10-year anniversary of the European Somnologist examination - A historic overview and critical appraisal.

The European Somnologist certification programme was developed by the European Sleep Research Society to improve patient care in sleep medicine by providing an independent evaluation of theoretical and practical knowledge. The examination of eligible experts plays a key role in this procedure. A process was started more than 15 years ago to create the European sleep medicine curriculum, eligibility criteria for certification, and sleep centre accreditation criteria. The process was characterised by interdisciplinary collaboration, consensus, and achieving new solutions. During the past 10 years, experience has been gained by the examination and certification of more than 1000 sleep medicine experts from more than 50 countries. The process has continuously been improved. However, as the programme was designed and administered mainly by medical experts in the field, systematic influence from teaching and pedagogic experts was partially underrepresented. The current critical appraisal pinpoints several missing links in the process - mainly as a missing constructive alignment between learning objectives, learning and teaching activities, and the final assessment. A series of suggestions has been made to further improve the ESRS certification programme.

Infrared spectra experimental analyses on alkali-activated fly ash-based binders.

One of the most used characterization techniques in the field of alkaline activated cements studies is infrared spectroscopy. Its prominence lies in that it allows characterizing mixtures during the alkaline activation by providing information about the vibrations of the chemical bonds in the molecular units, both of amorphous and crystalline products. This research paper is aimed at examining the influence of the concentration of calcium hydroxide (CH), sodium hydroxide (SH), temperature and curing time on the structure of alkaline activated cements, based on coal fly ash, from the deconvolution of the infrared spectrum between 4000 and 400 cm-1. 9 mixtures were analyzed by infrared spectroscopy at 3 and 28 days after curing, based on a surface's response experimental design by varying the amount of SH (5.17-10.83 M), CH (2.93-17.07% ash's wt.) and the curing temperature (25, 35 and 45 °C). The results show significant variations in the frequency and area of the deconvolved bands in the functional groups: O-H (2600-3800 cm-1), C-O (1580 and 1350 cm-1) and T-O (T: Si (Al), 1300-400 cm -1). Such variations are due to the reorganization of the forming elements (present in the ash) network and modifiers (present in CH and SH) for the formation of cementing gels C-(A) -S-H (970 cm-1) and N-A-S-H (1009 cm-1).

Data on natural radionuclide's activity concentration of cement-based materials.

Cement based materials may contain varying levels of radionuclides, mainly 226Ra (from the 238U series), 232Th and 40K, which are used to determine the Activity Concentration Index ("ACI"). According to the European directive Euratom 2013/59 in these materials, the "ACI" must be < 1 to be suitable for their use in construction. In this paper, data on the activity concentration of natural radionuclides in cement-based materials (i.e. cements, additions, pigments and aggregates) as well as their chemical composition are presented. Radioactivity measurements have been determined by using gamma spectroscopy the chemical compositions have been determined by X-Ray Fluorescence. Data for cements measured shown that white cements present a lower concentration of activity than conventional CEM I. In addition, the CAC (Calcium aluminate cements) present high activity concentration in the 232Th series. Regarding additions, FA (Fly Ash) are those that present the highest concentration of activity in the 238U and 232Th series, while olive biomass ashes are those supplementary cementitious materials that show the highest concentration of activity for 40K. Some pigments used in mortar and concrete technology were also characterized. Granitic and volcanic rocks, potentially used as aggregates present much higher activity concentration than the siliceous aggregate.

Characteristic limits of 230Th in alpha spectrometry with 229Th as tracer, calculated by simulating interfering tails and overlapping peaks.

This study explores the effect of 229Th tracer tail interference on the determination of the sensitivity of 230Th alpha spectrometry of samples with environmental levels of radioactivity. Tracer peak tail interference was calculated with Suma-Alpha, whilst Visual Basic for Applications (VBA in Excel©) software was used to study the variation in sensitivity in terms of the amount of tracer added. Unnecessary increases in the amount of tracer or extended sample measuring times were observed to have adverse effects on method sensitivity (Detection Limit- Ld).

Use of Genie 2000 and Excel VBA to correct for γ-ray interference in the determination of NORM building material activity concentrations.

The γ-radiation emitted by building materials is calculated from the activity indices for 232Th, 226Ra and 40K and expressed as the activity concentration index (ACI). Gamma spectroscopy is a non-destructive technique frequently used to simultaneously determine the indices for several radionuclides. Spectral interpretation poses a number of challenges, including identification of γ-lines subject to summing-in effects, interference from other γ-ray emitting radionuclides and the time required to reach secular equilibrium. These challenges are not fully addressed by Canberra Industries' Genie 2000, the software used by many laboratories to analyse samples. This article describes a Microsoft Excel workbook that exploits Genie 2000 flexibility to program applications with Visual Basic using Canberra's Nuclear Data Access Library and batch procedure tools. The workbook determines 40K activity concentration after correcting for 228Ac interference and 226Ra activity directly from the γ-peak at 186.5 keV. The method proposed was tested by participating in 13 national and international scale inter-comparison exercises. The results were statistically indistinguishable from the reference values at a coverage factor of k = 3 and no statistically significant differences were identified between the respective means by a Student's t pairwise comparison.

Neurophysiological study of the radial nerve variant in the innervation of the dorsomedial surface of the hand.

INTRODUCTION: Sensory innervation of the dorsomedial surface of the hand usually depends on the dorsal ulnar nerve (DUN). Innervation in this area by the superficial radial nerve (SRN) has been described as a normal variant. METHODS: We studied 358 patients using nerve conduction of the DUN and SRN with dorsomedial recording. Each hand was classified into usual innervation (only DUN response), mixed variant (response of both nerves), or complete variant (only SRN response). RESULTS: Mixed innervation was found in 14.2% of hands and complete innervation was found in 6.8% of hands, mostly unilaterally. No statistically significant differences were observed in age, sex, or clinical suspicion between usual and variant innervation. The potential amplitude after SRN stimulation was greater in the complete variant. DISCUSSION: It is important to know the characteristics of this variant in order to avoid diagnostic errors and to prevent iatrogenic lesions in surgery performed on the dorsum of the wrist. Muscle Nerve 58: 732-735, 2018.

A method for the complete analysis of NORM building materials by γ-ray spectrometry using HPGe detectors.

A methodology including software tools for analysing NORM building materials and residues by low-level gamma-ray spectrometry has been developed. It comprises deconvolution of gamma-ray spectra using the software GALEA with focus on the natural radionuclides and Monte Carlo simulations for efficiency and true coincidence summing corrections. The methodology has been tested on a range of building materials and validated against reference materials.

Consensus on drug treatment, definition and diagnosis for insomnia.

Thirty-four experts and a literature supervisor got together in order to reach a 'consensus' regarding the definition, diagnosis and pharmacological treatment of insomnia. Insomnia is a subjective perception of dissatisfaction with the amount and/or quality of sleep. It includes difficulty in initiating or maintaining sleep or early awakening with inability to fall asleep again. It is associated with complaints of non-restorative sleep and dysfunction of diurnal alertness, energy, cognitive function, behaviour or emotional state, with a decrease in quality of life. The diagnosis is based on clinical and sleep history, physical examination and additional tests, although polysomnography is not routinely indicated. Therapy should include treatment of the underlying causes, cognitive and behavioural measures and drug treatment. Hypnotic therapy can be prescribed from the onset of insomnia and non-benzodiazepine selective agonists of the GABA-A receptor complex are the drugs of first choice. It is recommended that hypnotic treatment be maintained in cases where withdrawal impairs the patient's quality of life and when all other therapeutic measures have failed. Experience suggests that intermittent treatment is better than continuous therapy. The available data do not confirm safety of hypnotics in pregnancy, lactation and childhood insomnia. Benzodiazepines are not indicated in decompensated chronic pulmonary disease but no significant adverse effects on respiratory function have been reported with zolpidem and zopiclone in stable mild to moderate chronic obstructive pulmonary disease and in treated obstructive sleep apnoea syndrome. Data for zaleplon are inconclusive. If the patient recovers subjective control over the sleep process, gradual discontinuation of hypnotic treatment can be considered.

Efficacy of the antioxidant ebselen in experimental uveitis.

Inflammation results in the production of free radicals. In a model of experimental uveitis upon subcutaneous injection of endotoxin to Lewis rats, i.e., endotoxin-induced experimental uveitis (EIU), we have evaluated the status of the antioxidant capacity of ocular tissues. EIU results in a decrease of glutathione (GSH) content and glutathione peroxidase (GPx) activity in whole eye homogenates 24-h after endotoxin administration. Furthermore, an increase in malondialdehyde (MDA) content was observed in these same samples, thus confirming the involvement of oxidative stress in the pathophysiology of the process. In view of the ability of the antioxidant ebselen as GPx enzyme mimic, we tested the effect of the oral treatment with two doses of 100 mg/kg body weight of ebselen (first dose administered at the same time of endotoxin, and the second after 12 h). Ebselen administration normalized the GSH and MDA contents and protected the GPx activity of the EIU rat eyes. The GPx activity in the eye homogenate of the treated rats could be completely acounted for by the ebselen-dependent GPx-like activity, i.e., GPx activity measured in the acidic supernatant of the homogenate after neutralization. Unmodified ebselen was detected in whole eye homogenates, thus it shows for the first time the penetration of ebselen through the blood-aqueous and blood-retina barrier. The results herein may allow the proposal of ebselen as a suitable antiinflammatory agent in ocular tissues.

Serum vitamin E levels negatively correlate with severity of age-related macular degeneration.

Age-related macular degeneration (AMD) pathogenesis has been related to UV radiation and other factors that may promote increased oxidative damage to the retina. Patients with different AMD grading (n = 25) were compared with an age-matched group of AMD-free subjects (n = 15), both groups older than 60 years. A modification of the AMD grading system is proposed that allows patient grading and not single eye grading. AMD patients showed statistically significant lower serum levels of vitamin E and Zn than AMD-free subjects. Moreover, a negative correlation (Spearman's correlation coefficient r = -0.815, P < 0.001) could be established between AMD grading of both the patients' eyes and serum vitamin E levels. Sun exposure index (SEI) was also compared and found to be significantly higher in the AMD group. The results presented establish the importance of antioxidants in AMD, and set the basis for further studies on adjuvant therapies with antioxidants for AMD. Finally, the results also confirm the pathogenic role of UV radiation in AMD.

[Arousal of respiratory origin and upper airway resistance syndrome: pathophysiological and diagnostic aspects]. / Arousals de origen respiratorio y síndrome de aumento de resistencia de la vía aérea superior: aspectos fisiopatológicos y diagnósticos.

INTRODUCTION: The description of Upper Airway Resistance Syndrome (UARS) let us to recognize the importance of the pair 'respiratory effort-arousal' on sleep-disordered breathing pathophysiology. DEVELOPMENT: First part of this paper reviews knowledge about respiratory arousal pathophysiology. Arousal response is normally needed to end obstructive respiratory episodes, but it is also the cause of sleep fragmentation. Among respiratory stimuli able to provoke arousal (respiratory effort, hypoxemia and hypercapnia), respiratory effort is the most constant. Neurophysiological mechanisms involved in arousal, sleep and vegetative consequences, and the possible role of non visible arousals, are also discussed. In UARS, because of the absence of apnea/hypopnea and significative O2 desaturations, arousals are induced by the increased respiratory effort. Diagnosis needs the simultaneous recording of polysomnography and esophageal pressure. Some symptoms and signs of UARS are similar to those of Obstructive Sleep Apnea Syndrome. However, UARS shows any differences: a lower Body Mass Index, less constant snoring, males and females are similarly affected or higher frequency of craniofacial abnormalities. Diagnostic difficulties may be due to confusion between hypopneas and episodes of increased resistance of upper airway, or to the lack of definitive diagnostic criteria. Finally, differential diagnosis needs a broad knowledge of disorders of excessive daytime sleepiness.

Granulomatous epididymo-orchitis: sonographic features and clinical outcome in brucellosis, tuberculosis and idiopathic granulomatous epididymo-orchitis.

PURPOSE: We reviewed and analyzed sonographic findings in granulomatous epididymo-orchitis in an attempt to differentiate this rare inflammatory entity from other causes of enlarged scrotum, such as tumors. MATERIALS AND METHODS: We retrospectively reviewed sonographic features of 9 patients a mean of 41 years old with specific and nonspecific granulomatous epididymo-orchitis, including brucellosis in 7, tuberculosis in 1 and idiopathic granulomatous epididymo-orchitis in 1. Histological confirmation was obtained in 3 cases, and in the remaining 6 positive clinical manifestations and laboratory tests for brucellosis were accepted as the main criteria for the diagnosis of brucellar epididymo-orchitis. RESULTS: The most notable echographic finding was an enlarged and heterogeneous epididymis, predominantly in the body and tail. Testicular involvement consisted of a diffusely hypoechoic testis or focal intratesticular areas. Thickening of the scrotal wall and tunica albuginea, and moderate hydrocele were also noted occasionally. Followup scans revealed intratesticular abscesses in 3 patients. CONCLUSIONS: These echographic findings may suggest the diagnosis of granulomatous epididymo-orchitis in the appropriate clinical setting, and help to avoid unnecessary orchiectomy for benign disease.

[Diagnostic difficulties in the narcolepsy-catalepsy syndrome: with reference to our series of cases]. / Dificultades diagnósticas en el síndrome narcolepsia-cataplejía: a propósito de nuestra casuística.

The narcolepsy-cataplexy syndrome is a disorder of unknown aetiology, characterized by excessive daytime sleepiness associated with cataplexy and other REM sleep phenomena. Diagnosis is based on the clinical findings, although this may be difficult especially with respect to confirming the cataplexy. Objective tests, such as typing for HLA, DR2DQ1 (DRw15DQw6, WHO90) and above all TMLS (average latency < 5 mn and two or more onsets of sleep in the phases REM and SOREMP's) is of great help. However, the exact diagnostic significance of some aspects of these tests and their parameters is still under discussion. In this paper we review our series of cases consisting of fourteen patients who fulfil the clinical diagnostic criteria required in the ICSD-1990. TMLS and HLA typing was done for all. Of the HLA types, DQ1 was present in all our patients, unlike DR2 which was not found in two patients. Regarding TMLS, the average latency < 5 mn is a parameter met by all cases, although one did not have SOREMP's. The findings of the objective tests done on our patients are in agreement with those described by other authors. They underline the significance of the support they lend to the diagnosis. However, they are not the definite answer to the problem.

Glutathione system of human retina: enzymatic conjugation of lipid peroxidation products.

The major aspects of the glutathione (GSH)-related antioxidant defense of human retina are presented. These include concentration of GSH and activities of some GSH-dependent enzymes: glutathione peroxidase, glutathione disulfide reductase, and glutathione S-transferase toward a broad spectrum substrate 1-chlor-2,4-dinitrobenzene and a toxic product of lipid peroxidation (4-hydroxynonenal). The presence of a relatively high GSH concentration, GSH peroxidase activity, and GSH S-transferase specific activity toward 4-hydroxynonenal in human retina might constitute a central defense mechanism in inflammation-promoted oxidative stress and subsequent lipid peroxidation. The use of different substrates for the determination of the GSH peroxidase activity showed no statistically significant difference, thus suggesting the lack of Se-independent GSH peroxidase in human retina. Large individual variations were obtained for GSH concentration and the different activities tested; the apparent correlation with age of these findings is currently under investigation.

Prevention of the acute neurotoxic effects of phenytoin on rat peripheral nerve by H7, an inhibitor of protein kinase C.

The neurotoxic effects of a single dose of phenytoin (150 mg/kg body weight) alone or 30 min after H7 (a protein kinase C inhibitor) injection (20 mg/kg body weight) were investigated in terms of peripheral neuromuscular function and Na+,K(+)-ATPase activity of the sciatic nerve. This intraperitoneal injection of phenytoin induced complete blockade of muscle action potentials in the dorsal segmental muscles of the rat tail evoked by electric stimulation of the caudal nerve and a 40% decrease in the Na+,K(+)-ATPase activity of the rat sciatic nerve when compared with control values, measured as the difference between total and ouabain-insensitive ATPase activity. Prior administration of H7 resulted in the complete prevention of both effects. Implications of protein kinase C inhibition in phenytoin neurotoxicity are discussed.

Oxygen toxicity in the nervous tissue: comparison of the antioxidant defense of rat brain and sciatic nerve.

Nervous tissue, central and peripheral, is, as any other, subject to variations in oxygen tension, and to the attack of different xenobiotics; these situations may promote the generation of activated oxygen species of free radical character. Results are presented showing that the content of total glutathione (GSH) in brain is 10-fold that found in the sciatic nerve of the rat (2620 vs. 261 nmol/g wet weight, respectively). The existence of a relatively high superoxide dismutase activity in peripheral nervous tissue, when compared with brain or liver, in combination with the DT-diaphorase activity detected in the sciatic nerve might represent an effective defense mechanism against quinone toxicity, as is also discussed. Nervous tissue, both central and peripheral lack Se-independent GSH peroxidase activity. Finally, the activities of other glutathione-related enzymes studied in the sciatic nerve are very low, when compared with the central nervous tissue, thus suggesting a higher susceptibility of peripheral tissue to oxidative stress damage, since GSH concentration and/or any GSH-related enzymatic activities, e.g. GSH peroxidase or glutathione disulfide reductase, might become limiting.

Antioxidant and glutathione-related enzymatic activities in rat sciatic nerve.

The present work tries to establish the antioxidant capacity of the peripheral nervous tissue of the rat, in terms of the enzymatic activities present in this tissue that either prevent the formation of activated species as the semiquinone radical (DT-diaphorase), protect against activated oxygen species (superoxide dismutase, glutathione peroxidase), conjugate natural toxic products or xenobiotics (glutathione S-transferase, especially the activity conjugating 4-hydroxy-nonenal), or complete the glutathione system metabolism (glutathione disulfide reductase, gamma-glutamyl transpeptidase). All the activities studied are lower in this tissue than they are in liver, except for gamma-glutamyl transpeptidase. The relevance of the results obtained and its possible relationship with different neuropathies is discussed. It is concluded that the peripheral nervous tissue is by far less protected than the liver against oxidative damage.