Sleep and circadian phase in a ship's crew

Numerous factors influence the increased health risks of seamen. This study investigated sleep (by actigraphy) and the adaptation of the internal clock in watch-keeping crew compared to day workers, as possible contributory factors. Fourteen watch keepers, 4 h on, 8 h off (0800-1200/2000-2400 h, 1200-1600/2400-0400 h, 1600-2000/0400-0800 h) (fixed schedule, n = 6; rotating by delay weekly, n = 8), and 12 day workers participated during a voyage from the United Kingdom to Antarctica. They kept daily sleep diaries and wore wrist monitors for continuous recording of activity. Sleep parameters were derived from activity using the manufacturer's software and analyzed by repeated-measures ANOVA using SAS 8.2. Sequential urine samples were collected for 48 h weekly for 6-sulphatoxymelatonin measurement as an index of circadian rhythm timing. Individuals working watches of 1200-1600/2400-0400 h and 1600-2000/0400-0800 h had 2 sleeps daily, analyzed separately as main sleep (longest) and 2nd sleep. Main sleep duration was shorter in watch keepers than in day workers (p < 0.0001). Objective sleep quality was significantly compromised in rotaters compared to both day workers and fixed watch keepers, the most striking comparisons being sleep efficiency (percentage desired sleep time spent sleeping) main sleep (p < 0.0001) and sleep fragmentation (an index of restlessness) main sleep (p < 0.0001). The 2nd sleep was substantially less efficient than was the main sleep (p < 0.0001) for all watch keepers. There were few significant differences in sleep between the different watches in rotating watch keepers. Circadian timing remained constant in day workers. Timing of the 6-sulphatoxymelatonin rhythm was later for the watch of 1200-1600/2400-0400 h than for all others (1200-1600/2400-0400 h, 5.90 +/- 0.85 h; 1600-2000/0400-0800 h, 1.5 +/- 0.64 h; 0800-1200/ 2000-2400 h, 2.72 +/- 0.76 h; days, 2.09 +/- 0.68 h [decimal hours, mean +/- SEM]: ANOVA, p < 0.01). This study identifies weekly changes in watch time as a cause of poor sleep in watch keepers. The most likely mechanism is the inability of the internal clock to adapt rapidly to abrupt changes in schedule.

Alerting effects of light are sensitive to very short wavelengths

In humans a range of non-image-forming (NIF) light responses (melatonin suppression, phase shifting and alertness) are short wavelength sensitive (440-480 nm). The aim of the current study was to assess the acute effect of three different short wavelength light pulses (420, 440 and 470 nm) and 600 nm light on subjective alertness. Healthy male subjects (n = 12, aged 27 +/- 4 years, mean +/- S.D.) were studied in 39, 4-day laboratory study sessions. The subjects were maintained in dim light (<8 lx) and on day 3 they were exposed to a single 4-h light pulse (07:15-11:15 h). Four monochromatic wavelengths were administered at two photon densities: 420 and 440 nm at 2.3 x 10(13)photons/cm(2)/s and 440, 470 and 600 nm at 6.2 x 10(13)photons/cm(2)/s. Subjective mood and alertness were assessed at 30 min intervals during the light exposure, using four 9-point VAS scales. Mixed model regression analysis was used to compare alertness and mood ratings during the 470 nm light to those recorded with the other four light conditions. There was a significant effect of duration of light exposure (p < 0.001) on alertness but no significant effect of subject. Compared to 470 nm light, alertness levels were significantly higher in 420 nm light and significantly lower in the 600 nm light (p < 0.05). These data (420 nm>470 nm>600 nm) suggest that subjective alertness may be maximally sensitive to very short wavelength light.

Melatonin: characteristics, concerns, and prospects

Melatonin is of great importance to the investigation of human biological rhythms. Its rhythm in plasma or saliva provides the best available measure of the timing of the internal circadian clock. Its major metabolite 6-sulphatoxymelatonin is robust and easily measured in urine. It thus enables long-term monitoring of human rhythms in real-life situations where rhythms may be disturbed, and in clinical situations where invasive procedures are difficult. Melatonin is not only a "hand of the clock"; endogenous melatonin acts to reinforce the functioning of the human circadian system, probably in many ways. Most is known about its relationship to sleep and the decline in core body temperature and alertness at night. Current perspectives also include a possible influence on major disease risk, arising from circadian rhythm disruption. Melatonin clearly has the ability to induce sleepiness and lower core body temperature during "biological day" and to change the timing of human rhythms when treatment is appropriately timed. It can entrain free-running rhythms and maintain entrainment in most blind and some sighted people. Used therapeutically it has proved a successful treatment for circadian rhythm disorder, particularly the non-24-h sleep wake disorder of the blind. Numerous other clinical applications are under investigation. There are, however, areas of controversy, large gaps in knowledge, and insufficient standardization of experimental conditions and analysis for general conclusions to be drawn with regard to most situations. The future holds much promise for melatonin as a therapeutic treatment. Most interesting, however, will be the dissection of its effects on human genes.

Melatonin as a chronobiotic

Melatonin, hormone of the pineal gland, is concerned with biological timing. It is secreted at night in all species and in ourselves is thereby associated with sleep, lowered core body temperature, and other night time events. The period of melatonin secretion has been described as 'biological night'. Its main function in mammals is to 'transduce' information about the length of the night, for the organisation of daylength dependent changes, such as reproductive competence. Exogenous melatonin has acute sleepiness-inducing and temperature-lowering effects during 'biological daytime', and when suitably timed (it is most effective around dusk and dawn) it will shift the phase of the human circadian clock (sleep, endogenous melatonin, core body temperature, cortisol) to earlier (advance phase shift) or later (delay phase shift) times. The shifts induced are sufficient to synchronise to 24 h most blind subjects suffering from non-24 h sleep-wake disorder, with consequent benefits for sleep. Successful use of melatonin's chronobiotic properties has been reported in other sleep disorders associated with abnormal timing of the circadian system: jetlag, shiftwork, delayed sleep phase syndrome, some sleep problems of the elderly. No long-term safety data exist, and the optimum dose and formulation for any application remains to be clarified.

Melatonin advances the circadian timing of EEG sleep and directly facilitates sleep without altering its duration in extended sleep opportunities in humans

The rhythm of plasma melatonin originating from the pineal gland and driven by the circadian pacemaker located in the suprachiasmatic nucleus is closely associated with the circadian (approximately 24 h) variation in sleep propensity and sleep spindle activity in humans. We investigated the contribution of melatonin to variation in sleep propensity, structure, duration and EEG activity in a protocol in which sleep was scheduled to begin during the biological day, i.e. when endogenous melatonin concentrations are low. The two 14 day trials were conducted in an environmental scheduling facility. Each trial included two circadian phase assessments, baseline sleep and nine 16 h sleep opportunities (16.00-08.00 h) in near darkness. Eight healthy male volunteers (24.4 +/- 4.4 years) without sleep complaints were recruited, and melatonin (1.5 mg) or placebo was administered at the start of the first eight 16 h sleep opportunities. During melatonin treatment, sleep in the first 8 h of the 16 h sleep opportunities was increased by 2 h. Sleep per 16 h was not significantly different and approached asymptotic values of 8.7 h in both conditions. The percentage of rapid eye movement (REM) sleep was not affected by melatonin, but the percentage of stage 2 sleep and sleep spindle activity increased, and the percentage of stage 3 sleep decreased. During the washout night, the melatonin-induced advance in sleep timing persisted, but was smaller than on the preceding treatment night and was consistent with the advance in the endogenous melatonin rhythm. These data demonstrate robust, direct sleep-facilitating and circadian effects of melatonin without concomitant changes in sleep duration, and support the use of melatonin in the treatment of sleep disorders in which the circadian melatonin rhythm is delayed relative to desired sleep time.

The effects of low-dose 0.5-mg melatonin on the free-running circadian rhythms of blind subjects

Exogenous melatonin (0.5-10 mg) has been shown to entrain the free-running circadian rhythms of some blind subjects. The aim of this study was to assess further the entraining effects of a daily dose of 0.5 mg melatonin on the cortisol rhythm and its acute effects on subjective sleep in blind subjects with free-running 6-sulphatoxymelatonin (aMT6s) rhythms (circadian period [tau] 24.23-24.95 h). Ten subjects (9 males) were studied, aged 32 to 65 years, with no conscious light perception (NPL). In a placebo-controlled, single-blind design, subjects received 0.5 mg melatonin or placebo p.o. daily at 2100 h (treatment duration 26-81 days depending on individuals' circadian period). Subjective sleep was assessed from daily sleep and nap diaries. Urinary cortisol and aMT6s were assessed for 24 to 48 h weekly and measured by radioimmunoassay. Seven subjects exhibited an entrained or shortened cortisol period during melatonin treatment. Of these, 4 subjects entrained with a period indistinguishable from 24 h, 2 subjects continued to free run for up to 25 days during melatonin treatment before their cortisol rhythm became entrained, and 1 subject appeared to exhibit a shortened cortisol period throughout melatonin treatment. The subjects who entrained within 7 days did so when melatonin treatment commenced in the phase advance portion of the melatonin PRC (CT6-18). When melatonin treatment ceased, cortisol and aMT6s rhythms free ran at a similar period to before treatment. Three subjects failed to entrain with initial melatonin treatment commencing in the phase delay portion of the PRC. During melatonin treatment, there was a significant increase in nighttime sleep duration and a reduction in the number and duration of daytime naps. The positive effect of melatonin on sleep may be partly due to its acute soporific properties. The findings demonstrate that a daily dose of 0.5 mg melatonin is effective at entraining the free-running circadian systems in most of the blind subjects studied, and that circadian time (CT) of administration of melatonin may be important in determining whether a subject entrains to melatonin treatment. Optimal treatment with melatonin for this non-24-h sleep disorder should correct the underlying circadian disorder (to entrain the sleep-wake cycle) in addition to improving sleep acutely.

Acute exposure to circularly polarized 50-Hz magnetic fields of 200-300 microT does not affect the pattern of melatonin secretion in young men

Environmental exposure to time-varying (alternating current) magnetic fields (MFs) produced by electrical current flow is a perceived public health risk. Several epidemiological studies report correlations between MF exposure and carcinogenesis. It has been hypothesized that MF-induced suppression of melatonin could provide the mechanism by which this effect is mediated. Here, we describe results from a controlled laboratory-based study designed to detect changes in human melatonin secretion after a 2-h exposure to 200-300 microTesla, 50 Hz circularly polarized MF. Exposure was timed to occur before or during the nightly melatonin rise, and levels administered were some 4-6 times higher than the commonly encountered maximum levels. Results from 19 male subjects aged between 18 and 35 yr indicate that acute exposure to 50 Hz MFs of this nature does not result in significant suppression, alteration of peak levels, or a change in timing of the nighttime melatonin rise. We conclude that acute exposure to 50 Hz MFs does not have a significant effect on the normal nighttime production of melatonin in young men.

Melatonin phase-shifts human circadian rhythms with no evidence of changes in the duration of endogenous melatonin secretion or the 24-hour production of reproductive hormones

The pineal hormone melatonin is a popular treatment for sleep and circadian rhythm disruption. Melatonin administered at optimal times of the day for treatment often results in a prolonged melatonin profile. In photoperiodic (day length-dependent) species, changes in melatonin profile duration influence the timing of seasonal rhythms. We investigated the effects of an artificially prolonged melatonin profile on endogenous melatonin and cortisol rhythms, wrist actigraphy, and reproductive hormones in humans. Eight healthy men took part in this double-blind, crossover study. Surge/sustained release melatonin (1.5 mg) or placebo was administered for 8 d at the beginning of a 16-h sleep opportunity (1600 h to 0800 h) in dim light. Compared with placebo, melatonin administration advanced the timing of endogenous melatonin and cortisol rhythms. Activity was reduced in the first half and increased in the second half of the sleep opportunity with melatonin; however, total activity during the sleep opportunities and wake episodes was not affected. Melatonin treatment did not affect the endogenous melatonin profile duration, pituitary/gonadal hormone levels (24-h), or sleepiness and mood levels on the subsequent day. In the short term, suitably timed sustained-release melatonin phase-shifts circadian rhythms and redistributes activity during a 16-h sleep opportunity, with no evidence of changes in the duration of endogenous melatonin secretion or pituitary/gonadal hormones.

A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference

STUDY OBJECTIVES

To investigate the link between extreme diurnal preference, delayed sleep phase syndrome, and a length polymorphism in Per3.

DESIGN

Subjects were genotyped using polymerase chain reaction.

PATIENTS OR PARTICIPANTS

Subjects with defined diurnal preference as determined by the Horne-Ostberg questionnaire and patients with delayed sleep phase syndrome.

MEASUREMENTS AND RESULTS

The Per3 polymorphism correlated significantly with extreme diurnal preference, the longer allele associating with morningness and the shorter allele with eveningness. The shorter allele was strongly associated with the delayed sleep phase syndrome patients, 75% of whom were homozygous.

CONCLUSION

The length of the Per3 repeat region identifies a potential genetic marker for extreme diurnal preference.

Phase advancing human circadian rhythms with short wavelength light

The photoreceptor(s) responsible for photoresetting of the human circadian system have not been identified. The aim of the present study was to assess the ability of short wavelength light to alter the timing of circadian rhythms. Eleven male subjects were studied in 15 4-day trials with a single 4 h light pulse administered on day 3, immediately after habitual wake time. The magnitude of the phase shifts in the melatonin acrophase and offset were similar after white (4300 microW/cm(2)) and short wavelength (28 microW/cm(2)) light exposure even though the white light pulse contained 185-fold more photons than the short wavelength light. This finding suggests short wavelength sensitivity of the photoreceptors mediating synchronization of human circadian rhythms.

[The treatment of assisted reproduction--clinical and preclinical aspects, functioning of the Unit of Human Reproduction at the Central Hospital of Luxembourg]

Since a few years the OBGYN department at the Centre Hospitalier in Luxembourg has intensified its practice of ART with the introduction of a multidisciplinary team and a decentralized IVF program. While clinical investigations, cycle-monitoring and surgery, oocyte pick-up are commonly performed at the CHL, the biological supplement is transferred to next situated Belgian laboratories. As Luxembourg has no national bio-ethical law, we apply partly the French law of 1994.

Importance and relevance of melatonin to human biological rhythms

The pineal hormone melatonin is a remarkable molecule, with a conserved time-keeping function across species. It is extensively used as a self-administered remedy for sleep disturbance in countries where it is freely available, and to some extent when it is available on prescription, as in the UK. In some circumstances, notably free-running sleep disorder of the blind, it is the treatment of choice. It is also the marker rhythm of choice for the determination of circadian phase and period. This review outlines the current state of knowledge within a physiological perspective with emphasis on human biological rhythms.

Does melatonin improve sleep in older people? A randomised crossover trial

STUDY OBJECTIVE

to determine whether melatonin will improve quality of sleep in healthy older people with age-related sleep maintenance problems.

DESIGN

a double blind randomised placebo controlled crossover trial in healthy older volunteers.

SETTING

a largely urban population, Auckland, New Zealand.

PARTICIPANTS

participants were part of the larger Possible Role of Melatonin in Sleep of Elders study. People 65 years or more of age were recruited through widespread advertising. We screened 414 potential participants by mail using the Pittsburgh Sleep Quality Index, and selected 194 for clinic interview. Exclusions included depression, cognitive impairment, hypnosedative medications, sleep phase abnormalities, medical and/or environmental problems that might impair sleep. Twenty normal and 20 problem sleepers were randomly allocated for this study from a larger sample of 60 normal and 60 problem sleepers.

MEASUREMENTS AND RESULTS

24-hour urine 6-sulphatoxymelatonin was measured to estimate melatonin secretion in each participant. Five milligrams of melatonin, or matching placebo were each taken at bedtime for 4 weeks, separated by a 4-week washout period. Sleep quality was measured using sleep diaries, the Leeds Sleep Evaluation Questionnaire, and actigraphy. There was a significant difference between the groups in self-reported sleep quality indicators at entry, but no difference in melatonin secretion. Melatonin did not significantly improve any sleep parameter measured in either group.

CONCLUSION

5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems.

Circularly polarised MF (500 micro T 50 Hz) does not acutely suppress melatonin secretion from cultured Wistar rat pineal glands

Magnetic fields (MF, 50 Hz) have been proposed to affect melatonin production in mammals; however, there is very little data about the mechanism by which this possible interaction may occur. Here we describe results from the first study in which circularly polarised 50 Hz MF have been administered to isolated pineals in highly controlled conditions. Melatonin release from isolated Wistar rat pineal glands, dissected 2 h after light onset ZT 2, was measured in a flow through culture system, during and after exposure to a 4 h MF similar in nature and magnitude to that produced in extremely close proximity to a high voltage power line (500 micro T 50 Hz circularly polarised). Melatonin release from isolated pineals was comparable to that observed in previous studies, plateauing to approximately 100 pg/ml/30 min. No significant alterations in pineal melatonin release were caused by exposure to the MF when compared to sham exposure (< 1 micro T). These results suggest that if the circadian system is acutely responsive to MF exposure of this nature, an intact circadian axis may be necessary in order to observe an effect on the production on melatonin from the pineal gland

Circadian neuroendocrine physiology and electromagnetic field studies: precautions and complexities

The suppression of melatonin by exposure to low frequency electromagnetic fields (EMFs) 'the melatonin hypothesis'. has been invoked as a possible mechanism through which exposure to these fields may result in an increased incidence of cancer. While the effect of light on melatonin is well established, data showing a similar effect due to EMF exposure are sparse and, where present, are often poorly controlled. The current review focuses on the complexities associated with using melatonin as a marker and the dynamic nature of normal melatonin regulation by the circadian neuroendocrine axis. These are issues which the authors believe contribute significantly to the lack of consistency of results in the current literature. Recommendations on protocol design are also made which, if followed, should enable researchers to eliminate or control for many of the confounding factors associated with melatonin being an output from the circadian clock.

The 3111 Clock gene polymorphism is not associated with sleep and circadian rhythmicity in phenotypically characterized human subjects

Mutations in clock genes are associated with abnormal circadian parameters, including sleep. An association has been reported previously between a polymorphism (3111C), situated in the 3'-untranslated region (3'-UTR) of the circadian gene Clock and evening preference. In the present study, this polymorphism was assessed in: (1) 105 control subjects with defined diurnal preference, (2) 26 blind subjects with free-running circadian rhythms and characterized with regard to circadian period (tau) and (3) 16 delayed sleep phase syndrome patients. The control group was chosen from a larger population (n = 484) by Horne-Ostberg questionnaire analysis, from which three subgroups were selected (evening, intermediate and morning preference). Data from sleep diaries completed by 90% of these subjects showed a strong correlation between preferred and estimated timings of sleep and wake. The mean timings of activities for the evening group were at least 2 h later than the morning group. Genetic analysis showed that, in contrast with the previously published finding, there was no association between 3111C and eveningness. Neither was there an association between 3111C and tau, nor a significant difference in 3111C frequency between the normal and delayed sleep phase syndrome groups. To assess the effect of this polymorphism on messenger RNA (mRNA) translatability, luciferase reporter gene constructs containing the two Clock polymorphic variants in their 3'-UTR were transfected into COS-1 cells and luciferase activity measured. No significant difference was observed between the two variants. These results do not support Clock 3111C as a marker for diurnal preference, tau, or delayed sleep phase syndrome in humans.

Human circadian phase in 12:12 h, 200: <8 lux and 1000: <8 lux light-dark cycles, without scheduled sleep or activity

The light levels required to maintain human circadian phase in the absence of other strong time cues are not defined. We investigated circadian phase in two groups of men, living in partial temporal isolation, exposed to 12 h:12 h light:dark cycles of: (A) 200: <8 lux, broad spectrum white light for 14 days; and (B) 1000: <8lux for 14 days. The rhythm variables measured were urinary 6-sulphatoxymelatonin, rectal temperature, activity and rest (actigraphy and sleep logs). In 200: <8 lux four/six individuals showed phase delays. Exposure to 1000: <8 lux appeared to maintain synchronisation of rest-activity to 24 h, but with a significant overall phase advance of 0.81 h in temperature. These observations suggest that domestic intensity light does not maintain phase without scheduled sleep/activity, possibly due to indirect effects on behaviour influencing light exposure.

[The long-term evaluation of artificial myoplastic anus and artificial classical anus based on manometric and radiological examinations]

The aim of this study was comparative evaluation of the pressure profile in the artificial myoplastic anus and the one created by the use of classical method. Radiological examinations of the colon by the use of the contrasting agent were performed in all patients in each group. In the group of patients with artificial myoplastic anus radiological examinations showed the narrowing of the lumen 4-7 cm in length in all patients. Above the narrowing the widening of the lumen was present. Reflexive flow of the contrasting agent from the colon was not present. In the group of patients with the artificial classical anus the narrowing of the terminal part of the colon was not noticed in the radiological examination. In all patients the reverse flow of the contrasting agent through the artificial anus was observed. Patients with the artificial myoplastic anus created by the use of pedunculated fold of the muscular coat of the colon have much higher average pressures around the myoplastic sphincter than in the presphincteric area, while the patients with the artificial classical anus did not present the area with the increased pressure in the terminal part of the colon. The possibility of preventing uncontrolled defecation and flatulence by the patients with the artificial myoplastic anus is related to the repeatedly higher pressures around the sphincter than in the presphincteric area, which do not decrease as the time passes by after the surgery.

Adaptation of the circadian rhythm of 6-sulphatoxymelatonin to a shift schedule of seven nights followed by seven days in offshore oil installation workers

This study evaluated circadian adaptation in a 'swing shift' schedule (seven nights, 18:00-06:00 h; then 7 days, 06:00-18:00 h) on North Sea oil installations. Eleven healthy men provided sequential urine collections for the study period offshore. The urinary melatonin metabolite 6-sulphatoxymelatonin (aMT6s) was used as an index of circadian phase. A significant difference (P=0.0004) was found between the mean aMT6s acrophase (calculated peak time) at the start (+/-SD: 05:34+/-2.42 h) and end (+/-SD: 10.95+/-3.34 h) of the night shift week, but not between the start (+/-SD: 11:04+/-4.03 h) and end (+/-SD: 12:59+/-8.83 h) of the day shift week. As a group, the subjects adapted to the night shift but very large individual variations were seen during the day shift. These individual differences clearly require further study.

Postprandial hormone and metabolic responses amongst shift workers in Antarctica

The circadian rhythms of many night-shift workers are maladapted to their imposed behavioural schedule, and this factor may be implicated in the increased occurrence of cardiovascular disease (CVD) reported in shift workers. One way in which CVD risk could be mediated is through inappropriate hormonal and metabolic responses to meals. This study investigated the responses to standard meals at different circadian times in a group of night-shift workers on a British Antarctic Survey station at Halley Bay (75 degrees S) in Antarctica. Twelve healthy subjects (ten men and two women) were recruited. Their postprandial hormone and metabolic responses to an identical mixed test meal of 3330 kJ were measured on three occasions: (i) during daytime on a normal working day, (ii) during night-time at the beginning of a period of night-shift work, and (iii) during the daytime on return from night working to daytime working. Venous blood was taken for 9 h after the meal for the measurement of glucose, insulin, triacylglycerol (TAG) and non-esterified fatty acids. Urine was collected 4-hourly (longer during sleep) on each test day for assessment of the circadian phase via 6-sulphatoxymelatonin (aMT6s) assay. During normal daytime working, aMT6s acrophase was delayed (7.7+/-1.0 h (s.e.m.)) compared with that previously found in temperate zones in a comparable age-group. During the night shift a further delay was evident (11.8+/-1.9 h) and subjects' acrophases remained delayed 2 days after return to daytime working (12.4+/-1.8 h). Integrated postprandial glucose, insulin and TAG responses were significantly elevated during the night shift compared with normal daytime working. Two days after their return to daytime working, subjects' postprandial glucose and insulin responses had returned to pre-shift levels; however, integrated TAG levels remained significantly elevated. These results are very similar to those previously found in simulated night-shift conditions; it is the first time such changes have been reported in real shift workers in field conditions. They provide evidence that the abnormal metabolic responses to meals taken at night during unadapted night shifts are due, at least in part, to a relative insulin resistance, which could contribute to the documented cardiovascular morbidity associated with shift work. When applied to the 20% of the UK workforce currently employed on shift work, these findings have major significance from an occupational health perspective.

Health in a 24-h society

With increasing economic and social demands, we are rapidly evolving into a 24-h society. In any urban economy, about 20% of the population are required to work outside the regular 0800-1700 h working day and this figure is likely to increase. Although the increase in shiftwork has led to greater flexibility in work schedules, the ability to provide goods and services throughout the day and night, and possibly greater employment opportunities, the negative effects of shiftwork and chronic sleep loss on health and productivity are now being appreciated. For example, sleepiness surpasses alcohol and drugs as the greatest identifiable and preventable cause of accidents in all modes of transport. Industrial accidents associated with night work are common, perhaps the most famous being Chernobyl, Three Mile Island, and Bhopal.

An action spectrum for melatonin suppression: evidence for a novel non-rod, non-cone photoreceptor system in humans

1. Non-image forming, irradiance-dependent responses mediated by the human eye include synchronisation of the circadian axis and suppression of pineal melatonin production. The retinal photopigment(s) transducing these light responses in humans have not been characterised. 2. Using the ability of light to suppress nocturnal melatonin production, we aimed to investigate its spectral sensitivity and produce an action spectrum. Melatonin suppression was quantified in 22 volunteers in 215 light exposure trials using monochromatic light (30 min pulse administered at circadian time (CT) 16-18) of different wavelengths (lambda(max) 424, 456, 472, 496, 520 and 548 nm) and irradiances (0.7-65.0 microW cm(-2)). 3. At each wavelength, suppression of plasma melatonin increased with increasing irradiance. Irradiance-response curves (IRCs) were fitted and the generated half-maximal responses (IR(50)) were corrected for lens filtering and used to construct an action spectrum. 4. The resulting action spectrum showed unique short-wavelength sensitivity very different from the classical scotopic and photopic visual systems. The lack of fit (r(2) < 0.1) of our action spectrum with the published rod and cone absorption spectra precluded these photoreceptors from having a major role. Cryptochromes 1 and 2 also had a poor fit to the data. Fitting a series of Dartnall nomograms generated for rhodopsin-based photopigments over the lambda(max) range 420-480 nm showed that rhodopsin templates between lambda(max) 457 and 462 nm fitted the data well (r(2) > or =0.73). Of these, the best fit was to the rhodopsin template with lambda(max) 459 nm (r(2) = 0.74). 5. Our data strongly support a primary role for a novel short-wavelength photopigment in light-induced melatonin suppression and provide the first direct evidence of a non-rod, non-cone photoreceptive system in humans.

Melatonin in older people with age-related sleep maintenance problems: a comparison with age matched normal sleepers

STUDY OBJECTIVES

To determine whether older people with age-related sleep maintenance problems have significantly lower melatonin levels than comparable normal sleepers.

DESIGN

Case-control study.

SETTING

A largely urban population, Auckland, New Zealand.

PARTICIPANTS

People over the age of 65 years, who either slept normally, or had age-related sleep maintenance problems. Participants were recruited through media advertising, and local interest groups. Initial screening was by mail (Pittsburgh Sleep Quality Index), followed by interviews at a hospital day clinic. Exclusions included those with depression, cognitive impairment, medical and/or environmental problems which might impair sleep.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

A metabolite of plasma melatonin, 6-sulphatoxymelatonin (aMT6s) was measured in the urine of 57 normal sleepers, and 53 people with age-related problems over 24 hours in three aliquots: 12:00-19:00h, 19:00-07:00h, 07:00-12:00h. There were clear differences in self reported quality of sleep but no difference in mean aMT6s 24 hour or total night excretory levels, or night/day ratios.

CONCLUSIONS

Older people with age-related sleep maintenance problems do not have lower melatonin levels than older people reporting normal sleep.

Postprandial triacylglycerol responses in simulated night and day shift: gender differences

A number of reports suggest that shift workers have an increased risk of coronary heart disease (CHD). One contributing factor may be the consumption of meals at night with consequent altered postprandial responses. This study investigated circulating triacylglycerol (TAG), a possible risk factor for CHD, after meals during a simulated day and night shift. Twenty-five healthy participants (10 women and 15 men) were studied. They were given a pre-meal at 0800 h and a test meal at 1330 h on a simulated day shift and then an identical pre-meal at 2000 h and test meal at 0130 h, respectively, on a simulated night shift with maintained wakefulness. Blood was sampled for 9 h after the test meal for analysis of basal and postprandial plasma TAG levels. ANOVA for repeated measures indicated higher TAG in men compared with women (p < 0.0001) and higher responses at night in both genders (p = 0.027). Incremental area under the curve (IAUC) analysis indicated that men had significantly increased postprandial TAG levels at night compared with the day: (IAUC 0-540 min, mean +/- SEM) 253.29 +/- 28.73 versus 148.33 +/- 17.28 mmol/L x min, respectively, p = 0.025. In women, night and day responses (61.16 +/- 8.93 versus 34.09 +/- 7.87 mmol/L x min, respectively, p = 0.457) were not significantly different. Circulating TAG remained elevated for longer at night in the men compared with the women (p = 0.009). This study demonstrates the existence of gender and time-of-day differences in TAG responses to a meal. These raised TAG levels at night, for a prolonged time in men, may be relevant to the increased risk of CHD in shift workers.

[Primary gastric non-Hodgkin lymphoma]

Authors discussed etiology, diagnostic and therapeutical problems in the treatment of primary gastric non-Hodgkin lymphoma. The first one was limited to the gastric region and was cured favourably. The second one extended gastric region and affected all alimentary tract. This case was terminated by death of the patient.

Artificial selection of microbial ecosystems for 3-chloroaniline biodegradation

We present a method for selecting entire microbial ecosystems for bioremediation and other practical purposes. A population of ecosystems is established in the laboratory, each ecosystem is measured for a desired property (in our case, degradation of the environmental pollutant 3-chloroaniline), and the best ecosystems are used as 'parents' to inoculate a new generation of 'offspring' ecosystems. Over many generations of variation and selection, the ecosystems become increasingly well adapted to produce the desired property. The procedure is similar to standard artificial selection experiments except that whole ecosystems, rather than single individuals, are the units of selection. The procedure can also be understood in terms of complex system theory as a way of searching a vast combinatorial space (many thousands of microbial species and many thousands of genes within species) for combinations that are especially good at producing the desired property. Ecosystem-level selection can be performed without any specific knowledge of the species that comprise the ecosystems and can select ensembles of species that would be difficult to discover with more reductionistic methods. Once a 'designer ecosystem' has been created by ecosystem-level selection, reductionistic methods can be used to identify the component species and to discover how they interact to produce the desired effect.

Use of melatonin in the treatment of phase shift and sleep disorders

When administered to humans the pineal hormone melatonin can phase shift a number of circadian rhythms. This property has prompted the investigation of exogenous melatonin in sleep disorders known to have an underlying chronophysiological basis (i.e. circadian rhythm sleep disorders). Both in field and simulated studies of jet lag and shift work suitably timed melatonin improved sleep and, in some cases, hastened readaptation of the circadian rhythms following the phase shift. Melatonin treatment has also been evaluated in the circadian sleep disorders: delayed sleep phase syndrome (DSPS) and non-24-hour sleep wake disorder. Compared with placebo, melatonin advanced the sleep period in subjects with DSPS. Melatonin also improved a number of sleep parameters in blind subjects suffering from non-24-hour sleep wake disorder.

Melatonin administration can entrain the free-running circadian system of blind subjects

Although melatonin treatment has been shown to phase shift human circadian rhythms, it still remains ambiguous as to whether exogenous melatonin can entrain a free-running circadian system. We have studied seven blind male subjects with no light perception who exhibited free-running urinary 6-sulphatoxymelatonin (aMT6s) and cortisol rhythms. In a single-blind design, five subjects received placebo or 5 mg melatonin p.o. daily at 2100 h for a full circadian cycle (35-71 days). The remaining two subjects also received melatonin (35-62 days) but not placebo. Urinary aMT6s and cortisol (n=7) and core body temperature (n=1) were used as phase markers to assess the effects of melatonin on the During melatonin treatment, four of the seven free-running subjects exhibited a shortening of their cortisol circadian period (tau). Three of these had taus which were statistically indistinguishable from entrainment. In contrast, the remaining three subjects continued to free-run during the melatonin treatment at a similar tau as prior to and following treatment. The efficacy of melatonin to entrain the free-running cortisol rhythms appeared to be dependent on the circadian phase at which the melatonin treatment commenced. These results show for the first time that daily melatonin administration can entrain free-running circadian rhythms in some blind subjects assessed using reliable physiological markers of the circadian system.

[Sigmoid-vesical fistula in the course of long-term conservative treatment for recurrent sigmoid diverticulitis]

The authors describe a case of sigmoidovesical fistula developed in a man with sigmoid diverticular disease. Appropriate surgical procedure has been done thanks to proper diagnosis. In authors' opinion early operation performing is the best therapy of colon diverticulitis even if a patient suffer from other serious disorders.

The prevention and treatment of jet lag

Travel across multiple time zones is a common feature of modern life. After transmeridian flights, the internal clocks are desynchronized from the external environment and it can take several days to readjust to the new external time cues. The time taken is related to the direction of the flight and to the number of time zones crossed as well as to individual variability. The result of this desynchronization between the human circadian system and the new environmental timing is described as "jet lag". Although the term "jet lag" refers to disturbances in a variety of symptoms, jet-lagged travellers mostly complain of loss of sleep and of its consequences (e.g., diurnal sleepiness, depressed mood, decreased efficiency, premature awakening, etc.). The direct reason for sleep disturbances after a multiple time-zone flight is that sleep is very sensitive to changes in its temporal setting. The present report reviews current data concerning the symptoms of jet lag, the approaches proposed for the alleviation of jet lag and the effectiveness of these strategies.

Comparison between subjective and actigraphic measurement of sleep and sleep rhythms

Sleep is often assessed in circadian rhythm studies and long-term monitoring is required to detect any changes in sleep over time. The present study aims to investigate the ability of the two most commonly employed methods, actigraphy and sleep logs, to identify circadian sleep/wake disorders and measure changes in sleep patterns over time. In addition, the study assesses whether sleep measured by both methods shows the same relationship with an established circadian phase marker, urinary 6-sulphatoxymelatonin. A total of 49 registered blind subjects with different types of circadian rhythms were studied daily for at least four weeks. Grouped analysis of all study days for all subjects was performed for all sleep parameters (1062-1150 days data per sleep parameter). Good correlations were observed when comparing the measurement of sleep timing and duration (sleep onset, sleep offset, night sleep duration, day-time nap duration). However, the methods were poorly correlated in their assessment of transitions between sleep and wake states (sleep latency, number and duration of night awakenings, number of day-time naps). There were also large and inconsistent differences in the measurement of the absolute sleep parameters. Overall, actigraphs recorded a shorter sleep latency, advanced onset time, increased number and duration of night awakenings, delayed offset, increased night sleep duration and increased number and duration of naps compared with the subjective sleep logs. Despite this, there was good agreement between the methods for measuring changes in sleep patterns over time. In particular, the methods agreed when assessing changes in sleep in relation to a circadian phase marker (the 6-sulphatoxymelatonin (aMT6s) rhythm) in both entrained (n = 30) and free-running (n = 4) subjects.

Complex effects of melatonin: evidence for photoperiodic responses in humans?

The primary function of melatonin in mammals is to convey information about the changing length of the night in the course of the year. This information is used by photoperiodic species to ensure the correct timing of seasonally variable functions such as reproduction, coat growth, and probably the duration and organization of sleep. Melatonin appears not to be essential for circadian organization but reinforces functions associated with darkness. In diurnal humans this of course includes sleep and lowered body temperature. It may act as an adjunct to light for the maintenance of synchrony with the solar day. Exogenous melatonin can both advance and delay the timing of sleep and other circadian functions and appears to stabilize sleep to a 24 h period taken daily at an appropriate time in free running conditions. However, there is as yet little evidence that it can consistently synchronize free running strongly endogenous variables such as core temperature. Its effects on sleep in free run are complex, depend on circadian time of administration, and can in part be interpreted on a photoperiodic basis.

Sleep and activity rhythms are related to circadian phase in the blind

STUDY OBJECTIVES

Sleep is controlled by both circadian and homeostatic mechanisms. As the light-dark cycle is the most important time cue in humans, blind individuals may have circadian rhythm disorders including sleep. The aim of the study was to assess sleep with simultaneous measurement of an endogenous marker of the circadian clock, namely 6-sulphatoxymelatonin (aMT6s).

SETTING AND PARTICIPANTS

59 registered blind subjects were studied in their own homes.

DESIGN

Subjects completed daily sleep and nap diaries for at least four weeks, wore activity monitors continuously, and collected urine samples over 48 hours each week for 3-5 weeks for assessment of aMT6s rhythms.

RESULTS

The most sensitive indicator of a circadian rhythm disorder was day-time napping. Subjects with normally entrained (NE) aMT6s rhythms had fewer naps of a shorter duration than abnormally entrained (AE) or free-running (FR) subjects. The timing of these naps was not random; significantly more naps occurred within a five-hour range before and after the aMT6s acrophase (phi (phi)) than outside this range. Disorders in the timing and duration of night sleep in AE subjects manifested as either a permanent advance (advanced sleep phase syndrome, ASPS) or delay (delayed sleep phase syndrome, DSPS). In FR subjects there were transient advances and delays in sleep timing that paralleled aMT6s timing with increased night sleep duration and reduced number and duration of day-time naps associated with a normal aMT6s phase.

CONCLUSIONS

Changes in sleep and activity rhythms reflect changes in circadian phase.

Methods for estimating areas under receiver-operating characteristic curves: illustration with somatic-cell scores in subclinical intramammary infections

The aim of this study was to demonstrate receiver-operating characteristic (ROC) methodology in the context of bovine intramammary infection (IMI). Quarter somatic cell scores (SCS) were available to evaluate quarter IMI, and the final IMI diagnosis was made from milk bacteriologic cultures. Data consisted of 11,453 quarter-milk samples collected on 2084 clinically healthy cows located in 154 Belgian herds. Bacteriological analyses showed 16.2%, 7.2%, and 11.9% of quarters infected with coagulase-positive Staphylococcus spp., Streptococcus agalactiae, and coagulase-negative Staphylococcus spp., respectively. The ROC curve indicated all the combinations of sensitivity and specificity that quarter SCS was able to provide as a test to identify quarter IMI. Among parametric, semi-parametric, and non-parametric methods to estimate area under ROC curves, the parametric method seemed the least appropriate for analyzing SCS in this study. With the non-parametric method, the total area under the ROC curves showed quarter SCS could identify quarter IMI with an overall accuracy of 69%, 76%, and 59% for coagulase-positive Staphylococcus spp., S. agalactiae, and coagulase-negative Staphylococcus spp., respectively. Parametric and non-parametric statistical tests showed that overall SCS diagnostic capability was significantly (p<0.01) different from chance and was different (p<0.01) across the three bacteria. However, the SCS thresholds yielding the highest percentage of quarters correctly classified as infected (for the observed prevalence and for equal costs assigned to false-positive and false-negative results) were so high that they had no practical value. The major advantage of ROC analysis is the comprehensive description of the discrimination capacity of SCS for all possible choices of critical values. The major disadvantage is the dependency upon the gold standard used for the final diagnosis--but recent improvements of the methodology will correct the problem.

Correlation between urinary cortisol and 6-sulphatoxymelatonin rhythms in field studies of blind subjects

OBJECTIVE

Blind individuals have different types of circadian rhythm disorders. In order to study these in the field reliable markers of circadian phase are required. The aim of the present study was to determine the usefulness of urinary cortisol as a marker rhythm in field studies. This was assessed by investigating the relationship between the cortisol rhythms and the previously determined melatonin rhythms from a large sample of blind people with different types of circadian rhythm disorders.

DESIGN

Field study

SUBJECT

Registered blind subjects (n = 49) classified as having light perception or better (n = 19, 12 men, 7 women, aged 23-61 years) or having no conscious perception of light (n = 30, 24 men, 6 women, aged 19-72 years) were studied in their normal environment.

MEASUREMENT

Sequential 4-hourly urine samples (plus an overnight sample) were collected for 48 h each week for 3-5 weeks. Urinary cortisol and 6-sulphatoxymelatonin were measured by radioimmunoassay.

RESULT

Irrespective of the type of circadian rhythm (entrained or free-running), there was a significant correlation between the characteristics of the 6-sulphatoxymelatonin and cortisol rhythms in the blind subjects.

CONCLUSION

Urinary cortisol is recommended as a useful marker of circadian phase in field studies in addition to urinary 6-sulphatoxymelatonin measurements.

Effects of maintaining solstice light and temperature on reproductive activity, coat growth, plasma prolactin and melatonin in goats

Interactive effects of light and temperature on aspects of seasonality were studied in female British Saanen dairy goats. Four groups of adult non-pregnant non-lactating goats (n = 5) were housed under the following conditions: controls (July-June): natural photoperiod and temperature; group 1 (July-December): long days (16 h light: 8 h dark) and natural temperature; group 2 (July-December): long days and average summer temperature (17.6 degrees C); group 3 (December-June): short days (8 h light: 16 h dark) and winter temperature (8.4 degrees C). Plasma prolactin and progesterone were measured once a week, circadian changes in prolactin and melatonin were determined in December and May, and coat development was assessed. Seasonal variation in prolactin was influenced by manipulation of both daylength and temperature. In group 1, prolactin concentrations decreased as the environmental temperature decreased, despite maintenance of long days. When light and temperature were maintained under summer (group 2) and winter (group 3) conditions, prolactin remained relatively constant, although at different high and low set points, respectively, but with indications of a seasonal rhythm. An asymptotic relationship between prolactin and temperature was maintained under all daylengths. The circadian pattern of melatonin was related to daylength and was not influenced significantly by temperature. Onset of oestrus was unaltered. In group 3 (maintained winter solstice light and temperature), anoestrus was delayed (P < 0.05) from a median control date of 17 March to a median date of 28 April. Winter coat development was delayed in group 1; group 2 showed premature moulting of the winter coat; and in group 3, development of the summer coat was delayed. The results imply that temperature modifies the influence of daylength on prolactin secretion and hair follicle growth by mechanisms that do not involve melatonin.

Effects of light on human circadian rhythms

Blind subjects with defective retinal processing provide a good model to study the effects of light (or absence of light) on the human circadian system. The circadian rhythms (melatonin, cortisol, timing of sleep/wake) of individuals with different degrees of light perception (n = 67) have been studied. Blind subjects with some degree of light perception (LP) mainly have normally entrained circadian rhythms, whereas subjects with no conscious light perception (NPL) are more likely to exhibit disturbed circadian rhythms. All subjects who were bilaterally enucleated showed free running melatonin and cortisol rhythms. Studies assessing the light-induced suppression of melatonin show the response to be intensity and wavelength dependent. In contrast to ocular light exposure, extraocular light failed to suppress night-time melatonin. Thus, ocular light appears to be the predominant time cue and major determinant of circadian rhythm type. Optimisation of the light for entrainment (intensity, duration, wavelength, time of administration) requires further study.

Melatonin in circadian sleep disorders in the blind

Assessment of sleep patterns in blind people demonstrates a high prevalence of sleep disorders. Our studies have shown that subjects with no conscious light perception (NPL) have a higher occurrence and more severe sleep disorders than those with some degree of light perception (LP). A detailed study of 49 blind individuals showed that those with NPL are likely to have free-running (FR) circadian rhythms (aMT6s, cortisol) including sleep. Non-24-hour (or FR) sleep-wake disorder, characterised by periods of good and bad sleep is a condition that may benefit from melatonin treatment. Melatonin has been administered to NPL subjects with FR circadian rhythms and compared with placebo (or the no-treatment baseline) sleep parameters improved. The results suggest that prior knowledge of the subject's type of circadian rhythm, and timing of treatment in relation to the individual's circadian phase, may improve the efficacy of melatonin.

[The threat of premature labor: new aspects for management]

Genital inflammation may play a major role in the pathogenesis of preterm labor. Screening and early treatment of subclinical genital tract infections (bacterial vaginosis, heavy group B streptococci colonization, primary genital HSV infection and other silent intra-uterine infections) seem to offer promise for the prevention of preterm labor. New factors have been studied in order to appreciate their benefit in the evaluation of the risk of preterm labor. None of these biologic markers (fetal-fibronectin, maternal interleukin-6, vaginal pH measuring) have enough sensitivity to permit efficient screening. Home uterine activity monitoring seems to be interesting for early identification of women with increased risk of preterm delivery, but can't be used on a large scale because of its costs. New tocolytic agents are investigated in order to protect from an adverse outcome. Atosiban exhibits more oxytocin selective and antagonistic activity without side-effects, and nimesulide seems to have a lack of effects on fetal functions.

Disturbance of sleep in blindness

PURPOSE

To determine the prevalence and severity of sleep disturbance in blind subjects and its relation to the form and duration of visual loss.

METHODS

Of 403 blind subjects (visual acuity of less than 20/200 or a visual field of less than 5 degrees) recruited for the study, 15 were excluded because of affective disorder as identified by Montgomery Asberg Depression Scale. The remaining 388 subjects and a comparison group of 44 normally sighted individuals underwent an interview, and the Pittsburgh Sleep Quality Index questionnaire was administered. Sleep disturbance was classified as mild, moderate, or severe.

RESULTS

Disturbance of sleep was recorded in 189 (48.7%) of the blind subjects. The prevalence was higher and the sleep disturbance was more severe in those with no perception of light than in those with light perception or better visual acuity. In the comparison group, four (9.1%) had mild sleep disturbance only. The differences between blind subjects and normally sighted individuals were highly significant (P < .001). The most common sleep-related problem among the blind subjects was interrupted sleep, followed by increased sleep latency, short sleep duration, and daytime naps. Among the blind subjects, no correlation was found between the extent of sleep disturbance and the duration and pattern of visual loss.

CONCLUSIONS

Blind subjects who retain light perception, as well as those with total loss of vision, have a high frequency of sleep disturbance, although disorder is more common and more severe in subjects with no light perception. Management of the sleep disturbance may improve the quality of life in the visually handicapped.