Prevalence of obstructive sleep apnoea in REM behaviour disorder: response to continuous positive airway pressure therapy.

OBJECTIVES: Rapid eye movement behaviour disorder (RBD) is a parasomnia in which there is loss of muscle atonia during rapid eye movement (REM) sleep, resulting in dream enactment. The aims of this study were to determine the prevalence of obstructive sleep apnoea (OSA) in RBD patients and determine whether continuous positive airway pressure (CPAP) therapy improved RBD symptoms in patients with concomitant RBD and OSA. METHODS: A questionnaire was mailed to 120 patients identified from a tertiary sleep centre with RBD meeting full International Classification for Sleep Disorders-3 (ICSD-3) criteria. Patients were diagnosed as having OSA if they had an apnoea-hypopnea index (AHI) ≥ 5. The questionnaire focused on CPAP-use, compliance and complications. Standard statistical analysis was undertaken using SPSS (v.21, IBM). RESULTS: One hundred and seven of the potential participants (89.2%) had an OSA diagnosis. Out of 72 who responded to the questionnaire, (60%) 27 patients were using CPAP therapy. CPAP therapy improved RBD symptoms in 45.8% of this group. Despite this positive response to treatment in nearly half of CPAP-users, there was no significant difference in subjective or objective CPAP compliance between those who reported RBD improvement and those who did not. Subjective compliance with CPAP was over-reported, with mean usage being 7.17 ± 1.7 h per night compared to objective mean compliance of 5.71 ± 1.7. CONCLUSIONS: OSA is a very common co-morbidity of RBD. CPAP therapy might improve self-reported RBD symptoms further, in addition to standard RBD treatment. However, further research into its topic is necessary.

Evaluation of immunophenotype of lymphoid cells isolated from malignant pleural effusions.

Lymphoid cells, isolated from malignant pleural effusions and collected from patients bearing primary lung carcinoma, were examined by means of indirect immunofluorescence and a panel of monoclonal antibodies vs several CD antigens. The percentages of CD4+ T lymphocytes were found to be significantly depressed in malignant effusions as compared to inflammatory ones. In relation to histological type of cancer it was especially evident in squamous cell and anaplastic carcinomas (small and large cell), in comparison to adenocarcinomas. Expression of T cell antigen receptor tau/delta (TCR-1) on T lymphocytes, demonstrated by BB3 MoAb (vs V delta 2), was significantly higher in malignant effusions as compared with non-malignant ones. This was not the case when A13 MoAb (equivalent of TCS 1) was used (vs V delta 1). Percentage values of NK cells, monocyte/granulocyte series activated cells and B lymphocytes did not differ significantly in malignant and non-malignant effusions. It is concluded that these are T lymphocyte subpopulations which are apparently distinct in both effusion groups examined.

Immunoregulatory effect of T cell subsets on PWM-induced IgG synthesis by blood lymphocytes in lung cancer.

The mechanism of pokeweed mitogen (PWM) dependent decreased IgG production by blood lymphocytes from lung cancer patients was studied in comparison to control patients and blood donors. It has been shown that the depletion of monocytes has some influence on IgG synthesis but is not a decisive factor. Also, quantitative alterations in the CD4 and CD8 lymphocyte subsets do not significantly influence the PWM stimulation index for IgG synthesis. The assessment of T lymphocyte suppressor activity in lung cancer patients was performed by means of a co-culture with blood mononuclear cells, while helper activity was evaluated through co-culture with donor B lymphocytes. It has been found that lung cancer patient T lymphocytes have no increased suppressor activity, however, especially in the CD4 subset, display the decrease of helper function for B lymphocytes in PWM-induced IgG synthesis. The weakened helper function of CD4 lymphocytes may explain the suppression of specific antibody synthesis do novo which is evident in patients with lung cancer.

Vitamin A (retinol) level in colon and lung cancer patient sera.

Serum vitamin A (retinol) level was determined in colon and lung cancer patients. As a control served young healthy people and non cancer hospital patients at the age similar to those with tumors. Vitamin A content in cancer patients was found to be statistically lower as compared to control groups.

[Disseminated interstitial lung lesions in Lung Diseases Clinic patients]. / Sródmiazszowe zmiany rozsiane w plucach u chorych Kliniki Chorób Pluc.

The large number of diseases with interstitial lesions in the lungs needs numerous expensive and complicated examinations for differential diagnosis. These difficulties and increasing number of patients made us to look for possibilities to facilitate diagnosis. In 103 patients with diagnosed disease with disseminated lung lesions, the age and gender, vital capacity of the lungs, arterial blood gases pressure, the number of lymphocytes in peripheral blood were assessed. In sarcoidosis patients the subtypes of lymphocytes in peripheral blood and in bronchial washings were examined. It was established, that the number of interstitial lung lesions patients every year was greater. In observed group of patients the interstitial lesions in chronic pulmonary congestion, infections, neoplasms and sarcoidosis were seen. In chronic pulmonary congestion group there were older men with decreased number of lymphocytes, severe decrease of vital capacity, slight hypoxemia and normal pCO2. Disseminated lung lesions in the course of infections, mainly in 36 to 60 year old men with severe lymphopenia were observed. In these men vital capacity, blood gases pressure was normal. Mostly, the interstitial lung lesions in miliary tuberculosis and fungosis were developed. Neoplasmatic interstitial lung lesions existed in the course of lung cancer, rarer in other malignancies occurred. There were found in middle-aged men with severe lymphopenia, mild decrease of vital capacity, severe hypoxia and normal or decreased pCO2. Sarcoidosis in middle-aged persons was seen. There was not dependence on gender. In these patients the severe decrease of vital capacity, hypoxia and increased pCO2 frequently were observed. The number of lymphocytes in peripheral blood and in bronchial washing in most patients was normal. The same was observed according to subtypes of lymphocytes. The results of presented examinations are useful in evaluation of the clinical patient's state but their value in differential diagnosis of disseminated interstitial lung lesions is limited.

[Analysis of circumstances of the development of chronic bronchitis in patients treated at Bydgoszcz Lung Disease Clinic in 1993-1996]. / Analiza warunków rozwoju przewleklego zapalenia oskrzeli u chorych leczonych w klinice w latach 1993-1996.

The fact, that more than 10% people suffer from COPD /chronic obstructive pulmonary disease/, that number of COPD patients increases rapidly all over the world, and at the moment COPD is one from four the most frequent cause of death, makes us to search for effective methods of prevention and treatment. The number and variety of factors cooperating in pathogenesis and development of the disease in contrast to poor knowledge of them was the reason, that the retrospective analysis of some factors of 300 COPD patients, treated in our Clinic from severe exacerbations was carried out. There were analysed the following factors; age, gender, body mass index, profession, the length and duration of the disease, incidence of exacerbations and habits; alcohol drinking and cigarette smoking. The aim of these searches was to establish the factors which most commonly cooperate in initiation and development of COPD in the province of Bydgoszcz. There was established, that chronic bronchitis was more frequent in men. That deference is caused not only by exposure to occupational irritant factors. COPD was also more frequent in smokers /about 70%/, elders, blue collar workers, especially exposed to irritants and/or toxic effects by virtue of their work, persons living in industrialized Bydgoszcz. There were no correlation between COPD incidence and malnutrition or alcohol consumption, but the simple correlation between time of the disease and severity of airway obstruction was seen. The longer time of chronic bronchitis, the more increased airway obstructions, and more frequent respiratory insufficiency. In the course of the disease was growing; the number of malnutritioned patients and the number of exacerbations of chronic bronchitis. The longer time of disease, the shorter free of symptoms intervals. In alcohol consuming patients the exacerbations occurred significantly more frequent and more severe. There was correlation between alcohol and cigarette consumption. The exacerbations of chronic bronchitis in November, December and March were the most frequently seen. In observed group of chronic bronchitis patients the importance of risk factors unconnected with smoking was significantly great, that suggest the growing role of other factors in pathogenesis and development of COPD.

[The frequency of atopy in lung cancer patients]. / Czestosc wystepowania skazy atopowej u chorych na pierwotnego raka pluca.

The controversial opinions on adverse correlation between atopy and incidence of lung cancer made us to undertake the research in that field in patients, treated in Department of Lung Diseases of University School of Medicine in Bydgoszcz. In 45 histologically diagnosed lung cancer patients in III and IV stage of the disease the tendency to atopy was assessed. In above mentioned patients the serum level of total IgE, the number of eosinophyls in peripheral blood and skin tests with popular allergens such as: home-dust, feather, grass particles, fungus and mould. It was established, that atopy in 25% of lung cancer patients was observed. That percents similar in persons without cancer burden. These findings suggest, that pathologically increased immunologic reactions, observed in atopic patients do not protect from lung cancer. From the other hand, the results of these examinations suggest also, that depressions of immunologic reactions, connected with lung cancer are selective in their nature.

[The quality of life after chemotherapy in advanced non-small cell lung cancer patients]. / Jakosc zycia chorych na zaawansowanego niedrobnokomórkowego raka pluca po chemioterapii cytoredukcyjnej.

The intensity of complains, short survival and great number of patients makes many oncologists to apply chemotherapy in advanced non-small cell lung cancer/NSCLC/. The achieved median duration of life after chemotherapy was 6 to 12 month. From the other hand non small cell lung cancer chemotherapy is a big burden even to healthy persons. It can worsen the quality of life. That was the reason we evaluated the quality of life after chemotherapy in advanced non small cell lung cancer patients. Taking into account, that the evaluation of quality of life, used in most diseases is useless in advanced NSCLC patients, for appreciation the quality of life in these cases the lung cancer symptoms scale/LCSS/was adopted. In 110 non small cell lung cancer patients in stage IIIB and IV, who received combined chemotherapy by Le Chevalier/Vindesine, Cisplatin, Cyclophosphamide, Lomustin/or by Rosell/Mitomycin, Cyclophosphamide, Cisplatin/the quality of life was evaluated. In 20-persons control group all patients received the symptomatic treatment. In observed group of 110 patients, tumor regressions after 4 courses of chemotherapy allowed to resect cancer in 14 cases, to apply radiotherapy in 42 and to continue chemiotherapy in 23 persons. In every person from above mentioned group the quality of life was evaluated on the basis of intensity of cancer symptoms, accordingly to LCSS. The intensity of cancer symptoms was compared before and after treatment. There were compared; the innensity of complains, weakness, appetite, malnutrition, and hematological, neurological, performans state as well as respiratory sufficiency, infections, cardiac disorders and pain. Apart it, the side effects of applied therapy were assessed in 5 degree scale. The level of hemoglobin, the number of leucocytes, thrombocytes, bilirubine and transaminases in peripheral blood, hematurie, proteinurie, bleedings, appetite, nausea, vomitings, diarrhea, mucosal lesions, infections, skin lesions, cardiac lesions, neurological lesions, respiratory disorders, allergy, alopecia. It was established that, chemotherapy in the most patients improved the performance status and minimized cancer symptoms especially, after good response to treatment. After anticancer therapy more frequently severe infections and cardiac disorders, independently to results of treatment were seen. In non-responders, the cancer symptoms were intensified by side effects of antineoplastic-therapy. In this group of patients the severe side effects of therapy more frequently were seen.

Alloantibodies, autoantibodies, and immune complexes in patients with lung cancer.

The sera of patients with lung cancer, nonmalignant lung disease, and blood donors were subjected to various immunologic assays. Nine assays, based on immunoradiometric (IRMA) and immunoenzymatic (ELISA) principles, included 3 types of fetal cell antibodies, 2 established lung cancer cell antibodies, anti-DNA, anti-IgG autoantibodies, and immune complex assays based on C1q binding and anti-C3 activity. Antitumor cell antibody level was significantly lower in patients with lung cancer compared to blood donors. In the remaining 7 assays, the lung cancer patients tended towards higher median values compared to both control patients and blood donors, but without statistical significance, with the exception of anti-DNA antibodies. Statistical analysis of all 9 assays taken together has shown significant differences between the 3 groups. When only 5 assays were used to assess 3 types of fetal cell antibodies, anti-DNA antibodies, and immune complexes by means of ELISA anti-C3, the margins between groups increased. A range of values for the selected assays was established that may discriminate 70% of tested individuals of the 3 groups. These results suggest the existence of a characteristic profile of deranged humoral immunity in lung cancer patients.

Assessment of phenotype of blood lymphocyte subsets prior and after PWM stimulation in patients with lung carcinoma.

Surface phenotypes of peripheral blood lymphocytes of lung cancer patients and those of two control groups were assessed by means of indirect immunofluorescence with monoclonal antibodies, prior and after 10 day pokeweed mitogen (PWM) in vitro stimulation. There was no significant alteration in pan T cell per cent values prior and after mitogen stimulation in all groups tested. CD4+ cells in lung cancer group were however significantly decreased as compared to blood donor group (37.3% vs 44.9%, p less than 0.05). This decline was even more pronounced in III/IVo stage of tumour progression according to TNM classification (36.8%, p less than 0.05). These changes, however were not cancer specific, because similar decrease of CD4+ cells was seen in a group of patients with nonneoplastic lung conditions (35.7%, p less than 0.01). Following 10 day PWM culture per cent values of CD4+ cells did not change significantly. The assessment of CD8+ lymphocytes has shown marked differences in two subgroups of lung cancer, namely in II (17.4%) and III/IV (26.2%) of tumour progression (p less than 0.05), which returned to normal values following PWM culture. CD4/CD8 ratio was distinctly depressed in cancer patients in relation to donors. The evaluation of surface markers of B lymphocytes activated cells and monocytes did not show significant alterations in all groups examined. Per cent of HNK1+ cells was heightened in cancer group, especially in III/IV stage of tumour progression in relation to donors (21.7% and 22.8% vs 17.3%, p less than 0.05 respectively). PWM stimulation resulted in marked fall of HNK1+ cells to values corresponding to those in donor group. This study indicates some alterations in per cent values of blood lymphocytes subpopulations belonging mainly to T cell lineage in lung cancer patients linked to tumour staging which only partially return to normal following PWM stimulation.