Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers.

We hypothesize that the sciatic nerve in the subgluteal space has a specific behavior during internal and external coxofemoral rotation and during isometric contraction of the internal and external rotator muscles of the hip. In 58 healthy volunteers, sciatic nerve behavior was studied by ultrasound during passive internal and external hip rotation movements and during isometric contraction of internal and external rotators. Using MATLAB software, changes in nerve curvature at the beginning and end of each exercise were evaluated for longitudinal catches and axial movement for transverse catches. In the long axis, it was observed that during the passive internal rotation and during the isometric contraction of external rotators, the shape of the curve increased significantly while during the passive external rotation and the isometric contraction of the internal rotators the curvature flattened out. During passive movements in internal rotation, on the short axis, the nerve tended to move laterally and forward, while during external rotation the tendency of the nerve was to move toward a medial and backward position. During the isometric exercises, this displacement was less in the passive movements. Passive movements of hip rotation and isometric contraction of the muscles affect the sciatic nerve in the subgluteal space. Retrotrochanteric pain may be related to both the shear effect of the subgluteus muscles and the endoneural and mechanosensitive aggression to which the sciatic nerve is subjected.

Obstructive sleep apnoea and cognitive decline in mild-to-moderate Alzheimer's disease.

We evaluated the influence of untreated obstructive sleep apnoea (OSA) on the magnitude of cognitive decline and on several cognitive subdomains in patients with mild-to-moderate Alzheimer's disease.In this single-centre study, 144 patients were recruited prospectively from a cognitive impairment unit and underwent overnight polysomnography.The mean±sd change in the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) score at 12 months was 3.19±5.61 in the non-OSA group and 0.08±5.62 in the OSA group, with an intergroup difference of -3.36 (95% CI 0.19-0.16; p=0.002). We did not observe a significant difference in any cognitive subdomains at 12 months. Regarding Mini-Mental State Examination scores at 36 months, the mean change was 1.69 (95% CI -1.26-4.64; p=0.445). No significant differences were found among different OSA severity groups.We observed that ADAS-cog scores were better in the OSA group than in the non-OSA group by a statistically but not clinically significant margin. We did not find differences in the different cognitive subdomains after 1 year or in global cognition after 3 years of follow-up.

The prevalence of narcolepsy in Catalunya (Spain).

Previous studies have estimated an overall prevalence for narcolepsy between 15 and 70 cases per 100 000 inhabitants. We aimed to estimate the prevalence of narcolepsy in Catalunya (Catalonia), a north-east region of Spain (7 424 754 inhabitants), on 31 December 2014 by identifying all living subjects diagnosed with narcolepsy. First, we identified patients diagnosed by one of the 13 sleep, paediatric or neurological departments that perform tests regularly to diagnose narcolepsy. In a second phase, we searched for additional patients with narcolepsy in a clinical database of the primary health-care system. Clinical files were reviewed and narcolepsy diagnosis validated according to the Brighton Collaboration case definitions. Three hundred and twenty-five patients had a validated diagnosis of narcolepsy in the specialized centres (mean age: 44.6 years, range: 6-89; male: 60.3%; 85% with narcolepsy type 1), including 17.8% cases in Brighton, definition level 1, 62.5% in level 2, 15.4% in level 3 and 4.3% in level 4a. The overall prevalence for narcolepsy was 4.4; 3.7 for narcolepsy type 1 and 0.7 cases per 100 000 inhabitants for narcolepsy type 2. Fifty-six additional narcoleptic patients were identified in the primary health-care system, increasing the overall prevalence to 5.2 cases per 100 000 inhabitants. Prevalence rates for narcolepsy type 1 increased from childhood to adulthood, but in subjects aged more than 50 years there was a substantial drop in prevalence rates, suggesting the presence of a significant pool of undiagnosed cases in this population. Narcolepsy can be considered a rare neurological disorder in Catalunya.

Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study.

OBJECTIVE: To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space. MATERIALS AND METHODS: Sonographic examination (high-resolution ultrasound machine at 5.0-14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were examined in pronation, pelvis-fixed position by forcing internal and external rotations of the hip with the knee in 90° flexion. Healthy volunteers were examined during passive internal and external hip rotation (prone position; lumbar and pelvic regions fixed). Subjects with a history of major trauma, surgery or pathologies affecting the examined regions were excluded. RESULTS: The analysis included eight hemipelvis from six fresh cadavers and 31 healthy volunteers. The anatomical study revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax. CONCLUSION: Anatomically, the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.

Cerebrospinal fluid lipidomic fingerprint of obstructive sleep apnoea in Alzheimer's disease.

BACKGROUND: Obstructive sleep apnoea (OSA) has a high prevalence in patients with Alzheimer's disease (AD). Both conditions have been shown to be associated with lipid dysregulation. However, the relationship between OSA severity and alterations in lipid metabolism in the brains of patients with AD has yet to be fully elucidated. In this context, we examined the cerebrospinal fluid (CSF) lipidome of patients with suspected OSA to identify potential diagnostic biomarkers and to provide insights into the pathophysiological mechanisms underlying the effect of OSA on AD. METHODS: The study included 91 consecutive AD patients who underwent overnight polysomnography (PSG) to diagnose severe OSA (apnoea-hypopnea index ≥ 30/h). The next morning, CSF samples were collected and analysed by liquid chromatography coupled to mass spectrometry in an LC-ESI-QTOF-MS/MS platform. RESULTS: The CSF levels of 11 lipid species were significantly different between AD patients with (N = 38) and without (N = 58) severe OSA. Five lipids (including oxidized triglyceride OxTG(57:2) and four unknown lipids) were significantly correlated with specific PSG measures of OSA severity related to sleep fragmentation and hypoxemia. Our analyses revealed a 4-lipid signature (including oxidized ceramide OxCer(40:6) and three unknown lipids) that provided an accuracy of 0.80 (95% CI: 0.71-0.89) in the detection of severe OSA. These lipids increased the discriminative power of the STOP-Bang questionnaire in terms of the area under the curve (AUC) from 0.61 (0.50-0.74) to 0.85 (0.71-0.93). CONCLUSIONS: Our results reveal a CSF lipidomic fingerprint that allows the identification of AD patients with severe OSA. Our findings suggest that an increase in central nervous system lipoxidation may be the principal mechanism underlying the association between OSA and AD.

Blood-based lipidomic signature of severe obstructive sleep apnoea in Alzheimer's disease.

BACKGROUND: Obstructive sleep apnoea (OSA) is the most frequent form of sleep-disordered breathing in patients with Alzheimer's disease (AD). Available evidence demonstrates that both conditions are independently associated with alterations in lipid metabolism. However, it is unknown whether the expression of lipids is different between AD patients with and without severe OSA. In this context, we examined the plasma lipidome of patients with suspected OSA, aiming to identify potential diagnostic biomarkers and to provide insights into the pathophysiological mechanisms underlying the disease. METHODS: The study included 103 consecutive patients from the memory unit of our institution with a diagnosis of AD. The individuals were subjected to overnight polysomnography (PSG) to diagnose severe OSA (apnoea-hypopnea index ≥30/h), and blood was collected the following morning. Untargeted plasma lipidomic profiling was performed using liquid chromatography coupled with mass spectrometry. RESULTS: We identified a subset of 44 lipids (mainly phospholipids and glycerolipids) that were expressed differently between patients with AD and severe and nonsevere OSA. Among the lipids in this profile, 30 were significantly correlated with specific PSG measures of OSA severity related to sleep fragmentation and hypoxemia. Machine learning analyses revealed a 4-lipid signature (phosphatidylcholine PC(35:4), cis-8,11,14,17-eicosatetraenoic acid and two oxidized triglycerides (OxTG(58:5) and OxTG(62:12)) that provided an accuracy (95% CI) of 0.78 (0.69-0.86) in the detection of OSA. These same lipids improved the predictive power of the STOP-Bang questionnaire in terms of the area under the curve (AUC) from 0.61 (0.50-0.74) to 0.80 (0.70-0.90). CONCLUSION: Our results show a plasma lipidomic fingerprint that allows the identification of patients with AD and severe OSA, allowing the personalized management of these individuals. The findings suggest that oxidative stress and inflammation are potential prominent mechanisms underlying the association between OSA and AD.

The acute effects of different stretching exercises on jump performance.

The purpose of this study was to demonstrate the short-term effects of different stretching exercises during the warm-up period on the lower limbs. A controlled, crossover clinical study involving 49 volunteers (14 women and 35 men; mean age: 20.4 years) enrolled in a "physical and sporting activities monitor" program. The explosive force was assessed using the Bosco test. The protocol was as follows: The test involved a (pre) jump test, general warm-up, intervention and (post) jump test. Each volunteer was subjected to each of the 5 interventions (no stretching [NS] and stretching: static passive stretching [P]; proprioceptive neuromuscular facilitation [PNF] techniques; static active stretching in passive tension [PT]; static active stretching in active tension [AT]) in a random order. The jump test was used to assess the squat jump, countermovement jump (CMJ), elasticity index (EI), and drop jump. An intragroup statistical analysis was performed before and after each intervention to compare the differences between the different stretching exercises. An intergroup analysis was also performed. Significant differences (p < 0.05) were found between all variables for the interventions "P," "PNF," and "TA" in the intragroup analysis, with each value being higher in the postjump test. Only the "P" intervention showed a significant difference (p = 0.046) for "EI," with the postvalue being lower. Likewise, significant differences (p < 0.05) were observed for the "CMJ" measurements during the intergroup analysis, especially between "NS" and the interventions "P," "PNF," "AT," and "PT," with each value, particularly that for "AT," being higher after stretching. The results of this study suggest that static active stretching in AT can be recommended during the warm-up for explosive force disciplines.

Transient upper limb ischaemia during veno-arterial extracorporeal membrane oxygenation in a child.

Neck cannulation is the most common cannulation strategy performed to provide veno-arterial extracorporeal membrane oxygenation support in paediatric patients, especially in small children. Upper limb ischaemia is a rare complication of neck cannulation and is likely caused by arterial cannula malposition. We describe a case of right arm ischaemia caused by extrinsic compression of the right subclavian artery by the venous drainage cannula inserted through the right internal jugular vein. Upper limb hypoperfusion was resolved immediately after changing the venous drainage cannula from the right jugular vein to the right femoral vein.

Sleep profile predicts the cognitive decline of mild-moderate Alzheimer's disease patients.

STUDY OBJECTIVES: To investigate the association between sleep and cognitive decline of patients with mild-moderate Alzheimer's disease. METHODS: Observational, prospective study, including consecutive patients diagnosed with mild-moderate Alzheimer's disease. Cerebrospinal fluid was collected for amyloid-beta, total-tau, and phospho-tau levels determination. Also, overnight polysomnography was performed, followed by neuropsychological evaluations at baseline and after 12 months of follow-up. Principal component analysis revealed two profiles of patients in terms of sleep: one with a propensity to deepen the sleep (deep sleepers) and the other with a propensity to spend most of the time in the lighter sleep stage (light sleepers). RESULTS: The cohort included 125 patients with a median [IQR] of 75.0 [72.0;80.0] years. Deep and light sleepers did not present differences in relation to the cerebrospinal fluid pathological markers and to the cognitive function at the baseline. However, there was a significant difference of -1.51 (95% CI: -2.43 to -0.59) in the Mini-mental state examination after 12 months of follow-up. Accordingly, sleep depth and cognitive decline presented a dose-response relationship (p-for-trend = 0.02). Similar outcomes were observed in relation to the processing speed (Stroop words test, p-value = 0.016) and to the executive function (Verbal fluency test, p-value = 0.023). CONCLUSIONS: Considering the increased cognitive decline presented by light sleepers, the sleep profile may have a predictive role in relation to the cognitive function of patients with mild-moderate Alzheimer's disease. The modifiable nature of sleep sets this behavior as a possible useful intervention to prevent a marked cognitive decline. CLINICAL TRIAL INFORMATION: Role of Hypoxia Ans Sleep Fragmentation in Alzheimer's Disease. and Sleep Fragmentation. Completed. NCT02814045.

Pharmaceutical humanitarian assistance in the establishment of a drug compounding laboratory in a refugee camp.

In 1992 Medicus Mundi Mediterrània and the Sahrawi Arab Democratic Republic spearheaded a cooperation project to set up a small  drug compounding laboratory in the Sahrawi refugee camps located in the desert town of Rabouni (Algeria's Tindouf province). The goal of the  project was to build a drug compounding facility, create a training center  for local staff, and ensure local production of medicines in cases of  inadequate supply.With the help of external experts and of multiple public and private organizations and institutions, a small compounding laboratory was established with separate work areas, similar to the lines of the  laboratories found in Spanish hospitals. The laboratory now has a stable team of 10-12 pharmacy technicians led by a pharmacist. In the  last 25 years, 40 Sahrawis have been trained through internships in  hospital pharmacy departments abroad, visits to drug compounding labs in other countries, tutoring, and ongoing training programs. Products that  can be compounded in the laboratory include capsules, oral solutions,  creams and ointments, topical solutions, eye drops, and sterile irrigation  and lavage solutions. Over fifty different formulations of varying degrees of complexity have been prepared. One of the most significant challenges, given the political situation and the geographical environment, has been  the procurement and transportation of the active ingredients and the packaging materials/equipment required for the compounding process. After 25 years of continuous work, this project is now a reality thanks to the effort and direct involvement of the Sahrawi people. The experience gained in the last few years has shown the importance of coordinating drug preparation with local prescribing physicians, as well as having quality standards and facilities with homologated low complexity basic equipment that allows, in other areas that is required, the replication of this model.

En 1992, Medicus Mundi Mediterrània y la República Árabe Saharaui Democrática iniciaron un proyecto de cooperación para el  establecimiento de un pequeño laboratorio de producción de  medicamentos en los campamentos de refugiados del pueblo saharaui,  situado en pleno desierto del Sahara, concretamente en Rabuni, Tindouf  (Argelia). Los objetivos del proyecto fueron establecer una estructura e  instalaciones que permitieran la elaboración de medicamentos, crear un  centro de formación de personal local y facilitar cierta capacidad de  producción en situaciones de crisis o emergencia ante la falta de  medicamentos.Mediante el asesoramiento externo y la ayuda de múltiples organizaciones, instituciones y entidades privadas, se construyó un  pequeño laboratorio de características similares al que teníamos en los  hospitales españoles, con áreas diferenciadas de trabajo. El laboratorio  dispone de un equipo humano estable de 10-12 técnicos superiores de  farmacia dirigidos por un farmacéutico.A lo largo de estos 25 años se han formado y capacitado 40 saharauis, a través de estancias externas en servicios de farmacia, visitas a  laboratorios de producción de otros países, tutorización de farmacéuticos y cursos de formación continuada. Se han incluido varias líneas de  producción de medicamentos como: cápsulas, soluciones orales, cremas y  pomadas, soluciones tópicas, colirios, soluciones de irrigación y lavado  estériles. Se han elaborado más de 50 formulaciones distintas, todas ellas de diferente grado de complejidad. Una de las limitaciones más relevantes, por la situación y entorno, fue y sigue siendo la adquisición y envío de materia prima, material de acondicionamiento y/o equipos, necesarios en  cualquier proceso de elaboración. Después de estos 25 años de trabajo  continuado se evidencia la realidad de este proyecto, fruto del esfuerzo e  implicación del pueblo saharaui. La experiencia adquirida en estos años  plantea la extrema necesidad de coordinar las actividades de elaboración  con los equipos médicos y/o prescriptores de la zona, así como disponer  de estándares de calidad e instalaciones con equipos básicos homologados y de baja complejidad, que faciliten la replicación del modelo en distintos ámbitos y/o zonas de actuación.

Prevalence of obstructive sleep apnea in Alzheimer's disease patients.

OBJECTIVE: To assess the prevalence of obstructive sleep apnea (OSA) in patients with mild-moderate Alzheimer's Disease (AD) and to evaluate cognitive characteristics according to the severity of OSA. METHODS: Patients with mild-moderate AD, recruited prospectively from a cognitive impairment unit, underwent overnight polysomnography. OSA was defined as an apnea-hypopnea index > 5/h. AD severity was assessed using the Mini-Mental State Examination and extensive neuropsychological battery. Epworth Sleepiness Scale and APOE status were analyzed. RESULTS: The cohort included 128 patients with a median [IQR] age of 75.0 [72.0;79.2] years and 57.8% were women. OSA was diagnosed in 116 subjects (90.6%). The distribution of mild, moderate and severe severity of OSA was 29 (22.7%), 37 (28.9%) and 50 (39.1%), respectively. Regarding sleep symptoms, the cohort showed normal values of daytime sleepiness (median EES score 5 [3, 8]), while nycturia (89.1%) and snoring (71.1%) were the most common symptoms. Participants with severe OSA included a higher proportion of older men, were associated with snoring and sedentariness. No significant differences in cognitive assessment were found between patients with and without severe OSA in any of the domains. The prevalence of APOE ε4 was not significantly different between patients with and without severe OSA. CONCLUSION: There was a high prevalence of OSA in patients with mild-moderate AD. OSA was not associated with sleepiness or worse cognitive function. APOE ε4 was not related to the presence or severity of OSA. Further longitudinal studies will be required to evaluate whether OSA impairs cognitive evolution in AD patients.

The STOP-Bang and Berlin questionnaires to identify obstructive sleep apnoea in Alzheimer's disease patients.

BACKGROUND: A close relationship between obstructive sleep apnoea (OSA) and Alzheimer's disease (AD) has been described in recent years. OSA is a risk factor for AD, but the diagnosis and clinical characteristics of OSA in patients with AD is not well understood. This study evaluated the clinical utility of two screening questionnaires, the STOP-Bang questionnaire (SBQ) and the Berlin questionnaire (BQ), to identify which patients with mild AD are at higher risk of having OSA and to determine the clinical predictors of OSA in this population. METHODS: In this study, 91 consecutive outpatients with mild AD were prospectively evaluated with the SBQ and the BQ. All patients underwent level 1 in-laboratory polysomnography. The predictive performance of the questionnaires were calculated for different apnoea-hypopnoea index (AHI) cut-offs. RESULTS: The median age of the patients was 76.0 (73.0; 80.0) years, and 58 (63.7%) were female. Of those, 81 patients (89.02%) were found to have OSA defined by an AHI > 5 events/h. Comparing the predictive performances of the SBQ and the BQ, the SBQ was found to have a higher diagnostic sensitivity (85% vs 4%), a lower specificity (35% vs. 96%), a higher positive predictive value (PPV) (44% vs 33%) and negative predictive value (NPV) (80% vs 65%) for detecting severe OSA at an AHI cut-off of 30 events/h. None of the items alone in the two questionnaires predicted the risk of OSA. A modified version of the SBQ, with new cut-off points for several variables according to the characteristics of AD patients, showed a slightly greater AUC than the standard SBQ (AUC 0.61 vs 0.72). CONCLUSION: There is a high prevalence of OSA among patients with mild AD. The SBQ and the BQ are not good screening tools for detecting OSA in patients with AD. A modified version of SBQ could increase the detection of these patients.