Around 50% of patients with the sleep apnea/hypopnea syndrome (SAHS) are not obese: body mass index (BMI) < 30 kg/m2. We hypothesized that local fat deposition around the upper airway may be different in nonobese patients with SAHS from that in normal subjects with the same body mass. We therefore examined the relationship between indices of general obesity; BMI, neck circumference (NC), and percentage total body fat with neck fat deposition measured by magnetic resonance imaging in three matched subject groups. Nine nonobese, nonsnoring control subjects (BMI, 25 SE 0.7 kg/m2; NC, 38.1 SE 0.5 cm; age, 37.5 SE 2.5 yr), nine nonobese patients with SAHS (BMI, 25.7 SE 0.4 kg/m2; NC, 39.8 SE 0.8 cm; age, 40 SE 4.2 yr), and nine obese patients with SAHS matched to the other groups for age (BMI, 34 SE 1.1 kg/m2; NC, 43.9 SE 0.6 cm; age, 40 SE 2.7 yr). Neck volume and fat content were assessed from the hard palate to the vocal cords using T1-weighted images. Percentage total body fat was 30 and 44% greater in nonobese and obese patients with SAHS, respectively, than in control subjects. Neck tissue volume was 10% greater in nonobese and 28% greater in obese patients with SAHS than in control subjects. The percentage of neck tissue volume attributed to fat was 27% greater in nonobese and 67% greater in obese patients with SAHS than in control subjects. The excess fat in both the nonobese and obese patients with SAHS compared with that in control subjects was localized to areas anterolateral to the upper airway, the differences were 52 and 88%, respectively. There were no significant differences between nonobese patients with SAHS and control subjects with respect to fat located in other areas of the neck; obese patients with SAHS had 42% more fat than control subjects (p < 0.05). We conclude that even relatively nonobese patients with SAHS have excess fat deposition, especially anterolateral to the upper airway when compared with control subjects with the same level of obesity assessed using BMI and NC. This may contribute to their predisposition to SAHS.

Most patients with sleep apnoea/hypopnoea syndrome (SAHS) are middle-aged men. As there are conflicting data on the effects of age and gender on upper airway calibre, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in normal subjects.We measured upper airway calibre using acoustic reflection in 60 men and 54 women (median 35, range 16-74 yrs) both seated and supine.All upper airway dimensions, except oropharyngeal junction (OPJ), decreased with increasing age in both men and women (r>-0.24, p≤0.05) while supine (r 2 >0.06). Men had greater changes in airway area at OPJ on lying down (mean (SEM) 0.5 (0.1), 0.2 (0.1) cm 2 ; p<0.02). Men had greater body mass indices (mean (SD) 26 (4), 24 (4) kg·m -2 ; p=0.04), and larger neck circumferences (mean (SD) 38 (3), 33 (2) cm; p<0.0001) than women. For any body mass index, neck circumference was larger in men than women (p<0.001).This study shows that upper airway size decreases with increasing age in both men and women, and that men have greater upper airway collapsibility on lying down at oropharyngeal junction than women. Eur Respir J 1997; 10: 2087-2090 The effects of age and gender on upper airway calibre are unclear. Clarification of their influences is important because the clinical condition associated with upper airway narrowing, the sleep apnoea/hypopnoea syndrome (SAHS), is predominantly a condition of middle-aged men [1]. BROOKS and STROHL [2] reported men to have larger upper airway calibre than women when seated and awake. Studies performed in the sitting position have indicated that upper airways resistance increases, and pharyngeal area decreases [3] with age in men but not in women. In contrast, computed tomography (CT) scan studies in supine men have shown no age-related increase in upper airway collapsibility in men [4]. In order to clarify this, we tested the hypothesis that increasing age and the male sex predispose to upper airway narrowing in the normal population. Methods SubjectsWe aimed to select a cross section of the local population and therefore recruited 60 male and 54 female subjects from the hospital workforce using an advertisement that did not refer to sleep. Their height, weight and neck circumference at the cricothyroid membrane were measured (table 1). Subjects were asked whether they snored and in which position, and whether they suffered from uncontrollable daytime sleepiness. Responses were noted but no one was excluded from the analysis as this was a population-based study. However, subjects with gross retrognathia were assessed clinically and excluded from the analysis. The study was approved by the local Ethics Advisory Committee.

Background-Obesity and increased neck circumference are risk factors for the obstructive sleep apnoea/hypopnoea syndrome (SAHS). SAHS is more common in men than in women, despite the fact that women have higher rates of obesity and greater overall body fat. One factor in this apparently paradoxical sex distribution may be the diVering patterns of fat deposition adjacent to the upper airway in men and women. A study was therefore undertaken to compare neck fat deposition in normal men and women. Methods-Using T1 weighted magnetic resonance imaging, the fat and tissue volumes in the necks of 10 non-obese men and 10 women matched for age (men mean (SE) 36 ( Conclusions-There are diVerences in neck fat deposition between the sexes which, together with the greater overall soft tissue loading on the airway in men, may be factors in the sex distribution of SAHS. (Thorax 1999;54:323-328) Keywords: sleep apnoea; neck fat; sex diVerences; magnetic resonance imaging Sleep disordered breathing, snoring, and the sleep apnoea/hypopnoea syndrome (SAHS) are 2-8 times more common in men than in women in all adult age groups.1 2 In men these conditions are associated with obesity, increased neck circumference, and reduced cross sectional area of the upper airway, 3-6 all factors which predispose to the partial or complete obstruction of the upper airway.The male predominance in SAHS has not been fully explained and is in some respects paradoxical. Compared with men, a greater proportion of total body soft tissue in normal women is fat and obesity is more frequent in women.7 8 A condition strongly associated with obesity might therefore be predicted to show a higher frequency in women. Similarly, pharyngeal airway cross sectional area has been reported to be less in women when matched for body mass index (BMI), 9 which would be expected to predispose to airway obstruction. However, women do have a smaller neck circumference when matched for BMI and so overall mass loading on the upper airway may be less.10 Dynamic factors are also relevant; the upper airway when seated is smaller in women, but there is no diVerence between supine men and women. 10 This suggests that women have a greater ability to defend the airway against posture related changes, and a higher waking upper airway dilating muscle tone in women may provide a physiological basis for this. 11Magnetic resonance imaging (MRI) has become an established method for the in vivo quantification of fat tissue.12 13 Fat has a relatively short T1 relaxation time, so fatty tissue has a higher intensity than other soft tissues in T1 weighted spin echo MRI images. The availability of this technique has prompted a number of studies which have attempted to clarify the relationship between obesity and upper airway obstruction at a detailed anatomical level. Although there is a clear relationship between overall neck size and airway obstruction in men, 3 there is still controversy about the significance of the precise anatomical distribution of fat deposition in the neck. Ho...

In wireless ad hoc sensor networks, energy use is in many cases the most important constraint since it corresponds directly to operational lifetime. Topology management schemes such as GAF put the redundant nodes for routing to sleep in order to save the energy. The radio range will affect the number of neighbouring nodes, which collaborate to forward data to a base station or sink. In this paper we study a simple linear network and deduce the relationship between optimal radio range and traffic. We find that half of the power can be saved if the radio range is adjusted appropriately compared with the best case where equal radio ranges are used.

A novel mutation in OTX2 binds normally to target genes and acts as a dominant negative inhibitor of HESX1 gene expression. This suggests that the expression of HESX1, required for spaciotemporal development of anterior pituitary cell types, when disrupted, results in an absent or underdeveloped anterior pituitary with diminished hormonal expression. These results demonstrate a novel mechanism for CPHD and extend our knowledge of the spectrum of gene mutations causing CPHD.

Cerebrolysin (Cere) is a compound with neurotrophic activity shown to be effective in Alzheimer's disease in earlier trials. The efficacy and safety of three dosages of Cere were investigated in this randomized, double-blind, placebo-controlled, study. Two hundred and seventy-nine patients were enrolled (69 Cere 10 ml; 70 Cere 30 ml; 71 Cere 60 ml and 69 placebo). Patients received iv infusions of 10, 30, 60 ml Cere or placebo 5 days/week for the first 4 weeks and thereafter, two iv infusions per week for 8 weeks. Effects on cognition and clinical global impressions were evaluated 4, 12 and 24 weeks after the beginning of the infusions using the CIBIC+ and the modified Alzheimer's Disease Assessment Scale (ADAS)-cog. At week 24, significant improvement of cognitive performance on the ADAS-cog (P=0.038) and global function (CIBIC+; P>0.001) was observed for the 10 ml dose. The 30 and 60 ml doses showed significant improvement of the global outcome but failed to show significant improvement of cognition. The results are consistent with a reversed U-shaped dose-response relationship for Cere. The percentage of patients reporting adverse events was similar across all study groups. Cere treatment was well tolerated and led to significant, dose-dependent improvement of cognition and global clinical impression.

Congenital adrenal hyperplasia (CAH) refers to a family of monogenic inherited disorders of adrenal steroidogenesis most often caused by enzyme 21-hydroxylase deficiency (21-OHD). In the classic forms of CAH (simple virilizing and salt wasting), androgen excess causes external genital ambiguity in newborn females and progressive postnatal virilization in males and females. Prenatal treatment of CAH with dexamethasone has been successfully used for over a decade. This article serves as an update on 532 pregnancies prenatally diagnosed using amniocentesis or chorionic villus sampling between 1978 and 2001 at New York Presbyterian Hospital-Weill Medical College of Cornell University. Of the 532 pregnancies, 281 were prenatally treated for CAH due to the risk of 21-hydroxylase deficiency. Follow-up telephone interviews with mothers, genetic counselors, endocrinologists, pediatricians, and obstetricians were performed in all cases. Of the pregnancies evaluated, 116 babies were affected with classic 21-OHD. Of these, 61 were female, 49 of whom were treated prenatally with dexamethasone. Dexamethasone administered at or before 9 wk gestation (in proper doses) was effective in reducing virilization. There were no statistical differences in the symptoms during pregnancy between mothers treated with dexamethasone and those not treated with dexamethasone, except for weight gain, edema, and striae, which were greater in the treated group. No significant or enduring side-effects were noted in the fetuses, indicating that dexamethasone treatment is safe. Prenatally treated newborns did not differ in weight from untreated, unaffected newborns. Based on our experience, prenatal diagnosis and proper prenatal treatment of 21-OHD are effective in significantly reducing or eliminating virilization in the newborn female. This spares the affected female the consequences of genital ambiguity, genital surgery, and possible sex misassignment.

BACKGROUND Despite extensive research and interest in endocrine disruptors, there are essentially no epidemiologic studies of estrogenic mycotoxins, such as zeranol and zearalenone (ZEA). ZEA mycoestrogens are present in grains and other plant foods through fungal contamination, and in animal products (e.g., meat, eggs, dairy products) through deliberate introduction of zeranol into livestock to enhance meat production, or by indirect contamination of animals through consumption of contaminated feedstuff. Zeranol is banned for use in animal husbandry in the European Union and other countries, but is still widely used in the US. Surprisingly, little is known about the health effects of these mycoestrogens, including their impact on puberty in girls, a period highly sensitive to estrogenic stimulation. OBJECTIVES AND METHODS We conducted a cross-sectional analysis among 163 girls, aged 9 and 10 years, participating in the Jersey Girl Study to measure urinary mycoestrogens and their possible relationship to body size and development. RESULTS We found that mycoestrogens were detectable in urine in 78.5% of the girls, and that urinary levels were predominantly associated with beef and popcorn intake. Furthermore, girls with detectable urinary ZEA mycoestrogen levels tended to be shorter and less likely to have reached the onset of breast development. CONCLUSIONS Our findings suggest that ZEA mycoestrogens may exert anti-estrogenic effects similar to those reported for isoflavones. To our knowledge, this was the first evaluation of urinary mycoestrogens and their potential health effects in healthy girls. However, our findings need replication in larger studies with more heterogeneous populations, using a longitudinal approach.