Interrelationship among Obstructive Sleep Apnea,Renal Function and Survival: A Cohort Study

Previous studies showed a bidirectional relationship between renal function decline and obstructive sleep apnea (OSA) syndrome. Continuous Positive Airway Pressure (C-PAP) treatment was shown to preserve the kidney function in OSA patients. This study aims to investigate the progression of long-term renal function in OSA patients treated with different PAP strategies (patients were divided into two groups, fixed C-PAP or other PAP—automatic and bilevel pressure). Comorbidities and 10-years survival were also evaluated. We performed a retrospective, observational, single-center, cohort study, including the first 40 consecutive patients enrolled from 2009 in the Respiratory disease Unit at the Vercelli University Hospital database. The patient inclusion criteria were: age ≥ 18 years with OSA syndrome according to AASM (American Academy of Sleep Medicine) guidelines. Creatinine serum levels (mg/dL) and the estimated Glomerular Filtration Rate (eGFR, mL/min calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation)) were measured at 3 different time points: at baseline, 3 years and 8 years after PAP treatment. The Kaplan–Meier survival curves stratified according to PAP treatment and compliance have been reported together with log-rank test estimation. In our study, we found a significant creatinine serum level reduction after 3 years of fixed C-PAP treatment (p value = 0.006) when compared to baseline values. However, we observed that the long-term C-PAP benefit was not significant (p value = 0.060). Our data confirmed the progressive renal function decline in OSA patients, especially in those using other-PAP treatments; nevertheless, OSA treatment with a fixed C-PAP device has shown, in the short term, a significant improvement in renal function. By contrast, in our study, long-term benefits after 8 years are not been demonstrated probably because of the lack of compliance of the patients and the aging effect

Predictive markers of bronchial hyperreactivity in a large cohort of young adults With cough variant asthma

Cough variant asthma (CVA), a common asthma phenotype characterized by nonproductive cough and bronchial hyperreactivity (BHR), is usually detected by bronchial provocation tests (BPTs) which are time-consuming, expensive, and unsafe. The primary study objective was to provide proof of concept for the use of fractional exhaled nitric oxide (FENO), eosinophil count percentage in induced sputum (sEOS%), forced expiratory flow between 25 and 75% of forced vital capacity (FEF25–75%) % predicted value, and FEF25–75% z-scores as surrogate markers predicting BHR in young adults with suspected CVA; the secondary objective was to compare the diagnostic performance of the various techniques. Three hundred and ten subjects (median age 24 years) were included in a cross-sectional study. Subjects were characterized as BHR positive (POS) (n 147) or BHR negative (NEG) (n 163) according to methacholine BPT. Classification accuracies were expressed as areas under the receiver operator characteristic curves (AUC). Compared with BHR NEG, FEF25–75% % predicted value and FEF25–75% z-scores were lower in the BHR POS group (p < 0.001), whereas FENO (p < 0.001) and sEOS% were higher (p < 0.001). AUC values for detecting BHR were as follows: FENO, 0.98 (SD 0.02); sEOS%, 0.98 (SD 0.02); FEF25–75% % pred, 0.93 (SD 0.05); FEF25–75% z scores, 0.92 (SD 0.05). Optimal cutoff values (OCV) for BHR prediction were as follows: FENO, 32.7 ppb (sensitivity 0.93, specificity 0.96), sEOS %, 3.80% (sensitivity 0.94, specificity 0.94), FEF25–75% % predicted value, 80.0% (sensitivity 0.90, specificity 0.87), and FEF25–75% z-score, −0.87 (sensitivity 0.89, specificity 0.87). Non-invasive/semi-invasive airway inflammatory or small airway functional measures might be used as surrogate markers predicting BHR in young adults with suspected CV

Gut microbiota modulates seizure susceptibility

A bulk of data suggest that the gut microbiota plays a role in a broad range of diseases, including those affecting the central nervous system. Recently, significant differences in the intestinal microbiota of patients with epilepsy, compared to healthy volunteers, have been reported in an observational study. However, an active role of the intestinal microbiota in the pathogenesis of epilepsy, through the so-called "gut-brain axis," has yet to be demonstrated. In this study, we evaluated the direct impact of microbiota transplanted from epileptic animals to healthy recipient animals, to clarify whether the microbiota from animals with epilepsy can affect the excitability of the recipients' brain by lowering seizure thresholds. Our results provide the first evidence that mice who received microbiota from epileptic animals are more prone to develop status epilepticus, compared to recipients of "healthy" microbiota, after a subclinical dose of pilocarpine, indicating a higher susceptibility to seizures. The lower thresholds for seizure activity found in this study support the hypothesis that the microbiota, through the gut-brain axis, is able to affect neuronal excitability in the brain

Acute exacerbation of idiopathic pulmonary fibrosis: Lessons learned from acute respiratory distress syndrome?

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease characterized by progressive loss of lung function and poor prognosis. The so-called acute exacerbation of IPF (AE-IPF) may lead to severe hypoxemia requiring mechanical ventilation in the intensive care unit (ICU). AE-IPF shares several pathophysiological features with acute respiratory distress syndrome (ARDS), a very severe condition commonly treated in this setting. A review of the literature has been conducted to underline similarities and differences in the management of patients with AE-IPF and ARDS. During AE-IPF, diffuse alveolar damage and massive loss of aeration occurs, similar to what is observed in patients with ARDS. Differently from ARDS, no studies have yet concluded on the optimal ventilatory strategy and management in AE-IPF patients admitted to the ICU. Notwithstanding, a protective ventilation strategy with low tidal volume and low driving pressure could be recommended similarly to ARDS. The beneficial effect of high levels of positive end-expiratory pressure and prone positioning has still to be elucidated in AE-IPF patients, as well as the precise role of other types of respiratory assistance (e.g., extracorporeal membrane oxygenation) or innovative therapies (e.g., polymyxin-B direct hemoperfusion). The use of systemic drugs such as steroids or immunosuppressive agents in AE-IPF is controversial and potentially associated with an increased risk of serious adverse reactions. Common pathophysiological abnormalities and similar clinical needs suggest translating to AE-IPF the lessons learned from the management of ARDS patients. Studies focused on specific therapeutic strategies during AE-IPF are warranted

Fabrication of Cu2ZnSnS4 solar cells by sulfurization of evaporated precursors

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Different Perception of Musical Stimuli in Patients with Monolateral and Bilateral Cochlear Implants

The aim of the present study is to measure the perceived pleasantness during the observation of a musical video clip in a group of cochlear implanted adult patients when compared to a group of normal hearing subjects. This comparison was performed by using the imbalance of the EEG power spectra in alpha band over frontal areas as a metric for the perceived pleasantness. Subjects were asked to watch a musical video clip in three different experimental conditions: with the original audio included (Norm), with a distorted version of the audio (Dist), and without the audio (Mute). The frontal EEG imbalance between the estimated power spectra for the left and right prefrontal areas has been calculated to investigate the differences among the two populations. Results suggested that the perceived pleasantness of the musical video clip in the normal hearing population and in the bilateral cochlear implanted populations has similar range of variation across the different stimulations (Norm, Dist, and Mute), when compared to the range of variation of video clip’s pleasantness for the monolateral cochlear implanted population. A similarity exists in the trends of the perceived pleasantness across the different experimental conditions in the mono- and bilaterally cochlear implanted patients

Elevated serum polyclonal immunoglobulin free light chains in patients with severe asthma

Background: Inflammation plays a pivotal role in the pathophysiology of asthma. Free light chains (FLC) can cause inflammation by mast cell antigen-activation. Serum immunoglobulin (Ig) FLC κ, but not λ, were shown elevated in adult males with asthma. We sought to investigate if serum Ig FLC concentrations are affected by asthma severity and their relationships with inflammatory outcomes.Methods: By using immunoassays, we measured serum κ and λ Ig FLCs in 24 severe persistent asthma patients, 15 patients with moderate persistent asthma, 15 steroid-naïve mild persistent asthma patients and 20 healthy control subjects in a cross-sectional observational study. Total and specific serum IgE concentrations, fractional exhaled nitric oxide (FENO), lung function, peripheral blood eosinophils and neutrophils, and C reactive protein (CRP) were also measured.Results: Serum κ FLC concentrations were elevated in severe asthma patients compared mild asthma patients (p < 0.05) and healthy subjects (p < 0.05). Serum λ FLCs were higher in severe asthma patients than in healthy subjects (p < 0.05) and correlated with blood eosinophil counts (percentage, κ: r = 0.51, p = 2.9678−6; λ: r = 0.42, p = 1.7377−4; absolute values, κ: r = 0.45, p = 6.1284−5; λ: r = 0.38, p = 7.8261−4), but not with total or specific serum IgE. In severe asthma patients, serum Ig FLC correlated with serum CRP (κ: r = 0.33; p = 0.003; λ: r = 0.38, p = 8.8305−4) and blood neutrophil cell counts (percentage, κ: r = 0.31; p = 0.008; λ: r = 0.29, p = 0.01; absolute values, κ: r = 0.40; p = 3.9176−4; λ: r = 0.40, p = 4.5479−4), were elevated in subjects with blood eosinophilia (≥300 cells/µL) (n = 13) compared with non-eosinophilic subjects (n = 10) (κ: 19.2 ± 1.2 mg/L versus 12.1 ± 1.3 mg/L, p < 0.001; λ: 27.2 ± 2.6 mg/L versus 16.8 ± 2.5 mg/L, p < 0.01), but were similar in atopic (n = 15) versus nonatopic subjects (n = 9) (κ: p = 0.20; λ: p = 0.80). Serum FLC were negatively correlated with lung function tests, including forced expiratory volume in one second (FEV1) (κ: r = −0.33; p = 0.0034; λ: r = −0.33; p = 0.0035), and FEV1/forced vital capacity ratio (κ: r = −0.33; p = 0.0034; λ: r = −0.33; p = 0.0036).Conclusion: Serum Ig FLCs are elevated in severe asthma adults and might represent new surrogate markers of inflammation. The pathophysiological implications of these findings require further research. This study was approved by the ethics committee of the University Hospital Agostino Gemelli Foundation and Catholic University of the Sacred Heart (approval number P/1034/CE2012)

Antimeningococcal and antipneumococcal vaccination determinants: A European systematic literature review

EACKGROUND: ESCULAPIO is a multicenter project, funded by the Italian Centre for Disease Prevention and Control, aimed at implementing communication strategies to improve vaccination knowledge and attitudes among different target populations. OBJECTIVE: The objective of the Sicilian research unit was, in the first phase, to identify, through systematic literature revision, which vaccination determinants play a role in the uptake of recommended vaccines included in the Italian Vaccination Plan. DESIGN: A systematic literature review was carried out on studies describing the determinants underlying pneumococcal and meningococcal vaccination uptake. The analysis was limited to papers published in English from 2000 to date. RESULTS: A total of 188 (meningococcal) and 731 (pneumococcal) papers were found. After selection by publication data, country (Europe), article type (original article), target population (healthy subjects), 7 (meningococcal) and 4 ( pneumococcal) manuscripts were finally included in the analysis. For meningococcal vaccination a better socioeconomic status is related to vaccination acceptance, whereas distance from immunization service is a negative determinant. For pneumococcal vaccination the determinants related to vaccination uptake are older parental age and a strong vaccine recommendation. Conversely, when the vaccine needs to be paid for, a refusal is more likely. CONCLUSIONS: Our results show that payment for vaccination is a major barrier and communication about meningococcal and pneumococcal vaccination should be targeted towards specific population groups, especially through the counseling activities by health professionals