Who, why, where: an overview of determinants of sunbed use in Europe.

Although exposure to indoor tanning has been established as a clear risk factor for skin cancer, sunbeds are still commonly used in Europe. Understanding the determinants of sunbed use in Europe is key to plan educational interventions, behavioural strategies and legislative measures, which should be tailored to subgroups with different risk profiles. Evidences show that the typical sunbed users in Europe are young-adult women, with intermediate skin type, a current employment and a medium/high socio-economic status. Typical users display sun-seeking behaviours and other risky behaviours such as smoking. Indoor tanning seems more common in northern than southern Europe. However, sunbed use remains common in fair-skinned individuals and among adolescents/pre-adolescents. Commonly reported reasons for sunbed use in Europe include aesthetic motives (i.e. looking attractive), the pursue of a prevacation tan, the influence of peers/parents engaging in the same habit, and the treatment of health conditions. The most commonly reported places to get an artificial tan in Europe are tanning studios and beauty salons. However, sunbeds are also available in sport venues, such as swimming pools and gyms, hotels and private houses. All these factors should be taken into account when planning educational, behavioural and legislative interventions to reduce the popularity of artificial tanning in Europe.

Respiratory effort during sleep apneas after interruption of long-term CPAP treatment in patients with obstructive sleep apnea.

Apneas generally reappear in patients with obstructive sleep apnea (OSA) when treatment with continuous positive airway pressure (CPAP) is interrupted. However, a single-night treatment interruption may be associated with a lesser severity of sleep apneas than before treatment. We hypothesized that this decrease in severity of sleep apneas reflects changes in the respiratory response to upper airway obstruction. Therefore, we compared indexes of respiratory effort during sleep in 25 patients with OSA before and after 1 year of CPAP treatment. Respiratory effort was assessed by means of an esophageal balloon. After 1 year of CPAP treatment, there was a decrease in the maximal end-apneic esophageal pressure swings (Pes) (from 56.7 +/- 5.4 to 30.3 +/- 2.6 cm H2O; p = 0.000; mean +/- SEM), in the overall increase in Pes during an apnea (35.2 +/- 3.6 vs 16.5 +/- 1.5 cm H2O; p = 0.000), as well as the rate of increase in Pes (1.1 +/- 0.1 vs 0.6 +/- 0.1 cm H2O/s; p = 0.000). Although body mass index (BMI) did not change significantly, the individual changes in BMI significantly correlated with the changes in respiratory effort after 1 year of CPAP treatment. Apnea duration and apnea-related oxygen desaturation also decreased significantly. We conclude that long-term CPAP treatment induces changes in respiratory control that persist at least on the first night of treatment interruption.

Respiratory effort during obstructive sleep apnea: role of age and sleep state.

OBJECTIVE: To evaluate the patients' individual characteristics predictive of the degree of respiratory effort developed during obstructive sleep apneas (OSAs). DESIGN: Prospective consecutive sample, collection of clinical and polysomnographic data. SETTING: University teaching hospital. PATIENTS: One hundred sixteen consecutive OSA patients with clinical symptoms of OSA and more than 20 apneas per hour of sleep. MEASUREMENTS: Anthropomorphic data, daytime blood gas values, and polysomnographic data. From esophageal pressure measurements during sleep, three indexes of respiratory effort during OSAs were derived: the maximal end-apneic esophageal pressure swing (PesMax), the increase in esophageal pressure swing (deltaPes) during the apnea, and its ratio to apnea duration (RPes). RESULTS: The indexes of respiratory effort were significantly lower in rapid eye movement (REM) than in non-REM sleep (PesMax: 50.9+/-2.5 vs 39.6+/-1.9 cm H2O, p<0.001; deltaPes: 30.9+/-1.7 vs 23.4+/-1.4 cm H2O, p<0.001; RPes: 1.05+/-0.05 vs 0.53+/-0.03 cm H2O/s, p<0.001); therefore, a separate analysis was conducted in non-REM and in REM sleep. Indexes were also significantly lower in subgroups of older as compared to younger patients (PesMax: 55.6+/-3.5 vs 40.0+/-2.2 cm H2O, p<0.001; deltaPes: 34.2+/-2.3 vs 24.1+/-1.6 cm H2O, p=0.001; RPes: 1.21+/-0.08 vs 0.8+/-0.05 cm H2O/s, p<0.001). The three indexes were closely correlated with each other and only PesMax correlation data are reported. In non-REM sleep, age was the most important single independent correlate of PesMax (r=-0.37, p=0.000). In REM sleep, the apnea-related hypoxemia, apnea duration, and age were the main contributors to the variance of PesMax. CONCLUSIONS: Respiratory effort in response to upper airway occlusion in OSA patients is lower in REM than in non-REM sleep and decreases with increasing age.

Respiratory effort. A factor contributing to sleep propensity in patients with obstructive sleep apnea.

To test the hypothesis that respiratory effort during obstructive apneas contributes, together with hypoxemia and sleep fragmentation, to excessive daytime sleepiness, we investigated the relationship between daytime sleepiness and polysomnographic variables in 44 patients with obstructive sleep apnea (OSA). In all patients, daytime sleep propensity was assessed by an 11-item standardized self-questionnaire yielding a sleepiness score and by a modified sleep latency test yielding a mean sleep latency. Respiratory effort during apneas was evaluated by measuring esophageal pressure swings using an esophageal balloon. Within each apneic cycle, we measured the esophageal pressure swings during the first three and the last three occluded efforts during the apnea to define the overall increase, its ratio to apnea duration, and the maximal effort developed during obstruction. In the group of patients as a whole, the sleepiness score was negatively correlated with the mean sleep latency (r=-0.38, p=0.01). The sleepiness score was correlated with the indexes of respiratory effort during apneas (ie, the overall increase, its ratio to apnea duration, and the maximal end-apneic swing in esophageal pressure) and with the apnea+hypopnea index. The mean sleep latency was correlated with all indexes of nocturnal hypoxemia (ie, the mean lowest oxyhemoglobin saturation [SaO2] and the index of apnea associated with a fall in SaO2 below 90% and 80%). We conclude that the degree of respiratory effort during obstructive apneas contributes to self-rated sleep propensity in patients with OSA.

Effect of alkalosis on maximum oxygen uptake in rats acclimated to simulated altitude.

The objective of the present experiments was to determine whether prevention or moderation of exercise acidosis would influence arterial blood oxygenation and exercise capacity in hypoxia. The effect of administration of 0.3 M NaHCO3 (3 ml/100 g) on maximum O2 uptake (VO2max) and arterial blood oxygenation was determined in rats acclimated to simulated altitude (370-380 Torr barometric pressure) for 3 wk (HxBic) and in normoxic littermates (NxBic). Controls were simulated-altitude (HxNaCl) and normoxic rats (NxNaCl) given 0.3 M NaCl. Inspiratory PO2 during treadmill exercise was approximately 70 Torr for hypoxic rats and 140-145 Torr for normoxic rats. VO2max was 18% higher in HxBic than in HxNaCl (62.8 + 1.6 vs. 53.1 + 1.0 ml STPD.min-1.kg-1, respectively, P less than 0.05) and only 8% higher in NxBic than in NxNaCl (74.0 + 1.1 vs. 68.7 + 1.5 ml STPD.min-1.kg-1, respectively, P less than 0.05). Exercise in HxNaCl resulted in a decrease in arterial O2 concentration (CaO2), which was largely due to a pH-induced decrease in O2 saturation of arterial blood, and occurred despite an increase in arterial PO2. NaHCO3 moderated the acidosis of exercise and largely attenuated the decrease in CaO2. The effects of acidosis and bicarbonate on CaO2 were much less evident in the normoxic controls. There was an almost linear relationship between VO2max and the corresponding CaO2 for all four groups, suggesting that the effect of NaHCO3 on VO2max may be related to moderation of the decrease in CaO2.

Respiratory disorders during sleep in patients with epilepsy: effect of ventilatory therapy on EEG interictal epileptiform discharges.

OBJECTIVE: Sleep disorders are common and may coexist with a variety of diseases, including epilepsy, with important implications for the clinical management of the latter. Sleep fragmentation and deprivation, and hypoxia associated to sleep disordered breathing (SDB) may contribute to the occurrence of seizures. On the other hand, antiepileptic drugs may worsen SDB by reducing the muscle tone of the upper airways, and increasing the arousal threshold. There is evidence indicating that treatment of the SDB can reduce both frequency and intensity of seizures. This study aimed at further understanding the relationship between SDB and epilepsy, particularly the influence of SDB on epileptogenicity - as evaluated by a quantitative analysis of interictal epileptogenic activity. METHODS: Eight consecutive patients affected by partial epilepsy associated to SDB (OSAS or an association between chronic obstructive pulmonary disease-- COPD - and snoring) underwent two nocturnal polysomnographies (PSG)-- before and after ventilatory therapy with CPAP (in 6 patients with OSAS) or oxygen (in two patients with COPD and snoring). Spiking was quantified during the first sleep cycle in both PSG studies, and spiking rates were calculated both for the entire sleep cycle and for each separate sleep phase (NREM 1, NREM 2, NREM 3-4, REM and wake time after sleep onset - WASO). RESULTS: In all patients, the improvement of the SDB after ventilatory treatment--as demonstrated by a reduction of the respiratory disturbances index (RDI) - was associated to a reduction of spiking rates, both in the entire cycle and in relationship to slow wave sleep. This reduction was particularly marked in patients with higher spiking rates in baseline conditions. CONCLUSION: Our data show that SDB treatment reduces the interictal epileptogenic activity, suggesting that SDB plays a role in increasing epileptogenicity. Further studies will be necessary to clarify the mechanisms whereby this reduction in epileptogenicity occurs, although improved sleep stability seems to play an important role. The presence of an underlying SDB in patients with refractory epilepsy should be investigated.

A video-polygraphic analysis of the cataplectic attack.

OBJECTIVES AND METHODS: To perform a video-polygraphic analysis of 11 cataplectic attacks in a 39-year-old narcoleptic patient, correlating clinical manifestations with polygraphic findings. Polygraphic recordings monitored EEG, EMG activity from several cranial, trunk, upper and lower limbs muscles, eye movements, EKG, thoracic respiration. RESULTS: Eleven attacks were recorded, all of them lasting less than 1 min and ending with the fall of the patient to the ground. We identified, based on the video-polygraphic analysis of the episodes, 3 phases: initial phase, characterized essentially by arrest of eye movements and phasic, massive, inhibitory muscular events; falling phase, characterized by a rhythmic pattern of suppressions and enhancements of muscular activity, leading to the fall; atonic phase, characterized by complete muscle atonia. Six episodes out of 11 were associated with bradycardia, that was maximal during the atonic phase. CONCLUSIONS: Analysis of the muscular phenomena that characterize cataplectic attacks in a standing patient suggests that the cataplectic fall occurs with a pattern that might result from the interaction between neuronal networks mediating muscular atonia of REM sleep and neural structures subserving postural control.

Actigraphy and leg movements during sleep: a validation study.

A study comparing actigraphy and polysomnography in the detection of leg movements was performed in a group of 35 patients with sleep disorders. Visual scoring used epochs of 5-second duration, and in each epoch, electromyographic activity of tibialis anterior muscle was classified in eight types on the basis of its duration and amplitude. Activity levels of the actigraphic data were logged in 5-second intervals and stored in memory for computer retrieval. To assess the reproducibility of actigraphic detection scoring, in 10 patients actigraphic and polysomnographic data were compared during two consecutive nights. Despite a high correlation between polysomnography and actigraphy in the detection of muscular activity (r = 0.78; P = 0.001), no agreement was obtained between the two analyses according to the Bland and Altman method of concordance (mean bias: -117.5). The greater agreement was found for electromyographic activity lasting more than 3 seconds and with an amplitude of more than 50 microV. In the group of patients examined during two consecutive nights the scoring error did not differ significantly. The results demonstrated that (1) despite a significant correlation between actigraphic and polysomnographic data, actigraphy substantially underestimated leg electromyographic activity and therefore could not be used routinely for diagnostic purposes; and (2) because error scoring did not undergo significant changes across the two nights, actigraphy may be used for follow-up evaluation.

[Propensity for sleep and diurnal somnolence in the course of sleep apnea syndrome]. / Propension au sommeil et somnolence diurne au cours du syndrome d'apnées du sommeil.

Daytime sleepiness is one of the major symptoms of obstructive sleep apnea. However, its definition raises problems, since it may be based on either subjective feeling (evaluated by means of questionnaires or analog visual scales), physiological drive or need (inferred by a sleep latency) or on the concept of sleep propensity defined as the probability of falling asleep (measured by the occurrence of sleep in various circumstances of daily life). Data from the literature suggest that sleep fragmentation and hypoxemia, both related to sleep apneas, cause daytime sleepiness. Our own data show that sleep propensity in a group of 44 patients with obstructive sleep apnea was correlated with the increase in esophageal pressure swings during obstructive apneas. This result suggests that the increased respiratory effort against occluded upper airways also contributes to daytime sleepiness in patients with obstructive sleep apnea.

[Pulmonary metastasis from an eccrine carcinoma: thoracic perfusion with the aorto-caval stop-flow technique. Description of a clinical case]. / Metastasi polmonari da carcinoma eccrino: perfusione toracica con tecnica dello stop-flow aorto-cavale. Descrizione di un caso clinico.

A case of a 64-year-old man with eccrine carcinoma arising from hand skin is reported. At the time of diagnosis he showed bilateral pneumonic metastases. Although the patient underwent two systemic chemotherapy lines, he showed further progressive disease of the lung. For this reason a third chemotherapy line was started through thoracic stop-flow infusion. In this way, a five month stable disease had been achieved. The patient died 7 months later for progressive disease. The rarity of this disease, the uncertain treatment, the feasibility and efficacy of thoracic stop-flow infusion are underlined and further studies are suggested.

[Testicular lymphomas. A clinico-pathological study of 5 cases and a review of the literature]. / I linfomi testicolari. Studio clinico patologico di 5 casi e revisione della letteratura.

The authors describe five consecutive patients with testicular non Hodgkin lymphoma, evaluate the clinical and histological characteristics and underline the importance of a chemotherapy approach both at diagnosis and at relapse. A review of the literature is carried on and particularly about the prognostic factors, the correlation with Ebstein Barr virus and the more recent integrated therapeutical approaches.

[Systemic mastocytosis. A review of current diagnostic and therapeutic approaches]. / La mastocitosi sistemica. Revisione degli attuali approcci diagnostico-terapeutici.

Mastocytosis is a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells in skin, bone marrow, bone, gastrointestinal tract, liver, spleen and lymph nodes. Today, regarding its biological features, mastocytosis (with or without myeloid accompanying disorders) is considered to be a hematologic disease. The classification proposed by Metcalfe in 1991 is the most useful in caring for patients with mastocytosis. In this classification 4 groups are described: 1) indolent mastocytosis with or without extracutaneous involvement; 2) systemic mastocytosis with an associated hematologic disorder; 3) aggressive mastocytosis; 4) mast-cell leukemia. Cutaneous mastocytosis typically presents as urticaria pigmentosa or diffuse cutaneous mastocytosis and these patients usually have a benign course. On the contrary, systemic mastocytosis is a disease with an increased risk to develop an aggressive hematologic disorder. In these patients a second hematologic process, such as myeloproliferative or myelodysplastic syndrome or acute leukemia, may occur. These patients often present without skin involvement and they have a very poor prognosis. Mast cell is a medium-sized granulated cell releasing chemical mediators (histamine, heparin, protease and cytokines). Mast cells originate from pluripotent hemopoietic progenitor cells that express the CD34 antigen. Mast cells are present in the bone marrow and are distributed throughout the connective tissues. Recently a mast-cell growth factor (MGF) has been identified. Clinical symptoms occur from the release of chemical mediators and the pathologic infiltration of cells. Although no effective therapy for patients with Mastocytosis is known, some patients may benefit from corticosteroid and interferon alpha treatment. The present article gives an overview of current knowledge about the biology, heterogeneity and treatment of human mastocytosis.

Role of chemosensitivity in intrathoracic pressure changes during obstructive sleep apnea.

We tested the hypothesis that the awake ventilatory response to hypoxia and hypercapnia may contribute to the variability of respiratory effort developed in response to upper airway obstruction in obstructive sleep apnea syndrome. The polygraphic recordings of 38 patients diagnosed as having obstructive sleep apnea on the basis of an apnea+hypopnea index greater than 10 were examined. All subjects received hypoxic and hypercapnic ventilatory tests the day before the nocturnal polysomnography. Thirty apneas during non-rapid eye movement (NREM) sleep and at least 10 apneas during rapid eye movement sleep were analyzed. For each considered apnea, we measured esophageal pressure (Pes) swings during the first three breaths preceding apnea and during the first three and last three occluded efforts occurring during the apnea. We considered as indices of respiratory effort the overall increase from the minimum to the maximum Pes (delta Pes), the rate of increase of Pes during apnea (RPes), and the maximal respiratory effort at the end of apnea (Pes max fin). In NREM sleep, all three indices of respiratory effort were correlated positively with the awake ventilatory response to hypoxia or hypercapnia and with the apnea index. No correlation was found between the indices of respiratory effort and body mass index, age, pulmonary function tests, awake blood gases, apnea duration, and apnea desaturation. In rapid eye movement sleep, none of the considered variables predicted the degree of respiratory effort. In conclusion, our results suggest that the degree of ventilatory response to upper airway occlusion in obstructive sleep apnea may be influenced by the sensitivity of central neural drive to chemical stimuli.

Determinants of effective continuous positive airway pressure in obstructive sleep apnea. Role of respiratory effort.

We investigated whether cephalometric measurements, nocturnal indices of negative intrathoracic pressure, or the frequency of sleep-related breathing disorders were related to the level of effective continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). We examined 22 OSA patients who underwent two consecutive polysomnographic recordings, the first for diagnosis and the second for CPAP titration. Cephalometric measurements, spirometric data, and blood-gas analysis results were available for all subjects. In the diagnostic polysomnography, at least 30 apneas were analyzed during non-rapid-eye-movement (NREM) sleep and 10 apneas during rapid eye movement (REM) sleep for each patient. Swings in esophageal pressure (Pes) during the preapneic period and during the beginning and the end of obstructive apneas were calculated as the average of three consecutive breaths (or ineffective efforts). The difference in Pes from the minimal initial to the maximal final apneic respiratory effort (DPes) and the rate of increase in Pes (RPes = DPes/apnea duration) during apnea were computed. Within an apnea, the lowest Pes always occurred during the first three occluded breaths and the highest during the last three, with a more marked difference in NREM sleep. The level of effective CPAP was correlated with the length of the soft palate (r = 0.69, p = 0.000), RPes (r = 0.55, p = 0.008), and DPes (r = 0.49, p = 0.02). The correlations of effective CPAP level with body mass index and apnea + hypopnea index were not significant. A model including length of the uvula, DPes, and RPes accounted for 56 to 59% of the variability in effective CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)

M-BCR breakpoint location does not predict survival in Philadelphia chromosome-positive chronic myeloid leukemia.

BACKGROUND: Some reports in the recent literature have shown that the site of molecular rearrangement within the M-BCR area may have a prognostic value in Ph1 + CML patients. A number of studies have, however, failed to demonstrate this finding. Here we report the molecular rearrangements of 107 patients and their clinical follow-up. METHODS: Localization of the breakpoints was determined according to conventional criteria, after digestion with 2 to 4 restriction endonucleases and hybridization with 1 or 2 molecular probes. RESULTS: Sixty two patients were rearranged in the 5' area and 45 in the 3' area: there was no difference between the survival curves of the two groups, at least not after 3 years of follow-up. CONCLUSIONS: The site of the breakpoint within the M-BCR has no prognostic significance in our series.

The type of BCR/ABL junction does not predict the survival of patients with Ph1-positive chronic myeloid leukaemia.

The prognostic value of the location of the breakpoint on chromosome 22 in patients with Ph1+ chronic myeloid leukaemia (CML) is still controversial. We analysed both DNA rearrangement and transcript type in a new continuous series of CML patients. By Southern blotting analysis, we found that, out of 72 patients, 43 had a 5' rearrangement and 29 a 3' one, of the 43 5'-rearranged patients, 35 carried an a2b2 transcript and eight an a2b3 one, while, of the 29 patients rearranged in the 3' part of the M-BCR area, 26 had an a2b3 transcript, one had an a2b2 transcript and two carried both types of transcript. Thus, mRNA studies allow to detect an a2b3 transcript in 17.7% of 5' rearranged patients. However, no correlation was observed between type of transcript and survival, as after DNA studies.