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In the present investigation, ibotenic acid lesion of mediodorsal thalamic nuclei reduced the wakefulness and increased paradoxical sleep, which contradicts the reports from earlier lesion studies in cats. Glutamate excitation of mediodorsal thalamic nuclei produced prolonged wakefulness.

The results suggest that the mediodorsal thalamic nuclei augments arousal in the ascending reticular wake promoting pathways in contrast to the earlier reports that mediodorsal thalamic nucleus is involved in generation of slow wave sleep. The present study adds another evidence for the role of thalamus in sleep-wake regulation.

The results suggest that the mediodorsal thalamic nuclei augments arousal in the ascending reticular wake promoting pathways in contrast to the earlier reports that mediodorsal thalamic nucleus is involved in generation of slow wave sleep. The present study adds another evidence for the role of thalamus in sleep-wake regulation.

Second generation (atypical) antipsychotics are increasingly being used for treatment of insomnia, but there is little evidence to show long-term efficacy of these medication. This follow-up study was designed to assess patients with chronic insomnia who were treated with atypical antipsychotics.

In this follow-up study, forty patients with chronic insomnia were evaluated between 2016 and 2018 following after one year of treatment with two atypical antipsychotic drugs of olanzapine and quetiapine in two groups in the sleep disorders research center of Kermanshah University of Medical Science in Iran. The Pittsburgh Sleep Quality Questionnaire (PSQI) and 5 consecutive nights of Actigraphy were utilized to evaluate both subjective and objective measures of sleep quality. Lastly, sleep quality before and after treatment and comparisons of sleep quality between the two groups were performed.

Nine male participants comprised olanzapine group (n=22) and six male participants comprised the quetiapine group (n=18). The average age in the olanzapine group was 45.23±10.18 and the average age in the quetiapine group was 46.33±7.99. Results showed total PSQI score improved significantly in both groups (p<0.05), while the actigraphy results showed only significant improvement in sleep quality parameters in the quetiapine group (p<0.05).

Two atypical antipsychotics drugs of olanzapine and quetiapine have long-term efficacy in managing chronic insomnia. More improvements in objective sleep quality with quetiapine is promising for patients with chronic insomnia. Further research to evaluate long-term adverse effects of atypical antipsychotic drugs is recommended.

Two atypical antipsychotics drugs of olanzapine and quetiapine have long-term efficacy in managing chronic insomnia. More improvements in objective sleep quality with quetiapine is promising for patients with chronic insomnia. Further research to evaluate long-term adverse effects of atypical antipsychotic drugs is recommended.

Obstructive sleep apnoea (OSA) is the most common sleep disorder and its prevalence has increased with the obesity pandemic. We aimed to explore the presence of OSA in severe obesity and to evaluate the association of body mass index (BMI) with sleep architecture, cognition, emotional distress and comorbidities in OSA versus non-OSA patients.

A sample of 61 patients performed a neuropsychological battery that included tasks of attention, memory, perceptual/visuospatial ability, vocabulary, inhibition, cognitive flexibility and distress symptomatology, before overnight polysomnography.

More than half of the sample had OSA. Excessive daytime sleepiness was not a prominent complaint. Sleep architecture was worse in the OSA than in the non-OSA group, and hypertension was increased with OSA, especially in the severe OSA group. A higher BMI was associated with cognitive distress and sleep variables and with type 2 diabetes. The apnoea-hypopnoea index (AHI) was correlated with gender and cognitive measurementsment.

Chronic heart failure is associated with changes in sleep pattern and affects quality of sleep among patients with heart failure. Poor sleep has a negative impact on the patients' quality of life, furthermore it compromises cognition and one's self-care practice. Though, factors affecting sleep among heart failure patients have been investigated in developed world, there are limited studies in regards to it in developing countries like Ethiopia.

The aim of the study is to assess the level of sleep quality and associated factors among heart failure patients who are on follow up at Jimma Medical Center (JMC).

Hospital based cross sectional study was employed among the total sample of 111 chronic heart failure patients admitted to medical ward and having follow up at cardiac center of JMC. The data was collected from April 1 - April 30, 2019 through face-to-face interview by using structured questionnaire. Pittsburg Sleep Quality Index (PSQI) was applied to assess sleep quality. PSQI score <5 refers to tients. Age >65 years and comorbidities are predictors of poor sleep quality in these patients.

65 years and comorbidities are predictors of poor sleep quality in these patients.Substantial evidence suggests that the timing of macronutrient intake affects cardiovascular health. The present study aims to assess the association between the dietary carbohydrate intake (DCI) and the high-sensitivity C-reactive protein (hs-CRP) combined with the implication of the chronotype. Thus, we explored the most recently released National Health and Nutrition Examination Survey (NHANES) data. We analysed data from 5,616 participants of the NHANES in 2015. We selected participants with available data for the DCI, sleep and wake-up time, and the hs-CRP. Chronotypes were categorized according to the sleep times. Binary logistic regression analysis was performed to predict participants with low or high levels of hs-CRP based on the DCI and chronotypes. Moderation analysis was used to investigate the effect of the chronotypes on the DCI-hs-CRP's association. A higher DCI was significantly associated with the higher hs-CRP levels (odds ratio (OR) = 1.36, 95% confidence interval (CI) = [0.9-1.8]). Moderate evening (ME) chronotypes had higher risk for high hs-CRP level (OR = 1.15, 95% CI = [1.22-1.23]) compared to the intermediate and the morning chronotypes. The chronotype significantly moderated the hs-CRP given the DCI (moderation coefficient, α2=0.05, 95% CI = [0.01-0.08]). The chronotype diminished the hs-CRP predicted by the DCI. The findings of the study underscore the significance of assessing the protective effect of individuals' chronotype concerning cardiovascular health.Patients with symptomatic stage D heart failure who require left ventricular assist device (LVAD) support and suffer concomitant severe mitral regurgitation are often difficult to manage. One reason is due to cardiac anatomic constraints that limit optimization of the mechanical assist device. Typically, these patients are not candidates for repeat sternotomy with surgical mitral valve repair, and heart transplantation may not be feasible or timely. This case describes two patients with LVAD support who received transcatheter edge-to-edge mitral valve repair for severe, symptomatic mitral regurgitation. We believe this procedure may be a therapeutic option in stable patients with severe mitral regurgitation who require mechanical support.Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients' health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.The column in this issue is supplied by Drs. Benjamin Lee, MD, and Usman Ansari, DO. Dr. Lee is an assistant professor of clinical medicine at the Houston Methodist Institute for Academic Medicine and Weill Cornell Medical College. After earning his medical degree at Harvard Medical School, Dr. Lee completed a residency in internal medicine and a nephrology fellowship at the University of California San Francisco (UCSF) while simultaneously obtaining a master of advanced study in clinical research from the UCSF departments of Epidemiology and Biostatistics. He maintains his clinical practice with the Houston Kidney Consultants. Dr. Ansari earned a Doctor of Osteopathy from Touro University College of Osteopathic Medicine in California and is completing his internal medicine residency at Houston Methodist.An outflow graft twist of a left ventricular assist device (LVAD) remains a challenging clinical diagnosis and may even be misdiagnosed for other outflow obstructions. We present a case of a patient with two LVAD exchanges due to suspected outflow graft twisting in both clinical scenarios. As new LVADs continue to be designed and upgraded, clinicians must have a high index of suspicion for this rare complication.Loperamide, a μ-opioid receptor agonist, can cause cardiotoxicity by inhibiting the potassium ion channel and slowing cardiomyocyte repolarization. This, in turn, can lead to frequent early afterdepolarizations, the most common mechanism of drug-induced long QT syndrome and torsades de pointes. Apical hypertrophic cardiomyopathy (AHCM) is a nonobstructive hypertrophic cardiomyopathy rarely associated with malignant arrhythmias. We present a case of loperamide-induced malignant ventricular arrhythmia revealing underlying AHCM in a 25-year-old woman with a history of sudden cardiac arrest (SCA) and opioid use. It is important to evaluate for structural heart disease in all patients presenting with SCA, regardless of presumed etiology such as drug-induced cardiotoxicity, to prevent missed opportunities for adequate treatment. Furthermore, the diagnosis of AHCM in SCA warrants further genetic evaluation for variances with a predilection for malignant arrhythmias.The surgical treatment of atrial fibrillation (AF) has evolved significantly over the last 20 years and even more so in the last 5 years. selleck There are now many clinically successful surgical procedures focused on eliminating AF and AF-related stroke. This review discusses the current types of surgical AF procedures, including minimally invasive and hybrid, and may assist clinicians in understanding the various surgical AF options available to patients today.Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it is less effective for persistent AF. The vein of Marshall (VOM) is located in the epicardial left atrium and can be a source of AF triggers as well as a tract for autonomic nerves. It directly communicates with the underlying myocardium, including the left atrial ridge and the posterior mitral isthmus. This review discusses the latest evidence regarding the mechanisms, procedural aspects, and outcomes of VOM ethanol infusion when used as an adjunct to pulmonary vein isolation in patients with persistent AF.