The role of sleep in the regulation of body weight.

Sleep participates in the regulation of body weight. The amount of sleep and synchronization of the biological clock are both necessary to achieve the energy balance and the secretion of hormones that contribute to weight regulation. In this review, we first reconsider what normal physiological sleep is and what the normative values of sleep are in the general population. Second, we explain how the biological clock regulates the hormones that may be involved in weight control. Third, we provide some recent data on how sleep may be disturbed by sleep disorders or reduced by sleep debt with consequences on weight. Finally, we explore the relationships between sleep debt and obesity.

Transfusions, major bleeding, and prevention of venous thromboembolism with enoxaparin or fondaparinux in thoracic surgery.

Enoxaparin 40 mg/day (E) or fondaparinux 2.5 mg/day (F) are recommended to prevent venous thromboembolism (VTE) in medical and surgical patients at risk. Over the two years after switching from E to F in our 35-bed department of pulmonology and thoracic surgery, an increase in the number of transfusions was observed. A retrospective explanatory investigation was undertaken. Hospitalised patients in the two years before and after switching from E to F were compared. The files of all transfused patients were reviewed. A blinded independent committee adjudicated major bleeding events. In the investigated time period, the overall transfusion rate increased from 1.8% of 2,989 patients to 3.1% of 3,085 patients (p=0.002). Mean ages (58.4 vs. 59.1 years), proportions of surgical patients (63.6% vs. 58.4%), cancer patients (72.1% vs. 69.5%), and treated patients (≥ 1 dose of E or F: 51.8% vs. 52.5%) were similar. The number of medical patients transfused while receiving E or F did not increase significantly (0.9% vs. 1.3%, RR=1.45 [0.66-3.17], p=0.35). The number of surgical patients transfused postoperatively while receiving E or F increased significantly (0.7% vs. 1.9% of all surgical patients, relative risk [RR]=2.75 [1.45-5.23], p=0.001), including a significant increase in transfusions for major bleeding (0.2% vs. 0.9%, RR=5.97 [1.74-20.4], p<0.001). A multivariate analysis did not find confounding factors. The incidence of symptomatic postoperative pulmonary embolism remained very low (0.05% vs. 0.17%). In conclusion, in thoracic surgery patients, switching from enoxaparin to fondaparinux to prevent VTE was associated with a significant increase in the risk of postoperative major bleeding. A causal relationship appears plausible.

Pulmonary toxicity related to systemic treatment of nonsmall cell lung cancer.

Physicians who are responsible for the delivery of systemic treatment in lung cancer should be aware of the potential risk of drug-induced pulmonary toxicity (DIPT), because such toxicity may develop in the context of a multifactorial clinical condition. First, most patients with lung cancer may suffer from other non-neoplastic, smoking-related lung diseases, such as emphysema and chronic obstructive lung disease, which may generate pathologic changes in lung parenchyma. In addition, lung cancer itself may worsen the respiratory function, inducing atelectasis and lymphangitic carcinomatosis. The superimposed iatrogenic damage may lead to respiratory failure and, sometimes, death. The risk of DIPT from chemotherapeutic agents has been widely examined in the past; and, currently, the potential for lung toxicity has been extended by the introduction of molecular targeted therapies. Because there are no univocal criteria with which to recognize DIPT, the diagnosis often is made by exclusion; consequently, it is hard to establish an early diagnosis. The objective of this review was to describe the major DIPTs associated with antineoplastic agents against nonsmall cell lung cancer to help physicians with this difficult diagnostic challenge.

The prognostic value of the otoacoustic emission test in low frequency sudden hearing loss.

Low frequency sudden hearing loss (LFSHL) is a frequent finding in the otological practice. Several prognostic indicators have been suggested concerning the prediction of the outcome of sudden hearing loss, but so far there are no proven factors to establish the prognosis. The aim of this study was to assess whether OAEs could be considered as a reliable prognostic test in LFSHL. The study group consisted of 20 patients presenting with a unilateral LFSHL. Each patient was submitted to spontaneous otoacoustic emissions (SOAEs), transient otoacoustic emissions (TEOAEs) and distortion products (DPOAEs) recording and then treated with glycerol administrated intravenously in 3-h intervals for 4 days. Pure tone audiometry (PTA) threshold was evaluated again 1 h after the last administration of glycerol. After osmotic therapy 12 patients (60%) showed a significant PTA improvement with a mean improvement of 11 dB; modifications were significant at the Student's t test for paired data (P<0.0001). The relationship between the pretherapy presence or absence of SOAEs, TEOAEs and DPOAEs and PTA modification was not significant at the exact Fisher's test. In conclusion, even if our study supports that OAEs could be an indicator of the inner ear functional state, they cannot be utilized as a prognostic test in LFSHL in relation to the efficacy of osmotic therapy. Among the other parameters evaluated, only the precocity of therapy seems to be related to prognosis in LFSHL.