Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Graphic representation of the relation between the mean values of alveolar volume, calculated by the quintile method, and those of the corresponding DLCO, in healthy individuals (panel A) and in COPD patients (panel B), at different expired volumes

<p><b>Copyright information:</b></p><p>Taken from "Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test"</p><p>http://www.biomedcentral.com/1471-2466/7/18</p><p>BMC Pulmonary Medicine 2007;7():18-18.</p><p>Published online 19 Dec 2007</p><p>PMCID:PMC2235885.</p><p></p> The alveolar volume does not show any remarkable change when related to the expired volume in healthy individuals (only 300 ml), at variance with those of COPD patients. In addition, DLCO decreases by 1.5 mmol/min/mmHg with respect to the slight changes of the alveolar volume in healthy individuals, whereas it increases by less than 1 mmol/min/mmHg for a total increase of 2.5 litres of alveolar volume in COPD patients from TLC to RV

Box-wisker plots of the percentage changes of VA per litre of expired volume (Delta VA/VE) in healthy individuals and in COPD patients

<p><b>Copyright information:</b></p><p>Taken from "Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test"</p><p>http://www.biomedcentral.com/1471-2466/7/18</p><p>BMC Pulmonary Medicine 2007;7():18-18.</p><p>Published online 19 Dec 2007</p><p>PMCID:PMC2235885.</p><p></p> The horizontal lines represent the 50th percentile (median); limits of boxes are the 25th and 75th percentiles; the wiskers are the 10th and 90th percentiles. More than 90% of patients with COPD showed significant changes in alveolar volume when sampled at different intervals of lung volume. This suggests a different time constant of lung units coupled with a non-homogeneous distribution of ventilation

Inappropriateness of cardiovascular radiological imaging testing; a tertiary care referral center study.

AIMS: Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. METHODS AND PRINCIPAL FINDINGS: With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67 ± 12 years, 75% males) admitted from January 1-May 31, 2010 to the National Research Council - Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR); 240 coronary computed tomographies (CCT); 250 coronary angiographies (CA); 200 percutaneous coronary interventions (PCI). For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate), uncertain (U, class IIb, probably inappropriate), or inappropriate (I, class III, definitely inappropriate). Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%); CCT (A = 58%, U = 24%, I = 18%); CA (A = 45%, U = 25%, I = 30%); PCI (A = 63%, U = 15%, I = 22%). Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR); first line application in asymptomatic low-risk patients (42% of CCT) or in patients with unchanged clinical status post-revascularization (20% of CA); PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI). CONCLUSION AND SIGNIFICANCE: Public healthcare system--with universal access paid for with public money--is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention

Graphic representation of the alveolar volume calculated by the two methods in healthy individuals

<p><b>Copyright information:</b></p><p>Taken from "Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test"</p><p>http://www.biomedcentral.com/1471-2466/7/18</p><p>BMC Pulmonary Medicine 2007;7():18-18.</p><p>Published online 19 Dec 2007</p><p>PMCID:PMC2235885.</p><p></p> The bars represent the mean values and the lines above the bars represent one standard deviation from the mean values. The alveolar volume calculated by the quintile method appears significantly different from that calculated by the ERS-ATS standard (the left hand image is taken from reference 18) from the third quintile, corresponding to 40% of exhaled volume, to residual volume (RV) from total lung capacity (TLC)

Graphic representation of the alveolar volume calculated by the two methods in COPD patients

<p><b>Copyright information:</b></p><p>Taken from "Assessment of the alveolar volume when sampling exhaled gas at different expired volumes in the single breath diffusion test"</p><p>http://www.biomedcentral.com/1471-2466/7/18</p><p>BMC Pulmonary Medicine 2007;7():18-18.</p><p>Published online 19 Dec 2007</p><p>PMCID:PMC2235885.</p><p></p> The bars represent the mean values and the lines above the bars represent one standard deviation from the mean values. The alveolar volume calculated by the quintile method appears significantly different from that calculated using the standard method for all quintiles, except for the second one. It is evident that the alveolar volume, measured on the instantaneous CH4 fraction of each quintile, progressively increases from the beginning to the end of exhalation from total lung capacity (TLC) to residual volume (RV)

How Reliable Are Current Data for Assessing the Actual Prevalence of Chronic Obstructive Pulmonary Disease?

BACKGROUND:Estimating COPD occurrence is perceived by the scientific community as a matter of increasing interest because of the worldwide diffusion of the disease. We aimed to estimate COPD prevalence by using administrative databases from a city in central Italy for 2002-2006, improving both the sensitivity and the reliability of the estimate. METHODS:Multiple sources were used, integrating the hospital discharge register (HDR), clinical charts, spirometry and the cause-specific mortality register (CMR) in a longitudinal algorithm, to reduce underestimation of COPD prevalence. Prevalence was also estimated on the basis of COPD cases confirmed through spirometry, to correct misclassification. Estimating such prevalence relied on using coefficients of validation, derived as the positive predictive value (PPV) for being an actual COPD case from clinical and spirometric data at the Institute of Clinical Physiology of the National Research Council. RESULTS:We found that sensitivity of COPD prevalence increased by 37%. The highest estimate (4.43 per 100 residents) was observed in the 5-year period, using a 3-year longitudinal approach and combined data from three sources. We found that 17% of COPD cases were misclassified. The above estimate of COPD prevalence decreased (3.66 per 100 residents) when coefficients of validation were applied. The PPV was 80% for the HDR, 82% for clinical diagnoses and 91% for the CMR. CONCLUSIONS:Adjusting the COPD prevalence for both underestimation and misclassification of the cases makes administrative data more reliable for epidemiological purposes