[E-cigarette and smoking cessation : current situation in Belgium]. / Cigarettes électroniques et arrêt du tabac : la situation en Belgique.

Because of the devastating health effect of chronic burned tobacco inhalation, smoking cessation is a public health priority. After a short review of the validated pharmacological tools for smoking cessation we have analysed the clinical data obtained with the increasingly popular e-cigarette as an aid to help current smokers to quit. Although e-cigarette has not proved its effectiveness in smoking cessation yet, the public health authorities have usually adopted a pragmatic position. They recommend trying e-cigarette when validated pharmacological tools have failed in making patients abstinent, on the basis that e-cigarette is strongly assumed to be less toxic and may still help reducing the amount of smoked cigarettes.

Compte tenu des effets dévastateurs du tabagisme chronique sur la santé, le sevrage tabagique est un objectif prioritaire de santé publique. Après un bref rappel sur les méthodes validées d'aide au sevrage, nous abordons les données cliniques obtenues avec la cigarette électronique, dont l'utilisation chez nous devient de plus en plus populaire. Au vu de la littérature actuelle, il semble bien que si la cigarette électronique n'a pas encore démontré de façon univoque son efficacité dans l'aide au sevrage complet, néanmoins, les autorités officielles de santé ont généralement adopté une position compréhensive et pragmatique à son égard, au vu de son potentiel à réduire la consommation de cigarette classique chez les patients ayant échoué avec les aides au sevrage validées.

[Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. / Rehabilitationsstandards für die Anschlussheilbehandlung und allgemeine Rehabilitation von Patienten mit einem Herzunterstützungssystem (VAD - ventricular assist device).

The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.

[Tobacco control in Belgium in 2013]. / Le contrôle du tabagisme en Belgique en 2013.

WHO, for the first time in its history, asked in 2003, all Member States to sign and enforce a Framework Convention on Tobacco Control (FCTC). Ten years later, it seems important to describe the achievements made in Belgium. The main legislative measures that are taken to control the major avoidable risk factor for health, are recalled. The present status of Belgium activity in this field is described, with an emphasis on the role of health professionals to help smokers quit. The difficult challenge of curing chronic tobacco dependence disease is underlined. Regarding the fight to render tobacco products less attractive, some breakthroughs are occurring in specific countries, and some are maybe coming soon in Europe.

International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes.

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.

Dependence of hemoglobin mass estimation with the optimized CO-rebreathing method on different spectrophotometers.

The assessment of total hemoglobin mass (tHb-mass) with the optimized carbon monoxide-rebreathing procedure (oCOR) is discussed as a promising method to detect blood doping. The method requires repeated measurements of the carboxyhemoglobin fraction (%HbCO) using spectrophotometers (CO oximeters). In order to determine whether %HbCO measurements with different spectrophotometers yield similar tHb-masses, the results of 57 tHb-mass calculations from simultaneous %HbCO measurements with two different spectrophotometers (RapidLab, OSM3) were analyzed. For the comparison of longitudinal tHb-mass alterations (ΔtHb-mass), 3 tHb-mass measurements were obtained at 6-month intervals (33-37 subjects). Because of significant differences in %HbCO measurements, the limits of agreement for tHb-mass(OSM3) and tHb-mass(RapidLab) were 11.2% (95% reference range -6.8 to +15.6%) and the correlation of ΔtHb-masses as determined with the two spectrophotometers over two time intervals was weak (r: 0.28-0.66). In only about 70% of all ΔtHb-mass estimations did ΔtHb-mass(OSM3) and ΔtHb-mass(RapidLab) show the same direction of change. Apparently, the analytical variation in tHb-mass determination with oCOR increases considerably with the use of different spectrophotometers. Therefore, agreement on the use of one spectrophotometer that accurately measures low %HbCO values is needed if oCOR should be used in an anti-doping setting.

Exercise reduces airway sodium ion reabsorption in cystic fibrosis but not in exercise asthma.

When ventilating large volumes of air during exercise, airway fluid secretion is essential for airway function. Since these are impaired in cystic fibrosis and exercise-induced asthma, it was the aim of this study to determine how exercise affects airway Na(+) and Cl(-) transport and whether changes depend on exercise intensity. Nasal potential was measured in Ringer's solution, with amiloride to block Na(+) transport, and in low chloride-containing isoproterenol to assess Cl(-) channels. Nasal potential was measured at rest and during submaximal and maximal bicycle ergometer exercise in individuals with cystic fibrosis, exercise-induced asthma and controls. At rest, nasal potential was significantly higher in cystic fibroses than in the others. Maximal exercise decreased nasal potentials in cystic fibrosis and controls but not in exercise asthma. Submaximal exercise decreased nasal potentials only in cystic fibrosis. Cl(-) transport was not affected. Our results indicate that nasal potentials and Na(+) transport were decreased by maximal exercise in healthy and cystic fibrosis, whereas submaximal exercise decreased potentials in cystic fibrosis only. Exercise did not affect nasal potentials in asthmatics. Decreased reabsorption during exercise might favour airway fluid secretion during hyperpnoea. This protective effect appears blunted in patients with exercise-induced asthma.

Retinitis pigmentosa and bronchiectasis: a case report on a rare association suggestive of a common underlying primary ciliary dyskinesia (PCD).

We describe a case of retinitis pigmentosa, associated with bronchiectasis, as the first sign of primary ciliary dyskinesia (PCD). Only a few cases were described in the literature and the association of both diseases is not obvious at first sight, although a common ciliary dysfunction of both respiratory epithelium and photoreceptors of the retina seems to be the common factor. It is important to recognize the association and to question patients with retinitis pigmentosa about their respiratory functions, because an early diagnosis of PCD can prevent recurrent infections and development of bronchiectasis with daily physiotherapy.

No evidence for interstitial lung oedema by extensive pulmonary function testing at 4,559 m.

The aim of the present study was to better understand previously reported changes in lung function at high altitude. Comprehensive pulmonary function testing utilising body plethysmography and assessment of changes in closing volume were carried out at sea level and repeatedly over 2 days at high altitude (4,559 m) in 34 mountaineers. In subjects without high-altitude pulmonary oedema (HAPE), there was no significant difference in total lung capacity, forced vital capacity, closing volume and lung compliance between low and high altitude, whereas lung diffusing capacity for carbon monoxide increased at high altitude. Bronchoconstriction at high altitude could be excluded as the cause of changes in closing volume because there was no difference in airway resistance and bronchodilator responsiveness to salbutamol. There were no significant differences in these parameters between mountaineers with and without acute mountain sickness. Mild alveolar oedema on radiographs in HAPE was associated only with minor decreases in forced vital capacity, diffusing capacity and lung compliance and minor increases in closing volume. Comprehensive lung function testing provided no evidence of interstitial pulmonary oedema in mountaineers without HAPE during the first 2 days at 4,559 m. Data obtained in mountaineers with early mild HAPE suggest that these methods may not be sensitive enough for the detection of interstitial pulmonary fluid accumulation.

General introduction to altitude adaptation and mountain sickness.

The key elements in acclimatization aim at securing the oxygen supply to tissues and organs of the body with an optimal oxygen tension of the arterial blood. In acute exposure, ventilation and heart rate are elevated with a minimum reduction in stroke volume. In addition, plasma volume is reduced over 24-48 h to improve the oxygen-carrying capacity of the blood, and is further improved during a prolonged sojourn at altitude through an enhanced erythropoiesis and larger Hb mass, allowing for a partial or full restoration of the blood volume and arterial oxygen content. Most of these adaptations are observed from quite low altitudes [approximately 1000 m above sea level (m a.s.l.)] and become prominent from 2000 m a.s.l. At these higher altitudes additional adaptations occur, one being a reduction in the maximal heart rate response and consequently a lower peak cardiac output. Thus, in spite of a normalization of the arterial oxygen content after 4 or more weeks at altitude, the peak oxygen uptake reached after a long acclimatization period is essentially unaltered compared with acute exposure. What is gained is a more complete oxygenation of the blood in the lungs, i.e. SaO(2) is increased. The alteration at the muscle level at altitude is minor and so is the effect on the metabolism, although it is debated whether a possible reduction in blood lactate accumulation occurs during exercise at altitude. Transient acute mountain sickness (headache, anorexia, and nausea) is present in 10-30% of subjects at altitudes between 2500 and 3000 m a.s.l. Pulmonary edema is rarely seen below 3000 m a.s.l. and brain edema is not seen below 4000 m a.s.l. It is possible to travel to altitudes of 2500-3000 m a.s.l., wait for 2 days, and then gradually start to train. At higher altitudes, one should consider a staged ascent (average ascent rate 300 m/day above 2000 m a.s.l.), primarily in order to sleep and feel well, and minimize the risk of mountain sickness. A new classification of altitude levels based on the effects on performance and well-being is proposed and an overview given over the various modalities using hypoxia and altitude for improvement of performance.

Intermittent hypoxia at rest for improvement of athletic performance.

Two modalities of applying hypoxia at rest are reviewed in this paper: intermittent hypoxic exposure (IHE), which consists of hypoxic air for 5-6 min alternating with breathing room air for 4-5 min during sessions lasting 60-90 min, or prolonged hypoxic exposure (PHE) to normobaric or hypobaric hypoxia over up to 3 h/day. Hypoxia with IHE is usually in the range of 12-10%, corresponding to an altitude of about 4000-6000 m. Normobaric or hypobaric hypoxia with PHE corresponds to altitudes of 4000-5500 m. Five of six studies applying IHE and all four well-controlled studies using PHE could not show a significant improvement with these modalities of hypoxic exposure for sea level performance after 14-20 sessions of exposure, with the exception of swimmers in whom there might be a slight improvement by PHE in combination with a subsequent tapering. There is no direct or indirect evidence that IHE or PHE induce any significant physiological changes that might be associated with improving athletic performance at sea level. Therefore, IHE and PHE cannot be recommended for preparation of competitions held at sea level.

[Smoking experimentation in adolescents. Is there a risk for health?]. / Tabagisme occasionnel de l'adolescent, où commence la nocivité?

It is clear that even low rate smoking is hazardous for health, the risk being independently increased by the daily number of cigarettes smoked and by the duration of smoking. The question raised is thus: will an adolescent experimenter be a non smoker, an experimenter for ever, a regular smoker, light or heavy? This short review shows that there are numerous factors from genetics, to familial environment not limited to tobacco issues, smoking situation at school as well as school performances of the student, and also individual psychological characteristics. The experimenter is a very good target for smoking cessation actions and should deserve particular attention from preventive medicine and, thus, from school medicine, before he becomes a regular smoker, who will be more resistant to smoking cessation programs.

Normobaric hypoxia and nitroglycerin as trigger factors for migraine.

Migraine prevalence is increased in high-altitude populations and symptoms of acute mountain sickness mimic migraine symptoms. Here we tested whether normobaric hypoxia may trigger migraine attacks. As positive control we used nitrolgycerin (NTG), which has been shown to induce migraine attacks in up to 80% of migraineurs. Sixteen patients (12 females, mean age 28.9 +/- 7.2 years) suffering from migraine with (n = 8) and without aura (n = 8) underwent three different provocations (normobaric hypoxia, NTG and placebo) in a randomized, cross-over, double dummy design. Each provocation was performed on a separate day. The primary outcome measure was the proportion of patients developing a migraine attack according to the criteria of the International Headache Society within 8 h after provocation onset. Fourteen patients completed all three provocations. Migraine was provoked in six (42%) patients by hypoxia, in three (21%) by NTG and in two (14%) by placebo. The differences among groups were not significant (P = 0.197). The median time to attacks was 5 h. In conclusion, the (remarkably) low response rate to NTG is surprising in view of previous data. Further studies are required to establish fully the potency of hypoxia in triggering migraine attacks.

[Acute colitis in Wegener's disease: a case report]. / Colite aiguë révélant une maladie de Wegener.

We report the case of a 52 year old man who was hospitalized within a context of a persistent deterioration of his general condition. He was suspected of having a chronic inflammatory colitis. A pulmonary radiography revealed the presence of voluminous bilateral excavated masses with hydro-aerical levels. After having refuted among others a suspicion of tuberculosis, the results of a thoracic percutaneous transpleural lung aspiration by needle under tomodensitometric control steered our diagnosis towards a vascularitis of the Wegener disease type. A treatment with corticotherapy in large doses completed with cyclophosphamid allowed for clinical, biological and radiological improvement. Wegener's granulomatosis usually starts in an insidious manner with febrile episodes and an impairment of the general condition associated with inflammatory biological signs, as observed in our patient. After these warning symptoms, come ORL and/or pulmonary and/or renal impairment, which represent the classical triad of diffused GW. However a certain number of particularities unusual for that diagnosis characterized our patient and prompted the discussion of this case.

Hypoxia causes permeability oedema in the constant-pressure perfused rat lung.

Alveolar hypoxia causes pulmonary oedema associated with increased lung capillary pressure and decreased alveolar fluid reabsorption. However, the role of altered permeability is unclear. The aim of the present study was to test whether hypoxia affects alveolar permeability and induces pulmonary oedema in rat lungs, and whether terbutaline affects oedema formation. Isolated lungs of normoxic rats were perfused at a constant pressure (12 cmH2O) and exposed to different levels of oxygenation (1.5-35% O2). Terbutaline (10-5 M) was applied as an aerosol or with the perfusate. Online measurements indicate an earlier onset of weight gain with an increasing degree of hypoxia and a shortened lung survival time (35% O2: approximately 220 min; 1.5% O2: approximately 120 min). Terbutaline did not prevent oedema formation in hypoxic lungs. The terbutaline-induced formation of cyclic adenosine monophosphate was decreased by 50% in hypoxia (1.5% O2). In experiments terminated after 75 min, bronchoalveolar lavage fluid of hypoxic lungs contained protein that originated from perfusate indicating alveolar leakage. Since lactate dehydrogenase in perfusate was not increased at the onset of oedema formation, cell damage does not explain the increased permeability. In conclusion, these results indicate the formation of a leak for macromolecules of the isolated perfused rat lung, which is accelerated by hypoxia and causes alveolar flooding even at low perfusion pressure at a rate that exceeds absorption even after stimulation with terbutaline.

[Stop smoking help: keys to long term success]. / L'aide a l'arrêt du tabagisme: la réussite au long terme. Aspects psychologiques et pharmacologiques.

This review deals with the pharmacological and psychological means to help in smoking cessation and compares the efficacy of the different methods. Pharmacological support results in a smoking cessation rate reaching at best 20-25%. The efficacy of behavioural and cognitive therapy have been much less validated so far. Multidisciplinary specialized centres for helping smokers have been raised under the care of FARES in the French Community of Belgium.

Platelet count and function at high altitude and in high-altitude pulmonary edema.

Platelet aggregation is the key process in primary hemostasis. Certain conditions such as hypoxia may induce platelet aggregation and lead to platelet sequestration primarily in the pulmonary microcirculation. We investigated the influence of high-altitude exposure on platelet function as part of a larger study on 30 subjects with a history of high-altitude pulmonary edema (HAPE) and 10 healthy controls. All participants were studied in the evening and the next morning at low altitude (450 m) and after an ascent to high altitude (4,559 m). Platelet count, platelet aggregation (platelet function analyzer PFA100; using epinephrine and ADP as activators), plasma soluble P (sP)-selectin, and the coagulation parameters prothrombin fragments 1+2 and thrombin-antithrombin complex were measured. High-altitude exposure decreased the platelet count, shortened the platelet function analyzer closure time by approximately 20%, indicating increased platelet aggregation, increased sP-selectin levels to approximately 250%, but left plasma coagulation unaffected. The HAPE-susceptible subjects were prophylactically treated with either tadalafil (a phosphodiesterase 5 inhibitor), dexamethasone, or placebo in a double-blind way. Subgroup analyses between these different treatments and comparisons of the seven placebo-treated individuals developing HAPE and controls revealed no differences in platelet count, platelet aggregation, or sP-selectin values. We conclude that exposure to high altitude activates platelets, which leads to platelet aggregation, platelet consumption, and decreased platelet count. These effects are, however, not more pronounced in individuals with a history of HAPE or actually suffering from HAPE than in controls and therefore may not be a pathophysiological mechanism of HAPE.