Obstructive sleep apnea and heart disease: the biomarkers point of view.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder. Important risk factors for this disease are represented by obesity, male gender, smoking, some endocrinological disturbances, alcohol intake, use of benzodiazepines, and craniofacial alterations. It is well known that OSAS is a frequent comorbidity as well as a relevant risk factor for cardiovascular diseases (CVD), especially in patients with hypertension, coronary artery disease (CAD), arrhythmias, and heart failure. Furthermore, therapy with continuous positive airway pressure devices (CPAP) has been shown to significantly reduce the incidence of serious cardiovascular consequences. Interactions between OSAS and the cardiovascular system (CVS) can eventually result mainly in coronary atherosclerosis. These two conditions are connected by a complex biomarkers network. An extensive overview of these pathways could be helpful to better understand the causes of cardiovascular impairment in patients with OSAS

Diagnostic Role of Bronchoalveolar Lavage in Patients with Suspected SARS-CoV-2 Pneumonia and Negative Upper Respiratory Tract Swab: A Systematic Review and Meta-Analysis

The added role of bronchoalveolar lavage (BAL) in SARS-CoV-2 detection in hospitalized patients with suspected COVID-19 pneumonia and at least one negative nasopharyngeal swab (NPS) has yet to be definitively established. We aimed to provide a systematic review and meta-analysis to summarize data from the literature on the diagnostic yield of BAL in this context. We searched Medline and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed all titles/abstracts and retrieved the selected full texts according to predefined selection criteria. The summary estimate was derived using the random-effects model. Thirteen original studies, involving 868 patients, were included. The summary estimate of proportions of SARS-CoV-2 positivity in BAL fluid in patients with at least one previous negative NPS was 20% (95% confidence interval [CI]; 11–30%). Moreover, microbiological tests of BAL fluid led to the identification of other pathogens, mainly bacteria, in up to two-thirds of cases. BAL plays a crucial role in the diagnostic work-up of patients with clinical suspicion of COVID-19 and previous negative NPS, as it allowed to detect the infection in a significant proportion of subjects, who would have been otherwise misclassified, with relevant implications in the prevention of disease spread, especially in hospital settings

Diagnostic Accuracy of Slow-Capillary Endobronchial Ultrasound Needle Aspiration in Determining PD-L1 Expression in Non-Small Cell Lung Cancer

Introduction: The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as "suction". One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar/mediastinal lymphadenopathies subsequent to NSCLC. Materials and Methods: Patients with hilar and/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of "Ospedali Riuniti di Ancona" (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan/ FDG-PET features and final histological diagnoses, including PD-L1 assessment. Results: A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the "Ospedali Riuniti di Ancona". Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29/30); in 15/29 (51.7%) samples with more than 1000 viable cells/HPF were identified, whereas in 14/29 (48.3%) samples contained 101-1000 viable cells/HPF. Conclusion: These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC

Diagnostic Accuracy of Slow-Capillary Endobronchial Ultrasound Needle Aspiration in Determining PD-L1 Expression in Non-Small Cell Lung Cancer

Introduction: The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as “suction”. One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar/mediastinal lymphadenopathies subsequent to NSCLC. Materials and Methods: Patients with hilar and/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of “Ospedali Riuniti di Ancona” (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan/ FDG-PET features and final histological diagnoses, including PD-L1 assessment. Results: A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the “Ospedali Riuniti di Ancona”. Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29/30); in 15/29 (51.7%) samples with more than 1000 viable cells/HPF were identified, whereas in 14/29 (48.3%) samples contained 101–1000 viable cells/HPF. Conclusion: These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC

Validation of a Cytological Classification System for the Rapid On-Site Evaluation (Rose) of Pulmonary and Mediastinal Needle Aspirates

Rapid on-site evaluation (ROSE) is a procedure that allows immediate assessment of adequacy of cytological specimens obtained by fine needle aspiration (FNA). The application of ROSE diagnostic categories has been applied in various organs, but not in thoracic pathology. We aimed to retrospectively assess the concordance with the final diagnosis of a categorization from C1 (inadequate) to C5 (neoplastic) during ROSE performed with bronchoscopic or percutaneous sampling procedures of thoracic lesions in a large series of consecutive cases. This retrospective single-center study evaluated 2282 consecutive ROSEs performed on 1827 patients from January 2016 to December 2020 in 994 cases of transbronchial needle aspiration (TBNA) in peripheral pulmonary lesions, in 898 transthoracic FNAs, in 318 ultrasound-guided TBNAs, in 50 conventional TBNAs and in 22 endobronchial TBNAs. False positive and false negative cases of ROSE were 43 (1.88%) and 73 (3.2%), respectively, when compared with the definitive diagnosis. The sensitivity, specificity and the positive and negative prognostic values of ROSE were 94.84%, 95.05%, 96.89% and 91.87%, respectively. Overall concordance between ROSE and the final diagnosis was 0.8960 (Cohen's kappa). No significant differences were observed in terms of sampling procedures and type and location of the lesions. A tiered classification scheme of ROSE from C1 to C5 during bronchoscopic and percutaneous sampling procedures is helpful in effectively guiding clinical management of patients with thoracic lesions

Association between obstructive sleep apnea and serum uric acid levels in obese women

Abstract INTRODUCTION Controversial data exist on association of hyperuricemia both with increased cardiovascular risk, particularly in obese patients, and with the presence and severity of obstructive sleep apnea (OSA). AIM We correlated acid uric (AU) levels with metabolic and polygraphic parameters in obese patients with suspected OSA. METHODS We studied 86 patients (44M) aged 44.3+9.7 yr, BMI 43.9+6.7), all CPAP naïve. At the cardiorespiratory monitoring AHI was >5, >15 and >30 in 90,70,and 46% of them. RESULTS Mean UA was greater in men (7.30+1.7 vs 5.6+0.12, p 0,003) and in the upper versus lowest AHI quartiles (7+1.5vs 5.5+1.6, p 0.007). Men showed also greater values of AHI, ODI, creatinine, haemoglobin and lower HDL cholesterol levels than women, with similar age and BMI. UA was directly correlated with AHI and ODI (r 0.33-0.36, p 0.005), time spent with SpO2<90% (r 0.25, p 0.013), serum creatinine (r 0.29, p 0.014) and triglycerides (0.36, p=0.003), but not with age or BMI, and inversely with HDL cholesterol (r -0.36,p=0.001). Multiple linear regression demonstrated a significant association with AHI independent of age and BMI only in women and with glycated haemoglobin (HbA1c) in both sex subgroups. The correlations with nocturnal OSA parameters were even stronger among women (r 0.46-0.52, p<0.004) but not significant in men. CONCLUSION Our results support the hypothesis of a significant association between UA and OSAS in obese women, both for number of events and for induced hypoxemia, while in obese men the more complex interaction between OSA, UA and classical cardiovascular risk factors requires further clarification

ECG is an inefficient screening-tool for left ventricular hypertrophy in normotensive African children population

Background Left ventricular hypertrophy (LVH) is a marker of pediatric hypertension and predicts development of cardiovascular events. Electrocardiography (ECG) screening is used in pediatrics to detect LVH thanks to major accessibility, reproducibility and easy to use compared to transthoracic echocardiography (TTE), that remains the standard technique. Several diseases were previously investigated, but no data exists regarding our study population. The aim of our study was to evaluate the relationship between electrocardiographic and echocardiographic criteria of LVH in normotensive African children. Methods We studied 313 children (mean age 7,8 ± 3 yo), in north-Madagascar. They underwent ECG and TTE. Sokolow-Lyon index was calculated to identify ECG-LVH (>35 mm). Left ventricle mass (LVM) with TTE was calculated and indexed by height2.7 (LVMI2.7) and weight (LVMIw). We report the prevalence of TTE-LVH using three methods: (1) calculating percentiles age- and sex- specific with values >95th percentile identifying LVH; (2) LVMI2.7 >51 g/m2.7; (3) LVMIw >3.4 g/weight. Results 40 (13%) children showed LVMI values >95th percentile, 24 children (8%) an LVMI2.7 >51 g/m2.7 while 19 children (6%) an LVMIw >3.4 g/kg. LVH-ECG by Sokolow-Lyon index was present in five, three and three children respectively, with poor values of sensitivity (ranging from 13 to 16%), positive predictive value (from 11 to 18%) and high values of specificity (up to 92%). The effects of anthropometrics parameters on Sokolow-Lyon were analyzed and showed poor correlation. Conclusion ECG is a poor screening test for detecting LVH in children. In clinical practice, TTE remains the only tool to be used to exclude LVH

Control of breathing in obstructive sleep apnoea patients: Role of CPAP therapy

Control of breathing in obstructive sleep apnoea patients: Role of CPAP therapy A. Re, F. Mormile, A. Di Marco Berardino, D. Visca, B. Iovene, S. Valente (Rome, Italy) Aim: Control of breathing during wakefulness in obstructive sleep apnoea (OSA) and the role of CPAP therapy is an ongoing controversy. We studied the ventilatory response of healthy controls and OSA patients before and after at least 1 year of CPAP therapy. Methods: 17 never treated OSA patients (16 M; 53±13.2yrs; BMI=34.5±8.1; AHI=45±14.7) underwent nocturnal cardiopulmonary monitoring, spirometry and blood gas analysis. Read's rebreathing test was used to evaluate hypercapnic ventilatory response (HVR CO2); hypoxic ventilator response (HVRO2) was studied by both progressive and transient methods, to explore both peripheral oxygen chemoceptors and the central modulation. The relationship between minute ventilation (VE) or mean inspiratory flow (VT/Ti) and PETCO2 or PETO2 was expressed in terms of slope of linear regression for HVRCO2 and of parameter A of hyperbolic relation for HVRO2. Results: OSA patients showed an increased responsiveness to transient, but not to progressive, hypoxemia, and a reduced response to hypercapnia when compared to controls. Transient HVRO2 showed a significant reduction during CPAP therapy (p<0.01), whereas HVRCO2 increased only slightly. Progressive HVRO2 was not modified by CPAP [Tab 1]. Conclusions: the daytime glomic reactivity to transient hypoxia is increased by repeated nocturnal hypoxic stimuli; CPAP significantly restores the ventilatory stability during sleep. Chemosensitivity in Controls and in OSAS pre e post CPAP Controls(a) OSAS Pre CPAP(b) p(a vs b) OSAS Post CPAP(c) p(b vs c) HVR CO2(l/min/mmHg) 2.7±1.2 2.0±0.9 <0.05 2.2±0.9 0.63 HPVRO2(l/min*mmHg) 355.3±115.2 357.5±117.9 0.46 336.9±129.9 0.99 HTVRO2(l/min*mmHg) 119.2±62.7 217.7±107.7 <0.01 97.5±24.1 <0.01 TAB

Effects of Malnutrition on Left Ventricular Mass in a North-Malagasy Children Population.

BACKGROUND:Malnutrition among children population of less developed countries is a major health problem. Inadequate food intake and infectious diseases are combined to increase further the prevalence. Malnourishment brings to muscle cells loss with development of cardiac complications, like arrhythmias, cardiomyopathy and sudden death. In developed countries, malnutrition has generally a different etiology, like chronic diseases. The aim of our study was to investigate the correlation between malnutrition and left ventricular mass in an African children population. METHODS:313 children were studied, in the region of Antsiranana, Madagascar, with age ranging from 4 to 16 years old (mean 7,8 ± 3 years). A clinical and echocardiographic evaluation was performed with annotation of anthropometric and left ventricle parameters. Malnutrition was defined as a body mass index (BMI) value age- and sex-specific of 16, 17 and 18,5 at the age of 18, or under the 15th percentile. Left ventricle mass was indexed by height2.7 (LVMI). RESULTS:We identified a very high prevalence of children malnutrition: 124 children, according to BMI values, and 100 children under the 15th percentile. LVMI values have shown to be increased in proportion to BMI percentiles ranging from 29,8 ± 10,8 g/m2.7 in the malnutrition group to 45 ± 15,1 g/m2.7 in >95th percentile group. LVMI values in children < 15th BMI percentile were significantly lower compared to normal nutritional status (29,8 ± 10,8 g/m2,7 vs. 32,9 ± 12,1 g/m2,7, p = 0.02). Also with BMI values evaluation, malnourished children showed statistically lower values of LVMI (29,3 ± 10,1 g/m2,7 vs. 33,6 ± 12,5 g/m2,7, p = 0.001). CONCLUSION:In African children population, the malnourishment status is correlated with cardiac muscle mass decrease, which appears to be reduced in proportion to the decrease in body size