Time course of pulmonary artery pressure during sleep in sleep apnoea syndrome: role of recurrent apnoeas

Recent results in animals have suggested that repetition of hypoxaemic stimuli may result in a progressive increase in pulmonary arterial pressure (Ppa). The purpose of the present study was to investigate the effects of recurrent obstructive apnoeas on Ppa. We have, therefore, examined the nocturnal trend of Ppa in seven obstructive sleep apnoea syndrome (OSAS) patients and in five snorers. Mean Ppa was measured before, at the start, at the end and after the selected apnoeas. The analysis was performed for each 1 h period for at least 7 h throughout the night on at least 10 randomly selected apnoeas per hour. In snorers, 100 randomly chosen values were measured during every hour of the night. In the morning after the nocturnal study, the Ppa responses to acute hypoxia and hypercapnia were measured. No Ppa changes throughout the 7 h were found during sleep in snorers [Ppa slope:-0.002+/-0.10 mmHg x h(-1)]. In OSAS patients a small but significant increase in Ppa throughout the night was noted, affecting the values before [Ppa slope: 0.7+/-0.16 mmHg x h(-1)], at the start of apnoea [Ppa slope: 0.530.1 mmHg x h(-1)] as well as at the end [Ppa slope: 0.44+/-0.08 mmHg x h(-1)] and in the postapnoeic period [Ppa slope: 0.55+/-0.1 mmHg x h(-1)]. When we limited the analysis to nonrapid eye movement (NREM) sleep, a trend in progressive Ppa was also present, irrespective of changes in apnoea duration and apnoea desaturation. The Ppa rise during the night was not affected by diurnal Ppa pulmonary vascular response to hypoxia and hypercapnia or indices of sleep apnoea severity. We conclude that in obstructive sleep apnoea, pulmonary artery pressure progressively increases during the night, reflecting the cumulative effects of apnoeas and nocturnal hypoxaemia.     

Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.     

Moult speed predicts pairing success in male harlequin ducks

The bright plumage of male ducks in sexually dichromatic species is thought to have evolved through intense sexual selection. This study examined the relationship between the timing and speed of moult into this bright plumage and subsequent mating success of male harlequin ducks, Histrionicus histrionicus. Males that moulted relatively slowly had a lower chance of establishing a pair bond than others. The timing of moult was unrelated to whether a male obtained a mate. Moult speed and timing were not correlated within individual males, but were significantly repeatable in individual males over 2 years. Moult speed probably reflects the condition of males, whereas timing of moult is more likely to be related to the distance to an individual's breeding area, which determines the timing of arrival to the moulting grounds. In waterfowl species that have been studied, males usually form dominance hierarchies before pairing and females tend to choose dominant males. We suggest that male harlequin ducks that moult slowly are poor-quality individuals, which are relegated to subordinate status and are unlikely to attract a mate the following autumn. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.     

Effect of 5-hydroxytryptamine on the peripheral chemoreceptors in the rat

5-Hydroxytryptamine (5-HT), in the doses of 2-5 mug/kg injected into the carotid body area, produced a significant increase in the respiratory rate and carotid sinus nerve activity. Selective ablation of the ipsilateral carotid sinus nerve abolished the respiratory stimulation produced by the drug. On the other hand, the same doses of 5-HT injected into the ascending aorta did not produce stimulation of respiration when the carotid sinus nerves were sectioned. The activity of the aortic nerves did not increase after injecting the drug into the ascending aorta or at the root of the right subclavian artery. These results indicate that 5-HT stimulates the chemoreceptors in the carotid body of the rat. The lack of responses to the injections of the drug in the aortic or subclavian region was due to the absence of chemoreceptors in these regions of the rat.     

A Carrier-Based Unipolar PWM Current Controller That Minimizes the PWM-Cycle Average Current-Error Using Internal Feedback of the PWM Signals

A carrier-based unipolar pulsewidth modulation (PWM) current controller is described using a one-phase PWM rectifier bridge as a test circuit. The controller PWM signal generator uses a sawtooth carrier signal to obtain both synchronized PWM waveforms and a constant switching frequency. A current-error signal and an amplitude modulation depth signal are used to create the input reference signal to the PWM signal generator. The amplitude modulation depth signal is obtained from the PWM-cycle average of the PWM signal generator output signals. This internal feedback is illustrated using a second-order low pass Butterworth filter. With an appropriately designed low-pass filter, the current-error signal is forced to be centered on zero over a PWM cycle. The maximum peak-peak magnitude of the current-error signal is used as a design guideline for deciding an appropriate gain constant in the controller current feedback loop. The low pass filter design is examined to determine a suitable gain and 20-dB attenuation frequency to minimize the current-error signal. The steady-state and transient operation of the proposed current controller is compared with a proportional-integral controller and an average current-error controller. SPICE simulations and experimental results are used to demonstrate the characteristics of the controller.     

Experimentelle Bestimmung der spezifischen elektrischen Leitfähigkeit hoch CaF2-haltiger Schlacken

In a comprehensive literature study applied measurement methods for determination of the specific electrical conductivity of slags were compared. Based on these conclusions, a Tammann furnace was modified to a conductivity measuring system with four electrodes. A qualitative and quantitative comparison of results from literature with the practical results of multiple investigations of CaF₂ slags with a purity of 99.5% was carried out.