Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

Background/Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by a multitude of underlying causes, treatment modalities and prognostic outcomes. Our aim was to evaluate the underlying causes, comorbidities and survival rates of CTEPH patients. Methods: A retrospective analysis was conducted regarding the evolution of CTEPH patients confirmed by right heart catheterization under treatment with specific vasodilator medication in our centre between 2008 and 2023. Results: We treated 14 CTEPH patients, 78.57% female, 52.79 ± 13.64 years at inclusion, representing 11.29% of our pulmonary arterial hypertension registry. Initially, the distribution of patients' NYHA class was II-14.28%, III-71.42% and IV-14.28%. In total, 71.42% of these patients were technically operable due to the central location of the thrombus, but 42.85% presented severe comorbidities and 28.57% refused the surgery or it was financially inaccessible. Only four patients were operated on by pulmonary endarterectomy (PEA). Unfortunately, all the post-PEA patients had persistent pulmonary hypertension and had to continue vasodilator treatment. Overall, 64.28% of patients had monotherapy, 21.42% double therapy and 14.28% triple therapy. Regarding underlying causes and comorbidities, we found the following incidences: 78.57% chronic venous insufficiency, 42.85% obesity, 35.71% thyroid disease, hypertension and hyperuricemia, 21.42% thrombophilia and ischemic heart disease, 14.28% atrial fibrillation, vasculitis and lung disease, and 14.28% neoplastic history and diabetes. Seven patients died (50%), six of whom were unoperated and one of whom was lost (abandoned the program). The survival rates at 1, 3, 5 and 7 years for unoperated patients were 100%, 58.3%, 29.2% and 29.2% versus 100%, 75%, 75% and 75% in post-PEA patients. Conclusions: CTEPH, marked by delayed diagnosis, multiple comorbidities and limited intervention options, requires proactive screening and comprehensive multimodal therapies, including PEA, to improve survival rates.

Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review

This systematic review evaluates the effectiveness of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in assessing quality of life improvements among patients with heart failure (HF) undergoing various forms of exercise training rehabilitation, including telemedicine and in-person modalities, across all stages of HF, irrespective of ejection fraction (EF) and clinical status. The aim was to collate evidence from studies employing the KCCQ as a measure of quality of life (QoL). A comprehensive search strategy was implemented across PubMed, Scopus, and Embase databases, adhering to the PRISMA guidelines, including literature up until October 2023. Inclusion criteria encompassed studies on patients diagnosed with HF undergoing exercise training rehabilitation assessed by KCCQ. Nine articles met the inclusion criteria, involving a total of 3905 patients from various global locations and conducted between 2012 and 2022. Results indicated significant heterogeneity in exercise interventions and patient characteristics. Notably, high-intensity interval training (HIIT) showed a marked improvement in KCCQ scores (from 68.0 to 80.0) compared to moderate continuous training (MCT) and control groups, underscoring its potential for enhancing QoL. Additionally, a significant improvement in the 6-min walking test (6MWT) outcomes was observed, with an average increase of 106 m (95% CI: 60, 152) in one study, reflecting physical capacity enhancements. However, the difference in KCCQ scores between intervention and control groups was not statistically significant in several studies. In conclusion, the KCCQ's effectiveness is highlighted by its ability to detect clinically meaningful improvements in QoL across diverse exercise modalities, including HIIT and MCT, tailored to the specific needs of HF populations. The consistent correlation between KCCQ score improvements and enhanced physical outcomes, such as the 6MWT, supports its reliability in capturing the nuanced benefits of exercise interventions on patient well-being.

Impact of Pre-Infection COVID-19 Vaccination on the Incidence and Severity of Post-COVID Syndrome: A Systematic Review and Meta-Analysis

This systematic review critically evaluated the impact of a pre-infection COVID-19 vaccination on the incidence and severity of post-COVID-19 syndrome and aimed to assess the potential protective effect across different vaccines and patient demographics. This study hypothesized that vaccination before infection substantially reduces the risk and severity of post-COVID-19 syndrome. In October 2023, a comprehensive literature search was conducted across three databases, PubMed, Embase, and Scopus, focusing on studies published up to that date. Utilizing a wide array of keywords, the search strategy adhered to the PRISMA guidelines and was registered in the Open Science Framework. The inclusion criteria comprised studies focusing on patients with a breakthrough SARS-CoV-2 infection who developed post-COVID-19 syndrome. We included a total of 13 articles that met the inclusion criteria, analyzing more than 10 million patients with a mean age of 50.6 years, showing that the incidence of intensive care unit (ICU) admissions post-vaccination was as low as 2.4%, with a significant reduction in mortality risk (OR 0.66, 95% CI 0.58-0.74). The prevalence of post-COVID-19 syndrome symptoms was lower in vaccinated individuals (9.5%) compared to unvaccinated (14.6%), with a notable decrease in activity-limiting symptoms (adjusted OR 0.59, 95% CI 0.48-0.73). Vaccinated patients also showed a quicker recovery and return to work (HR 1.37, 95% CI 1.04-1.79). The pooled odds ratio of 0.77 indicates that vaccination is associated with a 23% reduction in the risk of developing post-COVID-19 syndrome (95% CI 0.75-0.79). Despite the protective effects observed, a substantial heterogeneity among the studies was noted. In conclusion, a pre-infection COVID-19 vaccination is associated with a significant reduction in the risk and severity of post-COVID-19 syndrome. However, the observed heterogeneity across studies suggests a need for further research with standardized methods to fully comprehend vaccine efficacy against long COVID.

The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania

COVID-19 continues to impact global health systems even after being declared over, with some patients exhibiting severe complications linked to pre-existing conditions. This study aimed to investigate the association between comorbidities, complications, and survival outcomes among COVID-19 survivors in Western Romania. Our hypothesis posited that comorbidities and complications significantly influence survival rates. We conducted a retrospective analysis of 1948 COVID-19 survivors admitted from January to December 2021, with 192 selected for detailed analysis based on inclusion and exclusion criteria. The severity of COVID-19 was classified according to WHO guidelines, and conditions like hypertension and obesity were defined using criteria from the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and WHO, respectively. Among the 192 patients, 33 had mild, 62 had moderate, and 97 had severe COVID-19. The median age across the severity groups was 63.2 years. Patients undergoing tracheostomy had a mortality rate of 83.3% versus 22.2% for non-tracheostomy patients (p < 0.001) and presented with significantly higher lung injury, hospitalization duration, and complications. Remarkably, tracheostomized patients were 17.50 times more likely to succumb to the disease (95% CI 4.39-116.91, p < 0.001). Furthermore, pneumothorax increased the mortality risk significantly (OR 22.11, 95% CI 5.72-146.03, p < 0.001). Intriguingly, certain conditions like grade I hypertension and grade II obesity showed a protective effect against mortality, whereas type 2 diabetes mellitus increased mortality risk (univariate OR 2.89, p = 0.001). The presence of certain comorbidities and complications significantly impacts the survival rates of COVID-19 patients in Western Romania. Notably, tracheostomy, pneumothorax, and T2DM were associated with increased mortality. This study underscores the importance of personalized patient care and provides insights for healthcare policymakers in Western Romania to improve clinical management strategies.

Airborne Particulate Matter Size and Chronic Obstructive Pulmonary Disease Exacerbations: A Prospective, Risk-Factor Analysis Comparing Global Initiative for Obstructive Lung Disease 3 and 4 Categories

Current research primarily emphasizes the generalized correlations between airborne pollution and respiratory diseases, seldom considering the differential impacts of particular particulate matter sizes on chronic obstructive pulmonary disease (COPD) exacerbations in distinct Global Initiative for Obstructive Lung Disease (GOLD) categories. This study hypothesizes a critical association between particulate matter sizes (PM 1.0, PM 2.5, and PM 10) and exacerbation frequency in COPD patients categorized under GOLD 3 and GOLD 4, with a potential augmenting role played by proximity to main roads and industrial areas. This research aspires to offer a nuanced perspective on the exacerbation patterns in these groups, setting the stage for targeted intervention strategies. Utilizing a prospective design, this study followed 79 patients divided into GOLD 3 (n = 47) and GOLD 4 (n = 32) categories. The participants were monitored for ten days for daily activity levels, symptoms, living conditions, and airborne particulate matter concentrations, with spirometric evaluations employed to measure lung function. Statistical analyses were used to identify potential risk factors and significant associations. The analysis revealed substantial disparities in airborne particulate matter sizes between the two groups. The mean PM 1.0 concentration was notably higher in GOLD 4 patients (26 µg/m3) compared to GOLD 3 patients (18 µg/m3). Similarly, elevated PM 2.5 levels were observed in the GOLD 4 category (35 µg/m3) in contrast to the GOLD 3 category (24 µg/m3). A vital finding was the increased frequency of exacerbations in individuals residing within 200 m of main roads compared to those living further away (OR = 2.5, 95% CI: 1.5-4.1). Additionally, patients residing in homes smaller than 50 square meters demonstrated a greater frequency of exacerbations. Spirometry results corroborated the exacerbated condition in GOLD 4 patients, indicating a significant decline in lung function parameters compared to the GOLD 3 group. This study substantiates a significant association between airborne particulate matter sizes and exacerbation frequencies in COPD patients, particularly accentuating the increased risk in GOLD 4 patients. Our findings underscore the pivotal role of environmental factors, including the size of living areas and proximity to main roads, in influencing COPD exacerbations. These results suggest the need for personalized healthcare strategies and interventions, which account for environmental risk factors and the distinctions between GOLD 3 and GOLD 4 categories of COPD patients.

Post-Infection Oscillometry and Pulmonary Metrics in SARS-CoV-2 Patients: A 40-Day Follow-Up Study

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had significant impacts on pulmonary function. This study aimed to comprehensively evaluate pulmonary function and structure in patients 40 days post-SARS-CoV-2 infection, employing an array of testing methodologies including spirometry, plethysmography, forced oscillometry, and CT scanning. It also sought to establish potential correlations between these metrics and evaluate if forced oscillometry could provide additional value in post-infective lung function assessment. A 40-day post-infection follow-up observational study was conducted involving 66 patients with confirmed SARS-CoV-2 infection. The results revealed decreases in FVC and FEF25-75 with the increasing severity of COVID-19. Specifically, patients with severe symptoms exhibited statistically significant decreases in FVC (mean = 86.8) compared with those with mild symptoms (mean = 106.0; p = 0.018). The FEF25-75 showed a similar trend, with severe patients exhibiting a mean of 77.7 compared with 82.9 in the mild group (p = 0.017). Furthermore, resonant frequency (RF) increased with disease severity, with the severe group exhibiting a statistically significant increase (mean = 17.4) compared with the mild group (mean = 14.3; p = 0.042). CT scans showed an increase in ground-glass opacities with disease severity, with 81.8% of severe patients demonstrating this finding (p = 0.037). Multiple regression analysis revealed that Reactance at 4 Hz (X4), Forced Expiratory Flow 25-75% (FEF25-75), and Resonant Frequency (RF) were significantly related to COVID-19 severity. Specifically, for each unit increase in these factors, the risk of the event was estimated to increase by a factor of 3.16, 2.09, and 1.90, respectively. Conversely, Resistance at 4 Hz (R4) and Airway Resistance (RAW) were found to significantly decrease the event hazard, highlighting their potential protective role. Spirometry, plethysmography, and forced oscillometry are effective in assessing these changes. Forced oscillometry may be particularly beneficial in identifying subtle changes in lung function post-COVID-19. Further studies are warranted to validate these findings and develop strategies to manage post-infective pulmonary changes in SARS-CoV-2 patients.

Longitudinal Analysis of Pulmonary Function Impairment One Year Post-COVID-19: A Single-Center Study

Persistent pulmonary impairment post-COVID-19 has been reported, albeit variably. This single-center observational study aims to longitudinally evaluate pulmonary function in 140 COVID-19 survivors one year after recovery, assessing associations with disease severity and pre-existing lung conditions. Participants aged 18 and older, with confirmed SARS-CoV-2 infection, were evaluated using spirometry and Diffusion Capacity of Lungs for Carbon Monoxide (DLCO) tests. Pulmonary function parameters like Forced Expiratory Volume at 1 s (FEV1), Forced Vital Capacity (FVC), and Total Lung Capacity (TLC) were measured. Participants were stratified by age, gender, body mass index, smoking status, and lung damage severity via computed tomography (CT). The cohort consisted of mostly males (58.6%), with a mean age of 53.8 years and body mass index of 24.9 kg/m2. Post-COVID fibrosis was seen in 22.7%, 27.3%, and 51.9% of mild, moderate, and severe disease patients, respectively (p = 0.003). FVC significantly reduced with disease severity (p < 0.001), while FEV1, FEF25-75, and DLCO showed a non-significant downward trend. FEV1/FVC ratio increased with disease severity (p = 0.033), and TLC and RV significantly declined (p = 0.023 and p = 0.003, respectively). A one-year follow-up indicated a non-significant change in FVC, FEV1, FEV1/FVC ratio, FEF25-75, and RV compared with the 40-day measurement, but it revealed significant improvements in DLCO and TLC (p = 0.010). There were significant mean increases in FVC, FEV1, DLCO, TLC, and RV across all disease severities over one year. They were most pronounced in the patients with a history of severe COVID-19, who had a better recovery over one year, compared with the mild and moderate COVID-19 patients whose lung function almost normalized. One year after the SARS-CoV-2 infection, we observed a significant association between disease severity and post-COVID fibrotic changes. Though some lung function parameters remained stable over the year, significant improvements were noted in DLCO and TLC. Particularly, individuals with severe disease showed substantial recovery in lung function, indicating the potential reversibility of COVID-19-related pulmonary damage.

Bronchial Microbiota and the Stress Associated with Invasive Diagnostic Tests in Lung Cancer vs. Benign Pulmonary Diseases: A Cross-Sectional Study

Lung cancer is the leading cause of cancer-related deaths worldwide. This study aimed to compare the bronchial microbiota of patients with lung cancer and patients with benign pulmonary diseases undergoing bronchoscopy, and to assess the stress levels associated with invasive diagnostic lung tests. A cross-sectional study was conducted at the "Victor Babes" Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania. A total of 33 patients with histologically diagnosed bronchopulmonary cancer and 33 control patients with benign lung pathologies underwent bronchoscopy. Bronchial microbiota was analyzed by multiplex PCR, culture media, and cytology. Anxiety and depression levels were assessed using the ECOG performance status scale, Karnofsky scale, GAD-7, PHQ-9, and HADS questionnaires. There were no significant differences in the presence of common microbial species between the two groups, except for Acinetobacter spp. Which was identified in 15.2% of patients with lung cancer and 0.0% in the control group, Candida spp. Was more prevalent in the benign group (24.2% vs. 6.1%), and the Parainfluenza virus was detected only in the malignant group (21.1% vs. 0.0%). Cytology results showed a higher prevalence of atypical and tumoral cells in the malignant group (39.4% and 30.0%, respectively), as well as higher lymphocyte levels in the benign group (69.7% vs. 24.2%). Patients with lung cancer had significantly lower performance status on the ECOG scale (2.34 vs. 1.92), lower Karnofsky scores (71.36 vs. 79.43), and higher GAD-7 and PHQ-9 scores at the initial evaluation compared to the benign group. At the 90-day follow-up, ECOG and Karnofsky scores remained significantly different from the initial evaluation, but only GAD-7 scores showed a significant difference between the two groups. There were differences in the bronchial microbiota between patients with lung cancer and benign pulmonary diseases, with a higher prevalence of Candida spp. in the benign group and exclusive detection of Acinetobacter spp. and Parainfluenza virus in the malignant group. Patients with lung cancer exhibited higher stress levels, more severe anxiety, and depression symptoms, which persisted during follow-up. Further research is needed to understand the role of bronchial microbiota in lung cancer and the impact of stress on patient outcomes.

Serum and Bronchoalveolar Lavage Fluid Levels of Cytokines in Patients with Lung Cancer and Chronic Lung Disease: A Prospective Comparative Study

The role of chronic inflammation in the initiation and progression of carcinogenesis has been well-established in previous studies, particularly in the stages of malignant conversion, invasion, and metastasis. This study aimed to explore the potential correlation between the levels of cytokines in serum and bronchoalveolar lavage fluid (BALF) by comparing their levels between patients with lung cancer and those with benign lung diseases. The study measured the concentration of IFN-γ, TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-10, and IL-12p70, in venous blood and BALF of a total of 33 patients with lung cancer and 33 patients with benign lung diseases. Significant differences were found between the two groups in various clinical parameters. The cytokine levels were significantly higher among patients with malignant disease, while the BALF analysis revealed higher cytokine levels compared with serum analysis. It was discovered that the levels of cancer-specific cytokines in the lavage fluid increased significantly sooner and were present at a greater concentration than those in the peripheral blood. After one month of treatment, the serum markers decreased significantly but slower in the lavage fluid. The differences between serum and BALF markers remained significant. It was observed that the highest correlation was among IL-6 (serum) and IL-6 (lavage), with a coefficient of 0.774 (p-value < 0.001), and IL-1 (serum) and IL-1β (lavage), with a coefficient value of 0.610 (p-value < 0.001). Other significant correlations among serum and lavage cytokines were observed between IL-6 (lavage) and IL-1 (serum) (rho = 0.631, p-value < 0.001) and CRP (rho = 0.428, p-value = 0.001), respectively. This study revealed significant differences and correlations in clinical parameters, serum markers, and BALF inflammatory markers between patients with lung cancer and those with benign lung pathologies. The results highlight the importance of understanding the inflammatory profiles of these conditions and could contribute to the development of targeted therapies or diagnostic approaches in the future. Further research is needed to validate these findings, explore their implications for clinical practice, and determine the diagnostic and prognostic value of these cytokines for lung cancer.

The Association of IFN-γ, TNF-α, and Interleukins in Bronchoalveolar Lavage Fluid with Lung Cancer: A Prospective Analysis

Lung cancer is a leading cause of cancer-related mortality worldwide. Identifying novel diagnostic and prognostic biomarkers is essential for improving patient outcomes. This study aimed to investigate the predictive role of cytokines from bronchoalveolar lavage fluid (BALF) in lung cancer diagnosis and prognosis. A prospective study was conducted on 33 patients with suspected lung cancer, divided into inflammatory and non-inflammatory BALF groups. Inflammatory markers in BALF were assessed, and their association with lung cancer risk was analyzed using receiver operating characteristic (ROC) plot analysis, sensitivity and specificity percentages, and regression analysis. Statistically significant differences were observed between the inflammatory and non-inflammatory groups for several inflammatory markers, including IFN-gamma, IL-1b, IL-2, IL-6, IL-10, and IL-12p70. In the follow-up analysis, significant differences persisted for IFN-gamma, IL-1b, IL-2, IL-4, and IL-6. ROC plot analysis revealed that IL-12p70 had the highest area under the curve (AUC) value (0.702), followed by IL-2 (0.682), IL-6 (0.620), IL-4 (0.611), TNF-alpha (0.609), IL-10 (0.604), IL-1b (0.635), and IFN-gamma (0.521). IL-6 showed the highest sensitivity (73%), and IL-1b had the highest specificity (69%). Regression analysis demonstrated that IL-6 (cut-off = 25 pg/mL) and IL-12p70 (cut-off = 30 pg/mL) had the highest odds ratios for lung cancer risk, at 5.09 (95% CI: 2.38-9.24, p < 0.001) and 4.31 (95% CI: 1.85-8.16, p < 0.001), respectively. Cytokines from BALF, particularly IL-6 and IL-12p70, show potential as diagnostic and prognostic biomarkers for lung cancer. Further studies with larger cohorts are warranted to confirm these findings and elucidate the clinical implications of these markers in lung cancer management.

Definition, evaluation and therapy of progressive fibrosing interstitial lung disease associated with rheumatic diseases - a consensus paper of the Romanian Society of Rheumatology and Romanian Society of Pneumology

Interstitial lung diseases (ILD), of which the most well-known is idiopathic pulmonary fibrosis (IPF), are a heterogeneous group of diseases, with similar, inflammatory and/or fibrosing mechanisms, which lead to the rapid decline of lung function and implicitly to a high degree of morbidity and mortality. Besides IPF, other interstitial lung diseases, such as those associated with connective tissue diseases, the most common being rheumatoid arthritis and systemic sclerosis, can develop a progressive fibrosing phenotype. Thus, because they have similar pathogenic mechanisms and clinical manifestations, all these diseases are described under the term of progressive fibrosing interstitial lung disease (PF-ILD). It is recommended that the diagnosis, clinical and paraclinical evaluation of ILD be made through a standardized management, within a multidisciplinary team that must include a pulmonologist, radiologist and rheumatologist, evaluation after which the subsequent treatment will be decided. Early diagnosis leads to an effective therapeutic intervention and decreased mortality. The progressive character has been defined if the progression occurs despite the current optimal management and treatment, which includes glucocorticoids and immunosuppressive therapy, at which point the indication of the antifibrotic treatment appears. The complete evaluation of ILD involves a rigorous anamnesis and clinical examination to identify environmental and professional risk factors, the patient’s chronic medication, family and personal history, the onset of the disease, as well as the identification by auscultation of bilateral basal crackles. From the paraclinical examination, the most important is the imaging studies (standard chest X-rays and mandatory HR-CT) which provide information about the anatomy, pattern, evolution in time or clues related to the underlying disease. The progressive character has been defined if the progression occurs despite the current optimal management and treatment, which includes glucocorticoids and immunosuppressive therapy, at which point the indication of the antifibrotic treatment appears. Evaluation of lung function is very important to complete the patient picture with PF-ILD, and the gold standard is the combination of spirometry, body plethysmography with diffusing capacity for carbon monoxide (DLCO), gasometry and an exercise test. Using this information, the optimal treatment will be led by the same multidisciplinary team that established the diagnosis, taking into account many aspects related to the characteristics of the disease, the cause, the safety profile and it will be monitored according to the existing protocols.

Endothelial dysfunction: The possible link between cardiovascular comorbidities and phenomenon of inflammaging from COPD

Aging is a risk factor for many chronic noncommunicable diseases, including chronic obstructive pulmonary disease (COPD), which is often associated with cardiovascular disease (CVD). Moreover, aging is associated with a mild form of systemic inflammation. The aim of our study was to analyze the relationship between age, systemic and vascular inflammation, and the presence of CVD comorbidities in a stable COPD population. Forty COPD patients were divided into 2 age groups (<65 and ≥65 years of age), from which we collected the following inflammatory biomarkers: C-reactive protein, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and endothelin-1 (ET-1). Elderly COPD patients had more frequent exacerbation events per year (2 vs 1, P = .06), a higher prevalence of CVD (3 vs 2, P = .04), more limited exercise tolerance (6-minute walking test distance, 343 [283-403] vs 434 [384-484]; P = .02), and mild systemic inflammation (TNF-α, 9.02 [7.08-10.96] vs 6.48 [5.21-7.76]; P = .03; ET-1, 2.24 [1.76-2.71] vs 1.67 [1.36-1.98] pg/mL; P = .04). A weak correlation between age and ET-1 (r = 0.32, P = .04) was observed. Mild systemic inflammation, characterized by a slightly increased level of TNF-α, and endothelial dysfunction, marked by elevated ET-1, could be liaisons between aging, COPD, and CVD comorbidities.

ANCA-associated vasculitis in idiopathic pulmonary fibrosis: A case report and brief review of the literature

RATIONALE

Idiopathic pulmonary fibrosis (IPF) is a progressive disease with poor prognosis. Patients with IPF represent a heterogeneous population with several described clinical phenotypes. More recently, the development of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in IPF patients, with an incidence higher than that in the general population, has drawn attention.

PATIENT CONCERNS

A 64-year-old woman previously diagnosed with IPF presented to the emergency department with hemoptysis and hypoxemic respiratory failure.

DIAGNOSES

High-resolution chest computed tomography revealed bilateral ground-glass opacities associated with areas of consolidation superimposed on the patient's fibrotic background pattern. Diffuse alveolar hemorrhage was confirmed by the presence of hemorrhagic bronchoalveolar lavage fluid. Hematological and biochemical investigations revealed an inflammatory syndrome, moderate anemia, and rapidly progressive glomerulonephritis. Serological analysis revealed perinuclear antineutrophil cytoplasmic antibody positivity and high levels of antimyeloperoxidase antibodies antibodies. The patient underwent kidney biopsy, which revealed necrotizing glomerulonephritis. Clinical and laboratory findings were diagnostic of microscopic polyangiitis with lung and renal involvement.

INTERVENTIONS

Cyclophosphamide in combination with methylprednisolone was administered as remission induction therapy. The maintenance therapy consisted of mycophenolate mofetil and prednisone.

OUTCOMES

The patient achieved clinical, radiological, and serological remission within six weeks of treatment.

LESSONS

The association between IPF and ANCA-associated vasculitis may represent a distinct clinical phenotype. Autoimmune testing for ANCAs should be considered part of the diagnostic work-up and follow-up of patients with IPF because of the clinical and therapeutic implications of developing vasculitis in an already vulnerable patient.

Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and eosinophils correlation with high-resolution computer tomography severity score in COVID-19 patients

Inflammation has an important role in the progression of various viral pneumonia, including COVID-19. Circulating biomarkers that can evaluate inflammation and immune status are potentially useful in diagnosing and prognosis of COVID-19 patients. Even more so when they are a part of the routine evaluation, chest CT could have even higher diagnostic accuracy than RT-PCT alone in a suggestive clinical context. This study aims to evaluate the correlation between inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocytes ratio (PLR), and eosinophils with the severity of CT lesions in patients with COVID-19. The second objective was to seek a statically significant cut-off value for NLR and PLR that could suggest COVID-19. Correlation of both NLR and PLR with already established inflammatory markers such as CRP, ESR, and those specific for COVID-19 (ferritin, D-dimers, and eosinophils) were also evaluated. One hundred forty-nine patients with confirmed COVID-19 disease and 149 age-matched control were evaluated through blood tests, and COVID-19 patients had thorax CT performed. Both NLR and PLR correlated positive chest CT scan severity. Both NLR and PLR correlated positive chest CT scan severity. When NLR value is below 5.04, CT score is lower than 3 with a probability of 94%, while when NLR is higher than 5.04, the probability of severe CT changes is only 50%. For eosinophils, a value of 0.35% corresponds to chest CT severity of 2 (Se = 0.88, Sp = 0.43, AUC = 0.661, 95% CI (0.544; 0.779), p = 0.021. NLR and PLR had significantly higher values in COVID-19 patients. In our study a NLR = 2.90 and PLR = 186 have a good specificity (0.89, p = 0.001, respectively 0.92, p<0.001). Higher levels in NLR, PLR should prompt the clinician to prescribe a thorax CT as it could reveal important lesions that could influence the patient’s future management.

High School Pupils' Relationships with Their Parents, Schoolmates, and Friends, and Health-Related Risk Behaviors

Purpose

The aims of this study were to evaluate high school pupils’ relationships with their parents, schoolmates, and friends, and the presence of health-related risk behaviors among the family members and friends on the pupils’ smoking and binge drinking status.

Materials and Methods

The study was a cross-sectional population-based study that involved a questionnaire, and the sample involved 2908 pupils at high schools in Timis county, Romania. In our study, the following factors related to family members and friends and the living environment were identified. First, there were issues with the relationships with parents among some pupils, with 23.2% being neither satisfied nor unsatisfied and 4.9% being unsatisfied. Second, there were also issues regarding some pupils’ satisfaction with the financial situation of their family, with 21.8% being neither satisfied nor unsatisfied and 16.4% being unsatisfied. An odds ratio (OR) is a statistic that quantifies the strength of the association between two events.

Results

There were 1495 (51.5%) girls and 1407 (48.5%) boys aged 14–20 years, and 79.2% came from organized families. Among the pupils, 71.1% reported that they were satisfied with their relationship with their parents, while 4.9% were unsatisfied. Additionally, 46.2% were satisfied with the financial status of their families, while 16.4% were unsatisfied. Moreover, 59.2% were satisfied with their relationship with their schoolmates and 80.2% were satisfied with their relationship with their friends, while only 1.8% were unsatisfied with their relationship with their friends. The logistic regression model of the pupils’ smoking status identified two moderate predictive factors: this was defined “>1” friends who smoke (odds ratio [OR]=2.875) and smoking status of siblings (OR=2.222). The major predictive factor in the logistic regression model of occasional alcohol consumption in high quantities by pupils was male gender (OR=5.148).

Conclusion

The predictive model of pupils’ smoking status identified the following moderate predictors: high number of friends who smoke and smoking status of siblings. The major predictor in the model of occasional alcohol consumption in high quantities by pupils was male gender.

Romanian clinical guideline for diagnosis and treatment of COPD

Chronic obstructive pulmonary disease (COPD) is a disease with increasing prevalence and burden for health systems worldwide. Every country collects its own epidemiological data regarding COPD prevalence, morbidity and mortality while taking steps to educate the population and medical community to improve early detection and treatment. The rising COPD prevalence creates a need for comprehensive guidelines. In 2012 and 2017–2018, the Romanian Society of Pneumology (SRP) organised national inquiries for COPD, while lung physicians in Romania began receiving education regarding the correct algorithms for COPD diagnosis and therapy. During 2019, a Romanian clinical guideline for diagnosis and treatment of COPD was published, and a condensed version of key points from this guideline are presented herein. COPD is diagnosed based on the presence of three major components: relevant exposure history, respiratory symptoms, and airway limitation that is not fully reversible. Clinical evaluation of patients diagnosed with COPD should include the level of symptoms, exacerbation rate, the presence of comorbidities and determination of phenotypes. The present abridged guideline is designed to be accessible and practical for assessing and managing patients with COPD. The application of up-to-date COPD guidelines may enhance the optimism of physicians and patients in managing this disease.

Lung Function Assessment by Impulse Oscillometry in Adults

Over the past decades, impulse oscillometry (IOS) has gained ground in the battery of pulmonary function tests. Performing the test requires minimal cooperation of the patient; therefore, it is a useful tool, especially in evaluating lung mechanics in children, elderly patients, and those who cannot perform spirometry. Oscillometry has also been used in both clinical and research departments. Studies were published mainly in asthma regarding detection of bronchodilator response and the therapeutic response to different drugs. Furthermore, it has been shown to be a sensitive technique to evaluate disease control. Other studied diseases were COPD, interstitial lung diseases, small airway disease, impairment of lung function due to exposure to occupational hazards or smoking, central airways obstruction, cystic fibrosis, monitoring lung mechanics during mechanical ventilation and sleep, neuromuscular diseases, lung transplant, and graft function. The aim of this review is to present the utility of oscillometry on the previously mentioned clinical fields.

Risk factors of chronic obstructive pulmonary disease exacerbations

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterised by persistent respiratory symptoms and airflow limitation. COPD has a major impact on public health, mainly because of its increasing prevalence, morbidity and mortality. The natural course of COPD is aggravated by episodes of respiratory symptom worsening termed exacerbations that contribute to disease progression. Acute Exacerbations of COPD (AECOPD) can be triggered by a multitude of different factors, including respiratory tract infections, various exposures, prior exacerbations, non-adherence to treatment and associated comorbidities. AECOPD are associated with an inexorable decline of lung function and a significantly worse survival outcome. This review will summarise the most important aspects regarding the impact of different factors that contribute to COPD exacerbations.

Inhaler technique errors in Romanian patients with asthma - a multicenter study

BACKGROUND

Non-adherence to treatment is associated with poor asthma control, increased exacerbations, decline in lung function, and decreased quality of life. M-health applications have become increasingly in the last years, but little research regarding the efficiency of the instructional videos for correct inhaler use exist. The aim of this study is to assess and improve the inhalator technique and to establish which types of errors were made more often with the help of a mobile health application.

MATERIALS AND METHODS

Seventy-five patients with partially controlled or uncontrolled asthma, using any of turbuhaler, diskus, pressurized metered dose inhaler (pMDI) or soft mist inhaler (SMI), were included in the study. When they first entered the study, the patient's inhaler technique was assessed by a trained medical professional and the technique errors were categorized in handling, respectively inhalation errors. After the first evaluation, the patients downloaded an application on their Smartphone and were encouraged to use the application as much as needed to remind them the correct inhalation technique. The patients were re-called every three months for evaluation, treatment, and assessment of inhalation technique.

RESULTS

We analyzed both handling and inhalation errors for each of the four considered inhalers. We observed a significantly reduced number of inhalation technique errors after using the mobile phone application. Turbuhaler median errors were 6.00, and after six months we did not observe errors. Diskus median error was 6.00, and after six months we observed a maximum of one error. pMDI median errors were 7.00, and after six months we observed just one error. Similarly, SMI median error was 7.00, and after six months we observed just one error.

CONCLUSION

Although technique inhalation errors are very common among asthma patients, video instructions provided through specific mobile phone applications could improve the inhaler technique in order to achieve a better control of the disease.

Impact of moderate to severe obstructive sleep apnea on the cognition in idiopathic pulmonary fibrosis

Introduction

Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive lung disease with a fatal prognosis to whose rapid evolution multiple comorbidities may contribute, one of the most common being obstructive sleep apnea (OSA). There are several potential factors and conditions for the emergence of a cognitive deficit in relation to IPF or associated morbidities.

Objectives

The goals of this study were to assess cognition in patients with IPF in stable phase and to identify clinical cognition modifiers.

Methods

In a cross-sectional study, 23 patients with IPF were evaluated using Montreal Cognitive Assessment (MoCA), an instrument for detecting mild cognitive impairments and were screened for OSA through overnight cardiorespiratory polygraphy and for anxiety and depression with three specific scale (Generalized Anxiety Disorder 7-item scale: GAD-7; the Patient Health Questionnaire: PHQ-9; Hospital Anxiety and Depression Scale: HADS).

Results

MoCA score was lower in patients with IPF when compared to controls subjects (24 [21,26] vs. 27 [26,28], p = 0.003) but not as significantly as in COPD patients (21 [18.8,23.3], p<0.0001). OSA was diagnosed in 19 (82.6%) IPF patients, 12 patients showed the presence of moderate-severe forms (63.15%). IPF patients with cognitive impairment (MoCA<23) exhibit a higher severity of OSA (apneea hypopnea index–AHI: 33.0±19.1 vs. 12.44±8.2, p = 0.018), and a higher Epworth score (7.1±3.3 vs. 4.3±1.8, p = 0.013). Anxiety and depression scores were not correlated with MoCA results.

Conclusions

Impaired cognition in patients with IPF is mild and affect the areas of visuospatial abilities, language and working memory. OSA could be a possible predictor of IPF cognition deficit. Given the high prevalence of multiple types of sleep disorders in IPF patients, these should be investigated at least by cardiorespiratory polygraphy.

Chronic obstructive pulmonary disease phenotypes and balance impairment

BACKGROUND/OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress, also having many nonrespiratory manifestations that affect both function and mobility. Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with COPD. Our objective was to investigate balance performance in two groups of COPD patients with different body compositions and to observe which of these groups are more likely to experience falls in the future.

METHODS

We included 27 stable COPD patients and 17 healthy individuals who performed a series of balance tests. The COPD patients were divided in two groups: emphysematous and bronchitic. Patients completed the activities balance confidence scale and the COPD assessment test questionnaire and afterward performed the Berg Balance Scale, timed up and go, single leg stance and 6-minute walking distance test. We analyzed the differences in the balance tests between the studied groups.

RESULTS

Bronchitic COPD was associated with a decreased value when compared to emphysematous COPD for the following variables: single leg stance (8.7 vs 15.6; P<0.001) and activities balance confidence (53.2 vs 74.2; P=0.001). Bronchitic COPD patients had a significantly higher value of timed up and go test compared to patients with emphysematous COPD (14.7 vs 12.8; P=0.001).

CONCLUSION

Patients with COPD have a higher balance impairment than their healthy peers. Moreover, we observed that the bronchitic COPD phenotype is more likely to experience falls compared to the emphysematous phenotype.

Balance impairment and systemic inflammation in chronic obstructive pulmonary disease

Background/purpose

Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with systemic inflammation and balance impairment. The aim of our study was to evaluate the impact on equilibrium of stable and exacerbation (acute exacerbation of COPD [AECOPD]) phases of COPD and to investigate if there is a connection between lower extremity muscle weakness and systemic inflammation.

Methods

We enrolled 41 patients with COPD (22 stable and 19 in AECOPD) and 20 healthy subjects (control group), having no significant differences regarding the anthropometric data. We analyzed the differences in balance tests scores: Falls Efficacy Scale-International (FES-I) questionnaire, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Single Leg Stance (SLS), 6-minute walking distance (6MWD), isometric knee extension (IKE) between these groups, and also the correlation between these scores and inflammatory biomarkers.

Results

The presence and severity of COPD was associated with significantly decreased score in IKE (P<0.001), 6MWD (P<0.001), SLS (P<0.001), and BBS (P<0.001), at the same time noting a significant increase in median TUG score across the studied groups (P<0.001). The AECOPD group vs stable group presented a significant increase in high-sensitive C-reactive protein (hs-CRP) levels (10.60 vs 4.01; P=0.003) and decrease in PaO₂ (70.1 vs 59.1; P<0.001). We observed that both IKE scores were significantly and positive correlated with all the respiratory volumes. In both COPD groups, we observed that fibrinogen reversely and significantly correlated with the 6MWD, and FES-I questionnaire is correlated positively with TUG test. Hs-CRP correlated reversely with the walking test and SLS test, while correlating positively with TUG test and FES-I questionnaire.

Conclusion

According to this study, COPD in advanced and acute stages is associated with an increased history of falls, systemic inflammation, balance impairment, and lower extremity muscle weakness.

Balance impairment in patients with COPD

BACKGROUND/PURPOSE

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in progressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study was to compare and quantify functional balance between COPD patients and healthy subjects; to investigate the risk of falls in acute stages of the disease and to identify risk factors that could lead to falls.

METHODS

We studied 46 patients with moderate-severe COPD (29 stable and 17 in acute exacerbation--AECOPD) and 17 healthy subjects (control group) having similar demographic data. We analyzed the difference in Berg Balance Scale (BBS), Single Leg Stance (SLS) and Timed Up and Go test (TUG) between these three groups and the correlation of these scores with a number of incriminatory factors.

RESULTS

The presence of COPD was associated with significant worsening of balance tests: BBS (55 control, vs. 53 COPD, vs. 44 AECOPD points p<0.001), TUG (8.6 control vs. 12.3 COPD vs. 15.9 AECOPD seconds. p<0.001), SLS (31.1 control vs. 17.7 COPD vs. 7.2 AECOPD seconds p<0.001) which may be associated with an increased risk of falls. Anxiety and depression were significantly associated with decreased balance test scores; anxiety (2 control vs. 6 COPD vs. 9 AECOPD points p<0.001) depression (2 control vs. 7 COPD vs. 12 AECOPD points p<0.001).

CONCLUSIONS

According to our results COPD patients in moderate-severe stages and especially those in exacerbation have a high risk of falls.

Cognitive impairment in chronic obstructive pulmonary disease

BACKGROUND/PURPOSE

Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with multiple cognitive problems. Montreal Cognitive Assessment test (MoCA) is used to detect cognitive impairment evaluating several areas: visuospatial, memory, attention and fluency. Our study aim was to evaluate the impact of stable COPD and exacerbation (AECOPD) phases on cognitive status using MoCA questionnaire.

METHODS

We enrolled 39 patients (pts), smokers with COPD group D (30 stable and 9 in AECOPD) and 13 healthy subjects (control group), having similar level of education and no significant differences regarding the anthropometric measurements. We analyzed the differences in MoCA score between these three groups and also the correlation between this score and inflammatory markers.

RESULTS

Patients with AECOPD had a significant (p<0.001) decreased MoCA score (14.6±3.4) compared to stable COPD (20.2±2.4) and controls (24.2±5.8). The differences between groups were more accentuated for the language abstraction and attention (p<0.001) and delayed recall and orientation (p<0.001) sub-topics. No significant variance of score was observed between groups regarding visuospatial and naming score (p = 0.095). The MoCA score was significantly correlated with forced expiratory volume (r = 0.28) and reverse correlated with C-reactive protein (CRP) (r = -0.57), fibrinogen (r = -0.58), erythrocyte sedimentation rate (ESR) (r = -0.55) and with the partial pressure of CO2 (r = -0.47).

CONCLUSIONS

According to this study, COPD significantly decreases the cognitive status in advanced and acute stages of the disease.

Magnesium orotate elicits acute cardioprotection at reperfusion in isolated and in vivo rat hearts

Orotic acid and its salts chronically administered have been shown to significantly improve cardiac function in pathological settings associated with ischemia–reperfusion (I/R) injury. The aim of our study was to investigate the effect of magnesium orotate (Mg-Or) administration at the onset of post-ischemic reperfusion on myocardial function and infarct size (IS). Ex-vivo experiments performed on isolated perfused rat hearts were used to compare Mg-Or administration with a control group (buffer treated), ischemic post-conditioning, orotic acid treatment, and MgCl2 treatment. Mg-Or administration was also investigated in an in-vivo model of regional I/R performed in rats undergoing reversible coronary ligation. The effect of Mg-Or on mitochondrial permeability transition pore (mPTP) opening after I/R was investigated in vitro to gain mechanistic insights. Both ex-vivo and in-vivo experiments showed a beneficial effect from Mg-Or administration at the onset of reperfusion on myocardial function and IS. In-vitro assays showed that Mg-Or significantly delayed mPTP opening after I/R. Our data suggest that Mg-Or administered at the very onset of reperfusion may preserve myocardial function and reduce IS. This beneficial effect may be related to a significant reduction of mPTP opening, a usual trigger of cardiac cell death following I/R.

Ageing-induced decrease in cardiac mitochondrial function in healthy rats

It is widely recognized that mitochondrial dysfunction is a key component of the multifactorial process of ageing. The effects of age on individual components of mitochondrial function vary across species and strains. In this study we investigated the oxygen consumption, the mitochondrial membrane potential (Δψ), the sensitivity of mitochondrial permeability transition pore (mPTP) to calcium overload, and the production of reactive oxygen species (ROS) in heart mitochondria isolated from old compared with adult healthy Sprague-Dawley rats. Respirometry studies and Δψ measurements were performed with an Oxygraph-2k equipped with a tetraphenylphosphonium electrode. ROS production and calcium retention capacity were measured spectrofluorimetrically. Our results show an important decline for all bioenergetic parameters for both complex I and complex II supported-respiration, a decreased Δψ in mitochondria energized with complex I substrates, and an increased mitochondrial ROS production in the old compared with the adult group. Mitochondrial sensitivity to Ca²⁺-induced mPTP opening was also increased in the old compared with the adult animals. Moreover, the protective effect of cyclosporine A on mPTP opening was significantly reduced in the old group. We conclude that healthy ageing is associated with a decrease in heart mitochondria function in Sprague-Dawley rats.

Tempolenses with variable magnification for sonic representation of medical data. Application for cardiac signals

The purpose of this study was to develop the tools and the methodology for a systematic analysis of usefulness of adding sonic representation of data, supplementary to visualization. This paper is mainly dedicated various temporal lenses, including the newly developed lenses with variable magnification, proposed as a tool for a better perception of short events combined with a compression of irrelevant intervals. Sonification procedures are also briefly presented. The programs were tested using various cardiac signals: ECG and heart rate HR both in humans and in rats (experimental data). The results, represented by the sound files, were uploaded in an accessible library, which contains both sonic and visual representation of the signals.

Eating habits in an adolescent population from Timiş county

Dietary patterns during adolescence may contribute to eating disorders and may increase the risk for several important chronic diseases later in life.

OBJECTIVES

The aim of this study is to analyze eating behaviours among high school students residing in Timis county area.

MATERIAL AND METHOD

We conducted a cross sectional study using a stratified cluster sample design to produce a representative sample of students for the Timis county. From 1083 primary sampling units (classes) 149 were randomly selected, stratified proportionally according to grades 9-12, high school profile (theoretical, industrial, vocational, and confessional), urban and rural environment. The study was carried out in 2004.

RESULTS

The overall response rate of 74.6%. A total of 2908 students were included in the survey. The proportion of students consuming less than daily milk & diary products, green salad and fruits was: 58.3% for milk & dairy products, 71.2% for green salad and 59.1% for fruits. Based on multivariate analysis three common predictors for consuming fresh fruits, green salad and milk and diary products were identified: perceived weight, school performance and school grades.

CONCLUSIONS

Through examination of prevalence rates of nutrition-related concerns we have identified priority areas to be targeted with future interventions.

[Correlations between carotid intima-media thickness and serum uric acid levels in hypertensive patients]

Intima-media thickness (IMT) of the carotid arteries assessed noninvasively by ultrasonography is now validated as a sensitive marker for atherosclerosis and it is directly associated with increased risk of cardiovascular disease. Hyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases.

AIM

To evaluate the correlations between IMT and uric acid levels in patients with hypertension (HT).

MATERIAL AND METHOD

Our study consisted of: a group of 30 patients with HT without HU (men 55%, mean age +/- S.D.: 50 +/- 11 years), a group of 25 patients with HT and HU (men 52%, mean age +/- S.D: 52 +/- 10 years), and a control group of 25 healthy subjects (men 55%, mean age +/- S.D: 50 +/- 11 years). All the patients in the study groups were examined by high resolution B-mode ultrasound to measure the IMT of the common carotid artery.

RESULTS

IMT values were significantly higher in the patient groups (HT without HU and HT with HU) compared to the control group (0.98 +/- 0.28, 1.41 +/- 0.31 versus 0.56 +/- 0.15 mm, respectively, p < 0.001). In the patients groups, patients with HU had significantly higher carotid IMT compared to the patients without HU. In this study we have shown that higher SUA levels are associated with atherogenesis independent from hypertension.

CONCLUSION

Early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of IMT in hypertensive patients.

[Food intake and colorectal cancers; an ecological study in Romania]

The aim of the present study performed in a Romanian population was to identify the food which can be either associated with or protect against colorectal carcinoma.

MATERIAL AND METHOD

Correlation and regression analysis were used to examine the association between dietary intake and the rate of incidence for colon, rectum and anus cancers, in study groups from 7 regions of Romania.

RESULTS

A strong and positive association was observed for colonic cancer and the intake of coffee, tea and cocoa (r = 0.77, p = 0.042) whereas statistical significance of borderline value was found for margarine (r = 0.73, p = 0.06) and sweets (r = 0.74, p = 0.066) intake. A potential protective effect can be attributed to wine consumption ( r = -0.75, p = 0.03). The malignancies of the rectum and anus showed both a strong positive correlation with the intake of red meat ( r = 0.76, p = 0.048), sausages ( r = 0.87, p = 0.012), margarine (r = 0.97, p = 0.0004), butter ( r = 0.76, p = 0.049), sweets ( r = 0.93, p = 0.003), beverages (r = 0.97, p = 0.0003), coffee, tea, cocoa ( r = 0.94, p = 0.002). Negative correlations were reported for the recto-anal cancer and the consumption of: fish (r = -0.8, p = 0.032), cheese (r = -0.9, p = 0.006), wine (r = -0.85, p = 0.015).

CONCLUSION

The need for reducing the dietary intake of margarine, red meat, sausages and sweets while the beneficial effects of wine consumption have been also confirmed.

[Prognostic value of brachial artery flow--mediated dilation and carotid artery intima-media thickness in hypertensive patients]

Endothelial vasodilator dysfunction assessed by brachial artery flow-mediated dilatation (FMD) and carotid intima-media thickening (IMT) are two indicators of subclinical atherosclerotic disease. The aim of the study was to observe if there is a relationship between FMD and IMT in a group of hypertensive patients.

MATERIAL AND METHOD

We measured FMD and IMT by ultrasound in 75 subjects aged between 42 and 62 years. We examined their correlation and interaction with traditionally cardiovascular risk factors. Endothelial function was assessed by means of flow mediated dilation (FMD) on brachial artery, using B-mode ultrasonography.

RESULTS

The mean value of FMD was 8.00 +/- 2.02%. We observed a moderate but significant correlation between FMD and total cholesterol (r = -0.511, p < 0.01) and between FMD and triglycerides (r = -0.325, p < 0.01). All the patients in the study were also examined by high resolution B-mode ultrasound to measure the IMT of the common carotid artery. The mean value of IMT values was 1.41 +/- 0.3 mm. The correlation between FMD and IMT was inverse, moderate and significant. In conclusion, in hypertensive patients, B-mode ultrasound intima-media thickness and FMD measurement are important tools for evaluation of arterial wall remodeling and can be used as valid markers of atherosclerosis in cardiovascular risk prediction.

[The effects of chronic exposure to cigarette smoke on vasomotor endothelial function of guinea pig pulmonary arteries]

Chronic exposure to cigarette smoke on guinea-pigs induced a muscularization of pulmonary arterioles and endothelial dysfunction might be an early trigger of this vascular remodelling. Accordingly, the present study was aimed to evaluate the effect of a 12 weeks exposure to passive smoking on the pulmonary endothelial vasomotor function.

MATERIAL AND METHOD

Vasodilator response of pulmonary arteries rings isolated in organ bath, precontracted with phenylephrine, was compared in the presence of cumulative doses (10(-9) to 10(-4) M) of endothelial-dependent (acetylcholine, ACh and adenosine-diphosphate, ADP) and independent vasodilators (sodium nitroprusside, SNP), respectively.

RESULTS

Our results suggest that chronic exposure of guinea-pigs to cigarette smoke induces the impairment only of NO-mediated endothelial response (vasodilation was 9.83 +/- 4.36 % for ACh 10(-5)M vs. 39.72 +/- 16.61 % in control, p = 0.005, respectively 36.64 +/- 7.21 % for ADP 10(-5)M vs. 55.53 +/- 13.51 %, p = 0.02).

CONCLUSION

The in vitro study of pulmonary arteries vasomotor function in guinea pigs chronically exposed to cigarette smoke may represent a reliable and relevant experimental model for the assessment of pulmonary endothelial dysfunction in early stages of COPD.

[New concepts in the pathogenesis and pathophysiology of COPD]

Chronic obstructive pulmonary disease (COPD) is characterized by the progressive, partially reversible air flow limitation which occurs in association with a chronic inflammatory reaction triggered by smoking or other inhalation noxes in predisposed subjects. Genetic predisposition and /or latent adenoviral infections are responsible for the exacerbation and perpetuation of the inflammatory response despite smoking cessation. Inflammation is further aggravated by a process of chromatinic remodelling which amplify the expression of pro-inflammatory genes. Besides the role of macrophages, neutrophils and /CD8+ T lymphocytes, the involvement of dendritic cells, epithelial cells and eosinophils within the airway inflammation has also been reported. The other two contributors to the COPD pathogenesis are the oxidative stress and the proteases-antiproteases imbalance. Both processes together with the inflammatory one are responsible for the parietal remodelling of the bronchioles and the appearance of emphysema, the latter being aggravated by the apoptosis of the alveolar cells. Another important pathophysiological concept within the natural evolution of COPD is the pulmonary endothelial dysfunction which might be responsible for the arterial hypoxemia and pulmonary hypertension in these patients. The abnormal inflammatory response and the high oxidative stress are also present at the extrapulmonary level, thus explaining the systemic character of the disorder.

[Cigarette smoke extract induces endothelium dysfunction in isolated rabbit pulmonary arteries via an oxidative mechanism]

In early stages of COPD, lacking hypoxemia, pulmonary arteries yet show endothelial abnormalities. This vascular impairment could be assigned to noxious effects of some cigarette smoke components. The aim of the present study was to investigate the effect of cigarette smoke extract (CSE) on endothelial vasomotor function in isolated rabbit pulmonary arteries in the presence or absence of a natural antioxidant with superoxide dismutase activity (SODn). After incubation of vascular rings with CSE (5% in organ bath) vascular responses to acetylcholine (endothelial-dependent vasodilator agent) and sodium nitroprusside (endothelial-independent vasodilator agent) were evaluated. Our results showed the impairment of endothelial dependent vasodilation (maximal relaxation expressed as % was 28.32 +/- 10.15 vs. 46.36 +/- 8.04 in the group coincubated with SODn, p < 0.01) while endothelial independent relaxation was preserved (maximal response expressed as % was 95.04 +/- 7.40 vs. 97.54 +/- 4.58 in the group coincubated with natural antioxidant, p = NS). In conclusion, the hydrosoluble components of CSE induced endothelial vasomotor function impairment, most probable, via an oxidative mechanism.