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Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study.

Eur Respir J. 2014 Aug 7;

Authors: Tkacova R, McNicholas WT, Javorsky M, Fietze I, Sliwinski P, Parati G, Grote L, Hedner J, for the European Sleep Apnoea Database study

Abstract
Systemic hypertension is associated with obstructive sleep apnoea syndrome (OSAS) but the pathophysiological mechanisms are incompletely understood. A collaborative European network of 24 sleep centres established a European Sleep Apnoea Database to evaluate cardiovascular morbidity associated with OSAS. 11 911 adults referred with suspected OSAS between March 2007 and September 2013 underwent overnight sleep studies, either cardiorespiratory polygraphy or polysomnography. We compared the predictive value of the apnoea-hypopnoea index (AHI) and 4% oxygen desaturation index (ODI) for prevalent hypertension, adjusting for relevant covariates including age, smoking, obesity, dyslipidaemia and diabetes. Among patients (70% male, mean±sd age 52±12 years), 78% had AHI >5 events·h(-1) and 41% systemic hypertension. Both AHI and ODI independently related to prevalent hypertension after adjustment for relevant covariates (p<0.0001 for linear trend across quartiles (Q) of severity for both variables). However, in multiple regression analysis with both ODI and AHI in the model, ODI was, whereas AHI was not, independently associated with prevalent hypertension: odds ratios (95% CI) for Q4 versus Q1 regarding ODI were 2.01 (1.61-2.51) and regarding AHI were 0.92 (0.74-1.15) (p<0.0001 and p = 0.3054, respectively). This cross sectional study suggests that chronic intermittent hypoxia plays an important role in OSAS-related hypertension.

PMID: 25102963 [PubMed - as supplied by publisher]

Characteristics of Benign Solitary Pulmonary Nodules Confirmed by Diagnostic Video-Assisted Thoracoscopic Surgery.

Clin Respir J. 2014 Aug 8;

Authors: Sun Mi C, Eun Young H, Lee J, Park YS, Lee CH, Chang Min P, Chang Hyun K, Yim JJ, Young Tae K, Yoo CG, Han SK, Kim YW

Abstract
INTRODUCTION: The solitary pulmonary nodule (SPN) is a common clinical problem usually detected incidentally during screening tests for lung cancer. Video-assisted thoracoscopic surgery (VATS) is performed for diagnosing SPNs when there are technical difficulties with transthoracic needle aspiration biopsy or bronchoscopic biopsy, inconclusive biopsy results, or when there is a high suspicion of malignancy.
OBJECTIVES: This study aimed to identify factors that can reduce unnecessary VATS for the diagnosis of SPNs.
METHODS: We retrospectively analyzed patients with SPNs (n = 107) who had undergone diagnostic VATS at Seoul National University Hospital from January 2007 to December 2008. Clinical and radiological parameters were evaluated to compare benign and malignant SPNs.
RESULTS: Benign SPNs were diagnosed in 31 patients (29.0%). The most common reason for patients to undergo a diagnostic VATS was a previous history of previous malignancy. The most common histological findings in patients with benign SPNs were nonspecific inflammatory lesions (29.0%) and tuberculosis (TB) (16.1%). The presence of respiratory symptoms was significantly associated with benign diseases (p = 0.004, odds ratio [OR] 0.189, 95% confidence interval [CI] 0.060-0.590), and part-solid nodules were significantly related to malignancy (p = 0.026, OR 6.34, 95% CI 1.248-32.169).
CONCLUSION: Approximately 30% of SPNs resected by VATS were benign. Although we did not identify a definite factor for predicting benign disease or malignancy, the presence of respiratory symptoms was related to benign disease and the presence of part-solid nodules was associated with malignancy.

PMID: 25103572 [PubMed - as supplied by publisher]

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Trimodality Therapy for Lung Cancer With Chest Wall Invasion: Initial Results of a Phase II Study.

Ann Thorac Surg. 2014 Aug 7;

Authors: Kawaguchi K, Yokoi K, Niwa H, Ohde Y, Mori S, Okumura S, Shiono S, Ito H, Yano M, Shigemitsu K, Hiramatsu Y, Okami J, Saito H

Abstract
BACKGROUND: The chest wall is the most common neighboring structure involved by locally advanced lung cancers. However, the optimal treatment strategy for such tumors has not been established. This phase II trial was therefore conducted with the aim of evaluating whether induction chemoradiotherapy followed by surgery improves the survival of patients with T3N0 or T3N1 lung cancer involving the chest wall.
METHODS: Patients with resectable T3N0 or T3N1 non-small cell lung cancer involving the chest wall were candidates for this study. Induction therapy consisted of two cycles of cisplatin and vinorelbine chemotherapy concurrent with 40 Gy of radiation. Surgical resection was performed 3 to 6 weeks after the last day of chemotherapy.
RESULTS: From January 2009 to November 2012, 51 eligible patients (40 stage IIB and 11 stage IIIA tumors) were entered in this study. Induction therapy was completed as planned in 49 (96%) patients, and 25 (51%) had a partial response revealed on computed tomography. Forty-eight patients underwent pulmonary resection combined with chest wall resection, and 44 (92%) underwent a complete resection. Pathologic examinations of the resected specimens revealed no viable tumor cells in 12 (25%) cases and minimal residual disease in 31 (65%) cases. Five patients experienced major postoperative complications, and 1 patient died of postoperative exacerbation of interstitial pneumonia.
CONCLUSIONS: The initial results of this study showed the treatment regimen to be safe and feasible with a high rate of a pathologic response for patients with lung cancer involving the chest wall in a multiinstitutional setting.

PMID: 25110336 [PubMed - as supplied by publisher]

Respiratory diseases are increasingly recognized to have their origins during perinatal and early postnatal lung development, a time of significant adaptation to large changes in redox conditions as well as mechanical forces.
This issue of the Journal presents a Forum highlighting studies of the interplay between reactive oxygen/nitrogen species and the systems that have evolved to degrade them or exploit them, as well as the cellular repair processes that respond to early life redox stress in the lung. This group of authors suggests new understanding of these events that may point the way to improved therapeutic approaches.