Echolocation click parameters of short-finned pilot whales (Globicephala macrorhynchus) in the wild.

Short-finned pilot whales (Globicephala macrorhynchus) are large, deep-diving predators with diverse foraging strategies, but little is known about their echolocation. To quantify the source properties of short-finned pilot whale clicks, we made 15 deployments off the coast of Tenerife of a deep-water hydrophone array consisting of seven autonomous time-synced hydrophone recorders (SoundTraps), enabling acoustic localization and quantification of click source parameters. Of 8185 recorded pilot whale clicks, 47 were classified as being recorded on-axis, with a mean peak-to-peak source level (SL) of 181 ± 7 dB re 1 µPa, a centroid frequency of 40 ± 4 kHz, and a duration of 57 ± 23 µs. A fit to a piston model yielded an estimated half-power (-3 dB) beam width of 13.7° [95% confidence interval (CI) 13.2°-14.5°] and a mean directivity index (DI) of 22.6 dB (95% CI 22.5-22.9 dB). These measured SLs and DIs are surprisingly low for a deep-diving toothed whale, suggesting we sampled the short-finned pilot whales in a context with little need for operating a long-range biosonar. The substantial spectral overlap with beaked whale clicks emitted in similar deep-water habitats implies that pilot whale clicks may constitute a common source of false detections in beaked whale passive acoustic monitoring efforts.

Propofol sedation in Drug Induced Sedation Endoscopy without an anaesthesiologist â€" a study of safety and feasibility.

BACKGROUND: Propofol sedation in Drug Induced Sedation Endoscopy (DISE) of the upper airway of patients with obstructive sleep apnea (OSA) without the presence of anesthesiologist has not been done before. Propofol sedation is normally administered by an anesthesiologist. This is the first study of this new method. METHODOLOGY: Based on the positive experience with Nurse-administered Propofol Sedation (NAPS) for endoscopic procedures in the departments of gastroenterology we wanted to test the set-up as method of propofol sedation for DISE procedures in our Otorhinolaryngology (ORL) department. The ORL specialists and staff nurses that carry out DISE procedures all underwent a formalized education in Nurse-administered Propofol Sedation before the study. We included 200 patients with severe snoring and / or obstructive sleep apnea. They were referred for DISE examination prior to possible targeted surgery based on the findings. RESULTS: In our study the aforementioned ORL team successfully cared out propofol sedation without the presence of an anesthesiologist. All examinations were carried out according to plan. There were no adverse events during the procedures or in the following observational period. CONCLUSIONS: The NAPS method of sedation for DISE seems safe and feasible when performed by trained staff in a hospital setting.

Muscle Reference Values From Thoracic and Abdominal CT for Sarcopenia Assessment: The Framingham Heart Study.

BACKGROUND: Loss of muscle mass is a known feature of sarcopenia and predicts poor clinical outcomes. Although muscle metrics can be derived from routine computed tomography (CT) images, sex-specific reference values at multiple vertebral levels over a wide age range are lacking. OBJECTIVE: The aim of this study was to provide reference values for skeletal muscle mass and attenuation on thoracic and abdominal CT scans in the community-based Framingham Heart Study cohort to aid in the identification of sarcopenia. MATERIALS AND METHODS: This secondary analysis of a prospective trial describes muscle metrics by age and sex for participants from the Framingham Heart Study without prior history of cancer who underwent at least 1 CT scan between 2002 and 2011. Using 2 previously validated machine learning algorithms followed by human quality assurance, skeletal muscle was analyzed on a single axial CT image per level at the 5th, 8th, 10th thoracic, and 3rd lumbar vertebral body (T5, T8, T10, L3). Cross-sectional muscle area (cm 2 ), mean skeletal muscle radioattenuation (SMRA, in Hounsfield units), skeletal muscle index (SMI, in cm 2 /m 2 ), and skeletal muscle gauge (SMRA·SMI) were calculated. Measurements were summarized by age group (<45, 45-54, 55-64, 65-74, ≥75 years), sex, and vertebral level. Models enabling the calculation of age-, sex-, and vertebral-level-specific reference values were created and embedded into an open access online Web application. RESULTS: The cohort consisted of 3804 participants (1917 [50.4%] males; mean age, 55.6 ± 11.8 years; range, 33-92 years) and 7162 CT scans. Muscle metrics qualitatively decreased with increasing age and female sex. CONCLUSIONS: This study established age- and sex-specific reference values for CT-based muscle metrics at thoracic and lumbar vertebral levels. These values may be used in future research investigating the role of muscle mass and attenuation in health and disease, and to identify sarcopenia.

Association of Sarcopenia With Toxicity-Related Discontinuation of Adjuvant Endocrine Therapy in Women With Early-Stage Hormone Receptor-Positive Breast Cancer.

PURPOSE: Sarcopenia, an age-related decline in muscle mass and physical function, is associated with increased toxicity and worse outcomes in women with breast cancer (BC). Sarcopenia may contribute to toxicity-related early discontinuation of adjuvant endocrine  therapy (aET) in women with hormone receptor-positive (HR+) BC but remains poorly characterized. METHODS AND MATERIALS: This multicenter, retrospective cohort study included consecutive women with stage 0-II HR+ BC who received breast conserving therapy (lumpectomy and radiation therapy) and aET from 2011 to 2017 with a 5-year follow-up. Skeletal muscle index (SMI, cm2/m2) was analyzed using a deep learning model on routine cross-sectional radiation simulation imaging; sarcopenia was dichotomized according to previously validated reports. The primary endpoint was toxicity-related aET discontinuation; logistic regression analysis evaluated associations between SMI/sarcopenia and aET discontinuation. Cox regression analysis evaluated associations with time to aET toxicity, ipsilateral breast tumor recurrence (IBTR), and disease-free survival (DFS). RESULTS: A total of 305 women (median follow-up, 89 months) were included with a median age of 67 years and early-stage BC (12% stage 0, 65% stage I). A total of 60 (20%) women experienced toxicity-related aET discontinuation. Sarcopenia was associated with toxicity-related early discontinuation of aET (odds ratio, 2.18; P = .036) and shorter time to aET toxicity (hazard ratio [HR], 1.62; P = .031). SMI or sarcopenia were not independently associated with IBTR or DFS; toxicity-related aET discontinuation was associated with worse IBTR (HR, 9.47; P = .002) and worse DFS (HR, 4.53; P = .001). CONCLUSIONS: Among women with early-stage HR+ BC who receive adjuvant radiation therapy and hormone therapy, sarcopenia is associated with toxicity-related early discontinuation of aET. Further studies should validate these findings in women who did not receive adjuvant radiation therapy. These high-risk patients may be candidates for aggressive symptom management and/or alternative treatment strategies to improve outcomes.

Effect of CT screening on smoking habits at 1-year follow-up in the Danish Lung Cancer Screening Trial (DLCST).

BACKGROUND: The effect of low-dose CT screening for lung cancer on smoking habits has not been reported in large randomised controlled trials. METHODS: This study evaluated the effect on smoking habits of screening with low-dose CT at 1-year follow up in the Danish Lung Cancer Screening Trial (DLCST), a 5-year randomised controlled trial comprising 4104 subjects; 2052 subjects received annual low-dose CT scan (CT group) and 2052 received no intervention (control group). Participants were healthy current and former smokers (>4 weeks since smoking cessation) with a tobacco consumption of >20 pack years. Smoking habits were determined at baseline and at annual screening. Smoking status was verified using exhaled carbon monoxide levels. Lung function tests, nicotine dependency and motivation to quit smoking were assessed. Quit rates and relapse rates were determined at 1-year follow-up for all subjects. RESULTS: At 1 year the quit rates among smokers were 11.9% in the CT group and 11.8% in the control group (p = 0.95). Relapse rates for former smokers were 10.0% and 10.5% in the CT and control groups, respectively (p = 0.81). Significant predictors (p<0.05) for smoking cessation were: high motivation to quit, low dependency, low ratio of forced expiratory volume in 1 s to forced vital capacity, low pack years, higher age, longer period of abstinence and CT findings necessitating 3-month repeat CT scans. CONCLUSIONS: Overall, quit rates were similar in the CT and control group at 1-year follow-up, with a net quit rate of 6.0%. Quit rates were higher and relapse rate lower among subjects with initial CT findings that necessitated a repeat scan 3 months later.

Why whales are big but not bigger: Physiological drivers and ecological limits in the age of ocean giants.

The largest animals are marine filter feeders, but the underlying mechanism of their large size remains unexplained. We measured feeding performance and prey quality to demonstrate how whale gigantism is driven by the interplay of prey abundance and harvesting mechanisms that increase prey capture rates and energy intake. The foraging efficiency of toothed whales that feed on single prey is constrained by the abundance of large prey, whereas filter-feeding baleen whales seasonally exploit vast swarms of small prey at high efficiencies. Given temporally and spatially aggregated prey, filter feeding provides an evolutionary pathway to extremes in body size that are not available to lineages that must feed on one prey at a time. Maximum size in filter feeders is likely constrained by prey availability across space and time.

Medico-legal implications of sleep apnoea syndrome: driving license regulations in Europe.

BACKGROUND: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. METHODS: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK). RESULTS: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. CONCLUSION: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.

Cerebral blood flow, oxygen metabolism, and lactate during hypoxia in patients with obstructive sleep apnea.

Study Objectives: Obstructive sleep apnea (OSA) is associated with increased risk of stroke but the underlying mechanism is poorly understood. We suspect that the normal cerebrovascular response to hypoxia is disturbed in patients with OSA. Methods: Global cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and lactate concentration during hypoxia were measured in patients with OSA and matched controls. Twenty-eight patients (82.1% males, mean age 52.3 ± 10.0 years) with moderate-to-severe OSA assessed by partial polysomnography were examined and compared with 19 controls (73.7% males, mean age 51.8 ± 10.1 years). Patients and controls underwent magnetic resonance imaging (MRI) during 35 min of normoxia followed by 35 min inhaling hypoxic air (10%-12% O2). After 3 months of continuous positive airway pressure (CPAP) treatment, 22 patients were rescanned. Results: During hypoxia, CBF significantly increased with decreasing arterial blood oxygen concentration (4.53 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001) in the control group, but was unchanged (0.89 mL (blood)/100 g/min per -1 mmol(O2)/L, p = 0.289) in the patient group before CPAP treatment. The CBF response to hypoxia was significantly weaker in patients than in controls (p = 0.003). After 3 months of CPAP treatment the CBF response normalized, showing a significant increase during hypoxia (5.15 mL (blood)/100 g/min per -1 mmol(O2)/L, p < 0.001). There was no difference in CMRO2 or cerebral lactate concentration between patients and controls, and no effect of CPAP treatment. Conclusions: Patients with OSA exhibit reduced CBF in response to hypoxia. CPAP treatment normalized these patterns.

Pulmonary disease and antipyrine clearance.

We investigated hepatic microsomal enzyme activity by the one-sample saliva test for antipyrine clearance determination in 35 homozygous, alpha 1-antitrypsin-deficient outpatients with chronic pulmonary disease. Twenty-five outpatients with chronic obstructive lung disease and comparable lung function impairment and 31 healthy volunteers served as controls. Antipyrine clearance did not differ significantly between the two groups of patients with pulmonary disease. However, the clearance was 18% lower in these two groups than in the healthy volunteers (P less than 0.01). Antipyrine clearance was lowest in patients with severe lung function impairment (P less than 0.01).

The effect of ephedrine plus caffeine on smoking cessation and postcessation weight gain.

OBJECTIVES: To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation. METHODS: This randomized double-blind placebo-controlled study with a 1-year follow-up period was carried out at the Department of Pulmonary Medicine in Denmark. Study subjects were 225 heavy smokers who wanted to quit smoking without gaining weight. Two-thirds of the subjects were randomized to receive 20 mg ephedrine plus 200 mg caffeine three times a day; one-third of the subjects received placebo treatment. The dosage was gradually decreased from week 12 to discontinuation at week 39. Group support and control were performed at entry and after 1, 3, 6, 12, 26, 39, and 52 weeks. Main outcome measures were (1) self-reported abstinence with validation by carbon monoxide in expired air and serum cotinine and (2) weight gain. RESULTS: The success rates after 1 year were 17% in the group treated with ephedrine plus caffeine and 16% in the group treated with placebo; the success rates were not significantly different at any time. The success rates for the four counseling physicians varied between 7% and 27% after 1 year (p < 0.05). The weight gain was significantly lower in the ephedrine plus caffeine-treated group during the first 12 weeks, but weight gains were similar after 1 year. No differences in the smoking withdrawal symptoms could be observed between the treatment groups. HbA1c was lower 6 weeks and 1 year after smoking cessation (p < 0.05). CONCLUSIONS: We found an effect of this combination of ephedrine and caffeine on weight gain during the first 12 weeks, but we found no effect on the success rates or craving for cigarettes.

Smoking cessation methods: recommendations for health professionals. Advisory Group of the European School of Oncology.

Smoking is the leading preventable cause of death. Approximately 40% of Europeans now smoke. Many smokers want to stop but do not make the attempt, and of those who try, most are unsuccessful. Primary care health providers can help their patients to stop by using brief behavioural and pharmacological interventions. Specialised smoking cessation clinics can support selected patients referred by primary care providers. This report reviews intervention techniques for health care providers, which, in combination with effective legislative and educational interventions, can significantly reduce the prevalence of smoking.

Recycling with nicotine patches in smoking cessation.

The aim was to evaluate if recycling of failures from a smoking cessation study may be of value. The study comprised 126 smokers (50%) of 252 failures, from a double-blind smoking cessation trial with nicotine patch, who accepted recycling after 1 year. Subjects were allocated nicotine patches delivering 15, 20 or 25 mg of nicotine (over 16 hours) according to their base-line saliva cotinine concentrations in an open trial. The treatment period was 12 weeks followed by tapering over 6 weeks. The percentage of quitters after 3, 12, 26, and 52 weeks was 44, 20, 7 and 6%, respectively. After 26 weeks, all subjects had relapsed in the group previously treated with active nicotine patch compared with 12% abstainers in the previous placebo subjects. The sustained abstinence rate without slips after one year was 2%. Recycling does not seem to be of long-term clinical relevance in our set-up for subjects initially treated with nicotine, but of some value in subjects quitting without nicotine therapy initially.

Activator-associated Ca2+-ATPase in erythrocyte membranes from cystic fibrosis patients.

Erythrocyte membranes were prepared by a method which should ensure binding of an activator protein (calmodulin) to the calcium dependent membrane ATPase involved in calcium transport. The level of enzyme activity, assayed at optimum conditions, was 5-400 times higher than that found in previous investigations on cystic fibrosis patients. The Ca2+-ATPase activity of the cystic fibrosis patients was reduced by 15% compared to control subjects, whereas patients suffering from chronic pulmonary diseases did not deviate from controls. Even if a reduction of Ca2+ pumping activity occurs in other cells, a 15% decrease could hardly be the only cause of the changed calcium concentrations in secretions from cystic fibrosis patients.

Two and four mg nicotine chewing gum and group counselling in smoking cessation: an open, randomized, controlled trial with a 22 month follow-up.

The aim of this study was to examine any dose response effect of 2 and 4 mg nicotine gum (Nicorette) as well as the effect of the treatment in relation to a control group. One hundred seventy-two cigarette smokers were randomly allocated to group counselling and 2 mg- (n = 62) or 4 mg- (n = 54) nicotine chewing gum or to an "advice only" control group (n = 56). Six group meetings in a three month period were guided by physicians in groups of 10-12 members. The 4 mg gum was replaced by 2 mg after 4 weeks. The overall chemical verified success rate was significantly higher for the treatment group compared with the control group. The success rate for the gum group was 45.6% after three months versus 7.1% for the control group, 33.3% versus 3.7% after 12 months, and 27.2% versus 5.7% after 22 months, respectively (p less than 0.001). We could not demonstrate any significant dose response effect of 2 and 4 mg nicotine gum. The low dependent smokers had the best outcome. The subgroup of self-reported chronic bronchitis subjects had a significantly lower success rate than their healthy counterparts (p less than 0.002). Neither the p-nicotine level after smoking or chewing gum nor the difference between these two could predict the outcome. The gum p-nicotine after a week was only 37.1% for 2 mg and 64.3% for 4 mg of the corresponding smoking p-nicotine levels. Nicotine compensation was best for the high dependent smokers.

Smoking cessation: nicotine replacement, gums and patches.

This is an overview of smoking cessation with a clinical approach. The different nicotine replacement products approximately double the long-term success rate with a dose-response effect, but with an equal efficacy of the different administration forms, so there is no long-term effect of a combination of two products, and they have only mild side-effects. The success rate will increase with the level of adjunctive behavioural support. Total smoking abstinence during the first week after quit-day is a very strong predictor of long-term success. Bupropion, an antidepressant drug, seems to be a promising drug in smoking cessation and is at least equally efficacious as nicotine products. All health care workers in pulmonary units have an obligation to deliver up-to-date smoking cessation services to their smoking patients.

Adequacy of oxygenation in a group of Danish patients with COPD on long-term oxygen therapy.

The aim of this study was to assess the adequacy of oxygenation in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) in Copenhagen county. Twenty-six patients were enrolled and assessed prospectively by 24-h pulse oximetry. Patients comprised seven males and 19 females with a mean age of 69 +/- 5 yrs, arterial oxygen tension of 6.5 +/- 0.6 kPa, forced vital capacity of 1.47 L, forced expiratory volume in one second of 0.5 +/- 0.2 L (22 +/- 9% of predicted) and St. George's Respiratory Questionnaire total score of 61 +/- 14. The mean 24-h arterial oxygen saturation measured by pulse oximetry (Sp,O2) was within normal limits (94 +/- 1%), but mild hypoxaemia with a mean Sp,O2 of 89 +/- 4% and a total of 12 +/- 15 desaturation episodes per patient were observed, mostly during daily activities. Multiple regression analysis revealed no significant predictors for patient oxygenation. In summary, 24-h pulse oximetry showed adequate oxygenation in this group of COPD patients on LTOT, though mild hypoxaemia was present during some daily activities.

Self-reported smoking habits, biochemical markers, and nicotine dependence in a sample of the Danish population.

This study reports the smoking habits in a Danish population, evaluates plasma cotinine and thiocyanate levels in the detection of 'slips' (subjects participating in smoking cessation trials who begin to smoke a few cigarettes per week) and provides distribution scores on questionnaire measures of nicotine dependence. A total of 599 subjects with a mean age of 41 years participated in the study. Of these 46% were current smokers with no difference in the proportion of males(46%) and females(45%) and with a mean cigarette consumption of 12.7 daily. Plasma samples were analyzed for cotinine and thiocyanate, and the smokers completed two questionnaires to measure nicotine dependence: the Fagerström Tolerance Questionnaire and the modified Horn-Russell scale. The mean plasma cotinine was 207 micrograms/l for smokers, 14.4 micrograms/l for occasional smokers and 8.0 micrograms/l for non-smokers (ex-smokers and never-smokers). For plasma thiocyanate the levels were 130 mg/l, 54.8 mg/l, and 54.3 mg/l, respectively. The mean Horn-Russell score was 7.4 and the mean Fagerström score was 5.9. The two tests correlated with a t-value of 0.61 (p < 0.001) and the scores in both tests increased with increasing cigarette consumption. In conclusion, 75% of the smokers consumed 10 or more cigarettes per day and males smoked more cigarettes than females. It was impossible to distinguish occasional smokers (slips) from non-smokers using plasma cotinine or thiocyanate levels. We suggest that studies are needed to evaluate if light smokers benefit from nicotine replacement therapy because they achieve plasma cotinine levels which are similar to those seen when using patches for nicotine replacement therapy.

[Causes of relapse during attempted smoking cessation using nicotine or placebo plasters]. / Arsager til recidiv ved forsøg på rygeophør med nikotin- og placeboplaster.

The causes of relapses to smoking when attempting smoking cessation are not fully understood, but several factors are of importance. Addiction to nicotine is one of the most prominent factors. In order to determine predictors of outcome in smoking cessation, we performed univariate and multivariate analysis of a large smoking cessation trial comprising 289 subjects. Weight gain and withdrawal symptoms were analyzed separately as predictors. To determine the relative magnitude of self-perceived reasons for relapse we created a questionnaire, which was answered by 132 relapsers. Previous attempts to stop smoking and a low Horn-Russell scale were significantly associated with abstinence in the nicotine-treated group. A trend towards higher abstinence rates was found in males and in subjects with low smoking saliva cotinine levels. A logistic regression analysis showed higher success rates in subjects with the largest weight gain during the first week but there was a tendency towards higher relapse rates in subjects with the greatest weight gain later. Only 20% reported weight gain to be a major problem. Minor smoking was highly correlated to later relapse. The weight gain after smoking cessation should not be prevented in the first weeks after cessation. Complete abstinence should be emphasized in smoking cessation.

[A double-blind trial of nicotine patches in smoking cessation]. / En dobbeltblind undersøgelse af nikotinplaster ved rygeafvaenning.

The use of nicotine chewing gum combined with psychological support improves the success rate in stopping smoking. We studied the safety and efficacy of a transdermal nicotine patch in stopping smoking. We conducted a double-blind randomized study comparing the effect of a 16-hour nicotine patch (15 +/- 3.5 mg of nicotine in 16 hours) with those of a placebo patch. Of the 289 smokers (207 women and 82 men) enrolled in the study, 145 were treated with nicotine patches and 144 with placebo patches for 16 weeks. The rates of sustained abstinence were significantly better with active treatment than with the placebo: 53, 41, 24 and 17% of those in the nicotine-patch group were abstinent after 6, 12, 26, and 52 weeks, respectively, as compared with 17, 10, 5 and 4% of those in the placebo-patch group (p less than 0.0001). Only two subjects with the nicotine patch and one with the placebo patch withdrew from the study because of side effects. The nicotine skin patch proved to be safe and effective, as demonstrated by a higher rate of abstinence than with the placebo.

[Compliance of patients with chronic obstructive lung disease receiving oxygen therapy at home]. / Behandlingskomplians hos patienter med kronisk obstruktiv lungesygdom i behandling med ilt i hjemmet.

Twenty-nine patients with severe chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT) were prospectively studied for compliance with therapy. Seven patients (24%) used oxygen < 16 hours/day and their mean 24-hour pulse oximetry showed mild hypoxaemia. In addition, we found that eight patients (28%) were smokers. We suggest that the follow-up of these patients should focus on the daily duration of the use of oxygen and cessation of smoking to optimise the effect of this therapy.