy (80%) had similar reductions in headache frequency. Adverse events were usually mild to moderate and were seen in 58.1% (paresthesias in 25%, cognitive difficulties 14.9%). Mean weight loss was 3.1 +/- 4 kg (3.8% of total body weight).

Cluster headache in women: clinical characteristics and comparison with cluster headache in men.

OBJECTIVE: To study the clinical characteristics of cluster headache in women. Cluster headache is a disorder of men (male to female ratio 6-7:1). METHODS: Retrospective chart review to identify all women diagnosed with cluster headache at an academic headache centre from January 1995 through July 1998. RESULTS: Thirty two women and 69 men were identified. The mean age of onset of cluster headache was 29.4 years in women versus 31.3 years in men. Two peaks of onset in women (2nd and 5th decade) were identified compared with one in men (3rd decade). Episodic cluster headache was present in 75% of women and 77% of men. Women and men had on average 3 attacks a day, but attack duration was shorter in women (67.2 minutes v 88.2 minutes). Cluster headache period duration (11.1 weeks v 10 weeks) and remission periods (21.1 months v 23.1 months) were similar in women and men. Miosis and ptosis seemed to be less common in women (miosis 13.3% v 24.6%, ptosis 41.9% v 58.1%) whereas lacrimation and nasal congestion/rhinorrhoea were almost equally prevalent in women and men. Women had more nausea than men (62.5% v 43.5%, p=0.09) and significantly more vomiting (46.9% v 17.4%, p=0.003). Photophobia occurred in 75% of women and 81.2% of men, and phonophobia occurred in 50% of women and 47.8% of men. CONCLUSIONS: The clinical characteristics of cluster headache in women are very similar to those in men. Women develop the disorder at an earlier age of onset and experience more "migrainous symptoms" with cluster headache, especially vomiting. Both men and women have frequent photophobia and phonophobia with cluster headache attacks. These symptoms are not included in the International Headache Society cluster headache criteria, suggesting the need for possible criteria revision.