Is the exhaled breath temperature in lung cancer influenced by airways neoangiogenesis or by inflammation?

Recently the exhaled breath temperature (EBT) was seen to increase in non-small cell lung cancer and was subsequently proposed as a possible non-invasive tool for its diagnosis. The need for further studies that confirm the previous findings and support the potential scope of this method underlies the main aim of this study that seeks to explore the pathogenic mechanisms determining the EBT in lung cancer. We enrolled 44 consecutive patients with a radiological suspicion of lung cancer and ten healthy non-smoker volunteers, after which their EBT was measured. On the same day, the subjects underwent breath condensate collection for the measurement of leukotriene (LTB)-4 and of the vascular endothelial growth factor (VEGF), the former being a marker of airways inflammation and the latter of neoangiogenesis. We confirmed the presence of a higher EBT in lung cancer patients compared to the controls. The multiple linear regression model showed that the exhaled VEGF was the only predictor of elevations of EBT. In conclusion, it can be stated that for the first time in this study, we have shown that EBT is higher in subjects with lung cancer and that the airways angiogenesis drives the increase in EBT in lung cancer. Moreover, the study suggests the potential for the use of EBT in monitoring the lung cancer progression, although the implementation of more in-depth studies to verify this result is recommended

New non invasive ventilator strategy applied to COPD patients in acute ventilator failure

Introduction There is no evidence in the literature regarding the combined use of positive ventilation with negative ventilation. A recent study reported that the two techniques can be combined in patients with ARDS, who undergo ventilatory support for severe acute respiratory failure (ARF). There is experience of non-invasive ventilation in patients with chronic respiratory diseases and ARF. The aim of this study was to test the efficacy of a non-invasive ventilatory strategy based on the combined use of negative (N) and positive ventilation (P) in bi-level mode (PN). Methods We enrolled 8 patients with severe COPD exacerbations and exacerbated chronic respiratory failure admitted in a monitored setting of an intermediate-intensive respiratory Unit. Results Patients underwent combined positive/negative ventilation and at different times, in place of the two singular ventilation modes (P and N). After each cycle, in the combined P/N ventilatory mode, gas exchanges were significantly increased compared to the two singular P/N mode: pH (7.42 vs 7.40 and 7.40); PCO2 (85.01 vs 72.05 and 66.81 mmHg); FiO2/PO2 (488.75 vs 352.62 and 327.87). All patients well tolerated the application of the double ventilation mode. Conclusions In conclusion, the use of dual mode ventilation appears well tolerated and superior to the individual modes in patients with COPD exacerbations and ARF

Validation and psychometric properties of the Italian version of the Fear of Guilt Scale

Numerosi studi e osservazioni cliniche hanno dimostrato il ruolo centrale del timore di colpa nella genesi e nel mantenimento del disturbo ossessivo-compulsivo. Ad oggi, in lingua italiana sono disponibili questionari che misurano la propensione a sperimentare il senso di colpa e la sensibilità individuale verso questa emozione, ma nessuno strumento per valutare il timore di colpa e l’impegno a prevenire o neutralizzare questa esperienza. Lo scopo dello studio è di validare la versione italiana della Fear of Guilt Scale (FOGS), uno strumento che aiuterebbe a discriminare il peso di questo specifico fattore nella sintomatologia ossessiva. A tal fine, la FOGS è stata somministrata a due campioni non clinici (Studio 1) e a una popolazione clinica composta da un sottogruppo con diagnosi di Disturbo ossessivo-compulsivo, uno con diagnosi di Disturbo depressivo maggiore e un altro con diagnosi di Disturbo d’ansia (Studio2). Lo Studio 1 ha confermato la struttura originaria a due fattori (Punizione e Prevenzione del Danno) e ha mostrato un’adeguata coerenza interna, validità convergente e divergente della versione italiana della FOGS. Lo studio 2 ha rivelato che la FOGS è in grado di discriminare i pazienti con disturbo ossessivo-compulsivo dagli altri gruppi di controllo clinico e di prevedere la gravità dei sintomi ossessivi. Si discutono le implicazioni cliniche e di ricerca di questi risultati.Several studies and clinical observations have proven the central role of the fear of guilt in the genesis and maintenance of Obsessive-Compulsive Disorder. To date, questionnaires are available in Italian that measure one’s propensity to experience guilt and sensitivity towards this emotion, understood as a tendency to negatively judge this experience and its effects, but not the fear of guilt and the commitment to prevent or neutralise this experience. The purpose of this study is to validate the Italian version of the Fear of Guilt Scale (FOGS), a tool that would facilitate a more comprehensive understanding of the weight of this specific factor in the obsessive symptomatology. To this end, the FOGS was administered to two non-clinical samples (Study 1) and to a clinical population diagnosed with either Obsessive-Compulsive Disorder, Major Depressive Disorder or Anxiety Disorder (Study2). Study 1 confirmed the original two-factors structure (Punishment and Harm Prevention), and showed adequate internal consistency, convergent and divergent validity of the Italian version of the FOGS. Study 2 revealed that the Italian version of the FOGS was able to discriminate between patients with Obsessive-Compulsive Disorder and the other clinical control groups, and in predicting the severity of obsessive symptoms. Clinical and research implications are also discussed

Exhaled breath temperature in NSCLC: Could be a new non-invasive marker?

The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the EBT has been analysed in patients affected by non-small-cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the EBT for possible future clinical implications. Eighty-two consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrolment with the X-Halo device. Forty patients resulted as affected by lung cancer while 42 as false-positive (controls). We found a higher EBT in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/year and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Our results suggest that lung cancer causes an increase in the EBT, which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease

Exhaled breath temperature in NSCLC: Could be a new non invasive marker?

The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the exhaled breath temperature has been analysed in patients affected by non-small cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the exhaled breath temperature for possible future clinical implications. Material and Methods: 82 consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrollement with the X-Halo device. Results: 40 patients resulted as affected by lung cancer while 42 as false positive (controls). We found a higher exhaled breath temperature in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/years and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Conclusions: Our results suggest that lung cancer causes an increase of the exhaled breath temperature which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease. Key words: exhaled breath temperature, non invasive methods, non small cell lung cancer, airways inflammation, neoangiogenesis

Endothelial microparticles in sputum of COPD patients: A potential biomarker of disease

Background: Microparticles (MPs) are small membrane vesicles of 0.1–1 μm which are released by cells following chemical, physical, and apoptotic stimuli. MPs represent more than a miniature version of the cell. Their composition and function depend not only on cellular origin, but also on stimuli. Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by nearly irreversible lung destruction which results in airway limitation. Purpose: We investigated the presence and source of MPs in sputum of COPD patients to evaluate if changes in MP number and origin may reflect the pathophysiological conditions of disease and may serve as potential biomarkers for diagnostic and prognostic use. Methods: Induced sputum samples were collected from 18 male subjects and liquefied with Sputasol. MPs obtained were immunolabeled for leukocyte (CD11a), granulocyte (CD66b), monocyte-macrophage (CD11b), platelets and megakaryocytic cells (CD41), endothelial cells (CD31), and red blood cells (CD235ab) and analyzed by cytofluorimetry. Results: There was a negative correlation between CD31-MPs and forced expiratory volume in 1 second (R=−53, P<0.05) and CD66b-MP level was correlated with worse performance index of COPD such as the Body mass index airflow Obstruction, Dyspnea, and Exercise capacity (BODE); they were negatively correlated with 6-minute walking test: 0.65 and −0.64, respectively (P<0.05). CD235ab-MPs showed a negative correlation with body mass index (R=−0.86, P<0.05), while there was a positive correlation with dyspnea index (R=0.91, P<0.05). Conclusion: The main finding of this study was that MPs were detected in the sputum of patients affected by COPD. The phenotype of some of them was related to the main COPD parameters. These results suggest that MPs could be implicated in the pathogenesis of COPD

Cognitive–Behavioral Treatment of Obsessive–Compulsive Disorder: The Results of a Naturalistic Outcomes Study

Cognitive–behavioral therapy is a well-established treatment for obsessive–compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y–BOCS (Yale–Brown obsessive–compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y–BOCS in terms of the interference, severity, and impairment of obsessive–compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes

Imagery Rescripting on Guilt-Inducing Memories in OCD: A Single Case Series Study

Background and objectives: Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results. Methods: After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected. Results: Patients reported a significant decrease in OCD symptoms. The mean value on the Yale−Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety. Conclusions: Our findings suggest that after ImRs intervention focusing on patients’ early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD