Glycated hemoglobin and sleep apnea syndrome in children: beyond the apnea-hypopnea index.

PURPOSE: Snoring and obstructive sleep apnea syndrome (OSA) are frequent conditions in pediatrics. Glycated hemoglobin (HbA1C) is a useful homeostatic biomarker of glycemia and may reflect alterations deriving from sleep breathing disorders. The aim of this study was to relate the severity of OSA with blood HbA1C levels in children. METHODS: A descriptive observational study in snoring patients was performed. All patients underwent a sleep study and classified either as simple snorers (apnea-hypopnea index; AHI ≤ 1 episodies/h) or as OSA patients (AHI > 1 episodes/h). In the following morning, a blood glycemic profile (fasting glucose, insulin, HbA1C, and the HOMA index) was performed to every individual. RESULTS: A total of 48 patients were included. HbA1C levels were shown to be increased in the moderate OSA (AHI > 5 episodes/h) group (5.05 ± 0.25 vs. 5.24 ± 0.29%; p = 0.019). Significant correlations were found between HbA1C values and AHI (r = 0.345; p = 0.016) and also with oxygen desaturation index (r = 0.40; p = 0.005). Correlations remained significant after adjusting by age and body mass index. The AHI-associated change in HbA1C was 13.4% (p = 0.011). CONCLUSIONS: In the pediatric population, HbA1C is a biomarker associated with OSA severity, and this relationship is age- and obesity-independent. The fact that this association was observed in snoring patients could help the physician in the distinction between those patients affected with OSA and those with simple snoring. Therefore, HbA1C measurement could play a major role in the diagnosis and the management of the syndrome.

Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey.

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.

Nondestructive Detection of White Root Rot Disease in Avocado Rootstocks by Leaf Chlorophyll Fluorescence.

White root rot (WRR) disease caused by Rosellinia necatrix is one of the most important threats affecting avocado orchards in temperate regions. In this study, we monitored the progression of WRR disease at the leaf and root levels by the combination of nondestructive chlorophyll fluorescence measurements and confocal laser-scanning microscopy on avocado genotypes susceptible to R. necatrix. Leaf photochemistry was affected at early stages of disease development prior to the appearance of aboveground symptoms, made evident as significant decreases in the trapping efficiency of photosystem-II (Fv'/Fm') and in the steady-state of chlorophyll fluorescence yield (Fs) normalized to the minimal fluorescence yield (F0) (Fs/F0). Decreases in Fv'/Fm' and Fs/F0 were associated with different degrees of fungal penetration, primarily in the lateral roots but not in areas next to the main root collar. Aboveground symptoms were observed only when the fungus reached the root collar. Leaf physiology was also tracked in a tolerant genotype where no changes were observed during disease progression despite the presence of the fungus in the root system. These results highlight the usefulness of this technique for the early detection of fungal infection and the rapid removal of highly susceptible genotypes in rootstock avocado-breeding programs.

Total adult cardiovascular risk in Central America.

OBJECTIVE: To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. METHODS: Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. RESULTS: Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. CONCLUSIONS: Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

Clinically important pharmacokinetic drug-drug interactions with antibacterial agents.

Antimicrobial agents are widely used, and drug interactions are challenging due to increased risk of adverse effects or reduced efficacy. Among the interactions, the most important are those affecting metabolism, although those involving drug transporters are becoming increasingly known. To make clinical decisions, it is key to know the intensity of the interaction, as well as its duration and time-dependent recovery after discontinuation of the causative agents. It is not only important to be aware of all patient treatments, but also of supplements and natural medications that may also interact. Although they can have serious consequences, most interactions can be adequately managed with a good understanding of them. Especially in patients with polipharmacy it is compulsory to check them with an electronic clinical decision support database. This article aims to conduct a narrative review focusing on the major clinically significant pharmacokinetic drug-drug interactions that can be seen in patients receiving treatment for bacterial infections.

Development of robust discriminant equations for assessing subtypes of glioblastoma biopsies.

BACKGROUND: In the preceding decade, various studies on glioblastoma (Gb) demonstrated that signatures obtained from gene expression microarrays correlate better with survival than with histopathological classification. However, there is not a universal consensus formula to predict patient survival. METHODS: We developed a gene signature using the expression profile of 47 Gbs through an unsupervised procedure and two groups were obtained. Subsequent to a training procedure through leave-one-out cross-validation, we fitted a discriminant (linear discriminant analysis (LDA)) equation using the four most discriminant probesets. This was repeated for two other published signatures and the performance of LDA equations was evaluated on an independent test set, which contained status of IDH1 mutation, EGFR amplification, MGMT methylation and gene VEGF expression, among other clinical and molecular information. RESULTS: The unsupervised local signature was composed of 69 probesets and clearly defined two Gb groups, which would agree with primary and secondary Gbs. This hypothesis was confirmed by predicting cases from the independent data set using the equations developed by us. The high survival group predicted by equations based on our local and one of the published signatures contained a significantly higher percentage of cases displaying IDH1 mutation and non-amplification of EGFR. In contrast, only the equation based on the published signature showed in the poor survival group a significant high percentage of cases displaying a hypothesised methylation of MGMT gene promoter and overexpression of gene VEGF. CONCLUSION: We have produced a robust equation to confidently discriminate Gb subtypes based in the normalised expression level of only four genes.

Day-night variations in endothelial dysfunction markers and haemostatic factors in sleep apnoea.

Patients with sleep apnoea have a significant alteration in the day-night pattern of myocardial infarction and sudden cardiac death observed in the general population. The aim of this study was to investigate the influence of sleep apnoea on the diurnal variations in various haemostatic parameters (factor VII, von Willebrand factor and plasminogen activator inhibitor (PAI)-1) and markers of endothelial dysfunction (asymmetric dimethylarginine (ADMA) and soluble CD40 ligand (sCD40L)). We studied 26 male patients with obstructive sleep apnoea syndrome (OSAS; 13 patients with severe OSAS (apnoea/hypopnoea index (AHI) >30 events · h(-1)) and 13 patients with mild-to-moderate OSAS (AHI <30 events · h(-1))) and 12 controls of similar body mass index (BMI) and waist circumference. In each subject, six different samples were obtained over 24 h. Although all the markers values tended to be higher in patients with severe OSAS, differences did not reach statistical significance at any time. PAI-1 levels were significantly related to BMI (p<0.001), mean (p<0.001) and minimal (p = 0.047) nocturnal oxygenation saturation. ADMA levels were significantly related to arousal index (p = 0.046). The results of this study suggest that day-night variations in factor VII:antigen (Ag), von Willebrand factor:Ag, PAI-1, sCD40L and ADMA levels may be dependent on either the obesity index or metabolic dysfunction rather than on sleep apnoea alone.

Analysis of sedentariness in women from a gender and equity perspective.

ABSTRACTThis cross-sectional study aimed to analyse the social and gender-related factors influencing sedentariness in women, including occupation and family size (FS). We included women aged 45-70 years participating in the Breast Cancer Screening Programme of the Valencia Region (BCSP-VR) between November 2018 and October 2019 (n = 121,988). The response variable was sedentariness measured by sitting time in hours/day (h/day) (<3 h/day and ≥3 h/day). The explanatory variables were age, educational level, country of origin, living alone, childcare responsibilities, FS, disability, body mass index (BMI) and smoking status. Logistic regression models were adjusted for the whole sample and were stratified by occupation and FS. The variables that increased the odds of sedentariness were age ≥65 years (OR = 1.28; CI = 1.20-1.36), high educational level (OR = 1.39; CI = 1.31-1.47), non-manual occupation (OR = 2.38; CI = 2.27-2.48), living alone (OR = 1.11; CI = 1.05-1.17), disability (OR = 1.37; CI = 1.20-1.56) and BMI ≥ 30 (OR = 1.33; CI = 1.28-1.38). The variables decreasing the odds were large (OR = 0.90; CI = 0.87-0.96) and medium FS (OR = 0.93; CI = 0.90-0.97). Older age, high educational level and high BMI conferred a higher odd of sedentary lifestyle, independently of occupation and FS with statistical differences. Protective factors were childcare responsibilities in non-working women (OR = 0.86; CI = 0.74-0.99), large FS in women with manual occupations (OR = 0.88; CI = 0.80-0.97) and medium FS in housewives (OR = 0.91; CI = 0.86-0.97). This study identified social and gender-related inequalities in the factors influencing sedentariness, which were related to the type of occupation and FS.Highlights There are social and gender inequalities in the factors influencing sedentarinessNon-manual occupation increases the risk of sedentary lifestyleBelonging to a medium or large family decreases the risk of sedentary behaviourChildcare responsibilities are related to lower sitting time throughout the day.

Free fatty acids and the metabolic syndrome in patients with obstructive sleep apnoea.

Obesity and metabolic syndrome (MS) occur frequently in patients with obstructive sleep apnoea syndrome (OSAS). We hypothesised that circulating free fatty acids (FFAs) are elevated in OSAS patients independently of obesity. This elevation may contribute to the development of MS in these patients. We studied 119 OSAS patients and 119 controls. Participants were recruited and studied at sleep unit of our institution (Hospital Universitari Son Dureta, Palma de Mallorca, Spain) and were matched for sex, age and body mass index (BMI). The occurrence of MS was analysed by clinical criteria. Serum levels of FFAs, glucose, triglycerides, cholesterol, high-density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, C-reactive protein and 8-isoprostanes were determined. Prevalence of MS was higher in OSAS than in the control group (38 versus 21%; p=0.006). OSAS patients had higher FFAs levels than controls (mean±sd 12.2±4.9 versus 10.5±5.0 mg·dL(-1); p=0.015). Among subjects without MS, OSAS patients (OSAS+ MS-) showed higher levels of FFAs than controls (OSAS- MS-) (11.6±4.7 versus 10.0±4.4 mg·dL(-1); p=0.04). In a multiple regression model, after adjustment for age, sex, BMI and the presence of MS, FFAs were significantly associated with apnoea/hypopnoea index (p=0.04). This study shows that FFAs are elevated in OSAS and could be one of the mechanisms involved in the metabolic complications of OSAS.

To participate or not? Giving voice to gender and socio-economic differences in colorectal cancer screening programmes.

This paper examines the influence of gender and socio-economic status (SES) on participation in colorectal cancer (CRC) screening. Qualitative study with eight focus groups comprised of participants and non-participants in a CRC screening programme in Valencia (Spain), structural sample design and discursive analysis by gender, SES and participation. Non-participants and those with lower SES tended to have less knowledge about both the disease and the programme. Reasons for participation varied according to gender: women were motivated because they value the importance of self-care and early detection in order to prevent personal and family suffering while men were encouraged by their partners. Reasons for non-participation were also influenced by gender: women feared the results and considered the test unpleasant whereas men showed carelessness and lack of concern. In population-based programmes, people with lower SES and men are those with the most obstacles to participation due to low health literacy and traditional gender roles respectively. To increase participation in CRC screening programmes based on informed decision making and taking into account social inequalities, information should be more accessible, comprehensible and adapted to gender and SES differences and emphasise the greater vulnerability of men for CRC and the benefits of early detection.

Bilateral microphthalmos with bilateral orbital cysts: individualising the treatment according to the visual potential. A case report. / Microftalmia bilateral asociada con quistes orbitarios. Manejo individualizado según el potencial visual. Reporte de caso clínico.

The case is presented of a 3-month-old infant diagnosed with microphthalmos and orbital cysts. Magnetic Resonance Imaging revealed a bilateral microphthalmia with a moderate right cyst and a severe left cyst. Visual potential of the right eye was uncertain. Non-surgical treatment was decided. At the age of 2 years old, physical examination showed a significant decrease of the cysts and visual acuity of hand movements due to the residual vision of his right eye. Microphthalmos with orbital cyst is a rare congenital anomaly. Cysts tend to enlarge with time. At the moment, no standard protocol for the management of this pathology has been described. Unlike in our patient, visual acuity in these patients is usually of no-light perception. The observation could be an alternative in severe cases, since there is a possibility of spontaneous reduction, displacement, or regression of the cysts.

[Knowledge in the prescription of Physical Exercise by Primary Care professionals in the Region of Murcia]. / Conocimiento en la prescripción de ejercicio físico en los profesionales de atención primaria de la región de Murcia.

OBJECTIVE: To determine if the Primary Health care professionals prescribe physical exercise (PE) using adequate knowledge criteria. MATERIAL AND METHOD: A comparative cross-sectional descriptive and observational study carried out in 32 health centres in the Region of Murcia. A total of 476 doctors and 327 nurses were included. A questionnaire was administered to all of them, in which the variables analysed were: Level of overall and specific knowledge by blocks of pathologies (lipids, diabetes, hypertension, obesity, and generalities) on the prescribing of PE to patients with cardiovascular risk, as well as related variables associated with the quality of prescribing PE. RESULTS: Statistically significant differences in knowledge were found in the group that recommends heart rate measurement in «30% to 70%¼ of their patients. Differences in the subgroups were observed in the sections on diabetes (P < 0.05), obesity (P < 0.05), and hypertension (P <0.05). When analysing the knowledge values obtained according to the proportion of patients to whom «very rarely¼ PE time is specified, significant differences are observed (P <0.05), showing doctors with a higher level of knowledge. The differences were accentuated between both professional groups in the group of respondents who specify time to «less than 30%¼ of their patients (P <0.01). There are no differences between those professionals who specify time to «more than 31%¼ of their patients, although the trend shows higher knowledge values among doctors. CONCLUSIONS: The prescription of physical exercise among Primary Care professionals is not carried out using adequate knowledge criteria.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial.

BACKGROUND: Previous studies have presented contradictory data concerning obstructive sleep apnoea syndrome (OSAS), lipid oxidation and nitric oxide (NO) bioavailability. This study was undertaken to (1) compare the concentration of 8-isoprostane and total nitrate and nitrite (NOx) in plasma of middle-aged men with OSAS and no other known co-morbidity and healthy controls of the same age, gender and body mass index; and (2) test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy attenuates oxidative stress and nitrate deficiency. METHODS: A prospective, randomised, placebo controlled, double-blind, crossover study was performed in 31 consecutive middle-aged men with newly diagnosed OSAS and 15 healthy control subjects. Patients with OSAS were randomised to receive sham CPAP or effective CPAP for 12 weeks. Blood pressure, urinary catecholamine levels and plasma 8-isoprostane and NOx concentrations were obtained before and after both treatment modalities. RESULTS: Patients with OSAS had significantly higher 8-isoprostane levels (median (IQR) 42.5 (29.2-78.2) vs 20.0 (12.5-52.5) pg/ml, p = 0.041, Mann-Whitney test) and lower NOx levels (264 (165-650) vs 590 (251-1465) micromol/l, p = 0.022) than healthy subjects. Body mass index, blood pressure and urinary catecholamines were unchanged by CPAP therapy, but 8-isoprostane concentrations decreased (38.5 (24.2-58.7) pg/ml at baseline vs 22.5 (16.2-35.3) pg/ml on CPAP, p = 0.0001) and NOx levels increased (280 (177-707) vs 1373 (981-1517) micromol/l, p = 0.0001) after CPAP. CONCLUSIONS: OSAS is associated with an increase in oxidative stress and a decrease in NOx that is normalised by CPAP therapy.

Class III peroxidases in plant defence reactions.

When plants are attacked by pathogens, they defend themselves with an arsenal of defence mechanisms, both passive and active. The active defence responses, which require de novo protein synthesis, are regulated through a complex and interconnected network of signalling pathways that mainly involve three molecules, salicylic acid (SA), jasmonic acid (JA), and ethylene (ET), and which results in the synthesis of pathogenesis-related (PR) proteins. Microbe or elicitor-induced signal transduction pathways lead to (i) the reinforcement of cell walls and lignification, (ii) the production of antimicrobial metabolites (phytoalexins), and (iii) the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Among the proteins induced during the host plant defence, class III plant peroxidases (EC 1.11.1.7; hydrogen donor: H(2)O(2) oxidoreductase, Prxs) are well known. They belong to a large multigene family, and participate in a broad range of physiological processes, such as lignin and suberin formation, cross-linking of cell wall components, and synthesis of phytoalexins, or participate in the metabolism of ROS and RNS, both switching on the hypersensitive response (HR), a form of programmed host cell death at the infection site associated with limited pathogen development. The present review focuses on these plant defence reactions in which Prxs are directly or indirectly involved, and ends with the signalling pathways, which regulate Prx gene expression during plant defence. How they are integrated within the complex network of defence responses of any host plant cell will be the cornerstone of future research.

Estimating Aspergillus fumigatus exposure from outdoor composting activities in England between 2005 and 14.

Bioaerosols, ubiquitous in ambient air, are released in elevated concentrations from composting facilities with open-air processing areas. However, spatial and temporal variability of bioaerosols, particularly in relation to meteorology, is not well understood. Here we model relative concentrations of Aspergillus fumigatus at each postcode-weighted centroid within 4 km of 217 composting facilities in England between 2005 and 2014. Facilities were geocoded with the aid of satellite imagery. Data from existing bioaerosol modelling literature were used to build emission profiles in ADMS. Variation in input parameters between each modelled facility was reduced to a minimum. Meteorological data for each composting facility was derived from the nearest SCAIL-Agriculture validated meteorological station. According to our results, modelled exposure risk was driven primarily by wind speed, direction and time-varying emissions factors incorporating seasonal fluctuations in compostable waste. Modelled A.fumigatus concentrations decreased rapidly from the facility boundary and plateaued beyond 1.5-2.0 km. Where multiple composting facilities were within 4 km of each other, complex exposure risk patterns were evident. More long-term bioaerosol monitoring near facilities is needed to help improve exposure estimation and therefore assessment of any health risks to local populations.

Post-mortem toxicology in the diagnosis of sudden death in young and middle-aged victims.

OBJECTIVE: We aimed to investigate the impact of the toxicological results found in cases of sudden death (SD) and to correlate the clinical, autopsy and genetic findings with the toxicology results. MATERIALS AND METHODS: Consecutive SD in people aged between 16 and 50 years with medico-legal autopsies and toxicology studies were included over a 3-year period. The comparison between the toxicological data and demographic characteristics, clinical circumstances, autopsy, and genetic results were taken into account. RESULTS: 101 cases were finally included. They were predominately males (84%) and the mean age was 39.8 years. 52 (51.5%) cases had positive toxicological findings and in 25 cases (24.8%), toxic compounds were considered the first cause of death. Ethanol was the most frequently identified agent (69%), following by licit drugs (56%) and drugs of abuse (39%). Cases with positive toxicology were younger than those with negative results (37.9±9.1 vs. 41.9±7.8; p=0.02). Patients with more than 3 comorbidities showed an association with positive toxicological results (n=14 vs. n=3; p=0.017). The genetic study was performed in 70 (69.3%) SD cases. We identified pathogenic or likely pathogenic variants in 17.1% cases and uncertain significance variants in 42.8% cases. 58% of these variants were probably related to the cause of death. CONCLUSIONS: A large fraction of SD victims had positive toxicological findings and a quarter of deaths were directly caused by toxic substances. The identification of the factors that trigger SD provides a good approach to contribute in avoiding future episodes.

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013).

PURPOSE: We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS: Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS: Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS: Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Insulin resistance and daytime sleepiness in patients with sleep apnoea.

BACKGROUND: Excessive daytime sleepiness (EDS), obesity and insulin resistance (IR) occur frequently in patients with obstructive sleep apnoea syndrome (OSAS). We hypothesised that in these patients, EDS is a marker of IR, independent of obesity. METHODS: We studied 44 patients with OSAS (22 with and 22 without EDS) matched for age (+/-5 years), body mass index (BMI +/-3 kg/m(2)) and severity of OSAS (as determined by the apnoea-hypopnoea index (AHI)), and 23 healthy controls. Patients (n = 35) were re-examined after 3 months of effective therapy with continuous positive airway pressure (CPAP). EDS was assessed by both subjective (Epworth Sleepiness Scale) and objective (Multiple Sleep Latency Test) methods. IR was determined by the HOMA index. Serum levels of glucose, triglycerides, cholesterol, cortisol, insulin, thyrotropin, growth hormone and insulin-like growth factor I (IGF-I) were also determined. RESULTS: Despite the fact that age, BMI and AHI were similar, patients with EDS had higher plasma levels of glucose (p<0.05) and insulin (p<0.01), as well as evidence of IR (p<0.01) compared with patients without EDS or healthy controls. CPAP treatment reduced cholesterol, insulin and the HOMA index and increased IGF-1 levels in patients with EDS, but did not modify any of these variables in patients without EDS. CONCLUSION: EDS in OSAS is associated with IR, independent of obesity. Hence EDS may be a useful clinical marker to identify patients with OSAS at risk of metabolic syndrome.

Prostaglandin D synthase (beta trace) levels in sleep apnea patients with and without sleepiness.

BACKGROUND: Excessive daytime sleepiness (EDS) occurs often in patients with obstructive sleep apnea syndrome (OSAS). However, not all patients present EDS. We hypothesized that the prostaglandin D2 system (PGD2) may be involved in the pathogenesis of EDS associated with OSAS. METHODS: We measured the levels of lipocalin-type PGD synthase (L-PGDS), the enzyme that produces PGD2, in the serum of 47 patients with OSAS (26 with and 21 without EDS) and 18 healthy controls. RESULTS: Patients with EDS had higher levels of L-PGDS (0.73+/-0.06 mg/L) than patients without EDS (0.58+/-0.03 mg/L, p<0.05) and controls (0.62+/-0.02 mg/L, p<0.05). L-PGDS levels in patients without EDS and controls were similar. CONCLUSION: The increased levels of circulating L-PGDS detected in OSAS patients with EDS suggest a possible role of the prostaglandin D system in the pathophysiology of daytime sleepiness in these patients.