Arterial Stiffness Assessment Using the Arteriograph in Patients with Moderate-Severe OSA and Metabolic Syndrome-A Pilot Study.

BACKGROUND: Both obstructive sleep apnea (OSA) and metabolic syndrome (MS) promote arterial stiffening. As a basis for this study, we presumed that arterial stiffness could be assessed using the Arteriograph (TensioMed, Budapest, Hungary) to detect early modifications induced by continuous positive airway therapy (CPAP) in reversing this detrimental vascular remodeling. Arterial stiffness is increasingly acknowledged as a major cardiovascular risk factor and a marker of subclinical hypertension-mediated organ damage. The aim of this pilot study was to evaluate the arterial stiffness changes in patients with moderate-severe OSA and MS after short-term CPAP use. METHODS: We performed a prospective study that included patients with moderate-severe OSA and MS who had not undergone previous CPAP therapy. All subjects underwent clinical examination and arterial stiffness assessment using the oscillometric technique with Arteriograph (TensioMed, Budapest, Hungary) detection before and after 8-week CPAP therapy. RESULTS: 39 patients with moderate-severe OSA were included. Eight weeks of CPAP therapy significantly improved central systolic blood pressure (Δ = -11.4 mmHg, p = 0.009), aortic pulse wave velocity (aoPWV: Δ = -0.66 m/s, p = 0.03), and aortic augmentation index (aoAix: Δ = -8.25%, p = 0.01) only in patients who used the device for a minimum of 4 h/night (n = 20). CONCLUSIONS: Arterial stiffness was improved only among CPAP adherent patients and could be detected using the Arteriograph (TensioMed, Budapest, Hungary), which involves a noninvasive procedure that is easy to implement for the clinical evaluation of arterial stiffness.

Efficacy of indacaterol as a single therapy versus salmeterol/fluticasone therapy in patients with milder chronic obstructive pulmonary disease.

INTRODUCTION: In non-exacerbation chronic obstructive pulmonary disease (COPD) with mild lung function impairment, single bronchodilator therapy might be as effective as combined inhaled corticosteroid/bronchodilator therapy, whereas the risk of pneumonia associated with the latter would be practically absent. AREAS COVERED: We performed an analysis of a recent study evaluating the efficacy and safety of inhaled indacaterol versus inhaled salmeterol/fluticasone in COPD patients. EXPERT OPINION: Both therapies were found to exert comparable effects on lung function, symptom severity and health status.

[Prevalence of obstructive sleep apnea symptoms in a rural population]. / Prevalenta simptomelor de apnee obstructiva în somn într-o populatie rurala.

AIM: Obstructive Sleep Apnea Syndrome (OSAS) is an under diagnosed condition with significant consequences on health. The aim of this study is to estimate the prevalence of symptoms and key features of OSAS in a rural population. MATERIAL AND METHODS: 254 subjects were enrolled. We measured height (H) and weight (W), calculated body mass index (BMI) and determined glycated hemoglobin (HbA1c). Information about age, gender, medical history (diabetes, hypertension) was collected. All the participants filled in the Berlin questionnaire, which has separate questions regarding the symptoms of OSAS. RESULTS: Snoring was reported by 44.1% of the subjects, observed apneas by 6.7% and excessive daytime sleepiness by 36.6%. All symptoms were more frequently reported by women. A higher percentage of obese, hypertensive and diabetics reported snoring (p < 0.001). When analyzing gender differences, the significance was maintained, except for diabetic men. Witnessed apneas were more prevalent in hypertensive subjects (p = 0.034), but were significantly associated with hypertension only in (p = 0.003). No correlation was found regarding excessive daytime sleepiness and the risk factors studied. CONCLUSIONS: Prevalence of OSAS symptoms and risk factors in this rural population was noticeable and efforts for early diagnosis and treatment are recommended.

Socio-demographic and lifestyle characteristics associated with the risk for obstructive sleep apnea syndrome in a rural population.

AIM: To evaluate socio-demographic and lifestyle characteristics in relationship to the risk for obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: The study was carried out on 254 subjects. Socio-demographic data (age, gender, occupation, education level, and economic status), smoking status, alcohol consumption, and hours/day spent watching TV were recorded. For physical activity assessment the international physical activity questionnaire and for identifying the risk for OSAS Berlin Questionnaire were used. RESULTS: Of the 254 subjects, 29.4% of men and 36.8% of women were at high risk for OSAS (p=0.22). Age was higher in the group at high risk for OSAS (p=0.002) and in women (p<0.001). The highest percentage (47.5%) of participants at high risk for OSAS was found among retired people, whereas farmers generated the lowest percentage (18.6 %) (p<0.001). 57.1% of retired women were at high risk for OSAS as compared to 5.6% of the farmers (p<0.001). Education level and monthly income did not influence the risk of OSAS (p=0.172, p=0.113, respectively). No differences in the risk of OSAS were found in relation with smoking (p=0.887), alcohol consumption (p=0.688), and sedentary lifestyle. We found that individuals at low risk for OSAS performed more physical activity at work (p=0.053) and significantly more vigorous physical activity (p=0.036). CONCLUSIONS: In the study rural population, age, occupation and physical activity are related to the risk for OSAS.

Obstructive sleep apnea patients voice analysis.

UNLABELLED: It is generally considered that obstructive sleep apnea may associate larynx abnormalities--either anatomic or functional in nature; considering the vocal tract as a series of uniform loss cylindrical pipes the idea of non-invasively exploring this by means of spectral analysis emerged. The aim of our study is to evaluate potential changes in acoustic features of voice in sleep apnea patients as compared to matched controls in order to develop a potential screening test. MATERIAL AND METHOD: Sleep apnea subjects and controls were asked to produce sustained vowels such as "a" and "i" which were recorded and analyzed. Some parameters were estimated--average of fundamental frequency, peak amplitude variation and compared and others are still to be developed.

[Scintigraphic visualization of Pgp protein: a non-invasive method to evaluate the MDR cellular character]. / Vizualizarea prin scintigrafie a proteinei Pgp--metoda neinvaziva de evaluare a caracterului MDR tumoral.

The MDR character is a major factor that influence the effectiveness of cancer chemotherapy. This feature can be noninvasively evaluated through 99mTc isonitrils (MIBI, Tetrofosmin) scintigraphy, because these radiotracers cellular efflux is mediated by the Pgp membranar active transport system, the same that mediate chemotherapy drugs cellular efflux. The Pgp glycoprotein overexpression in the case of the MDR positive tumoral cells will determine both the chemotherapic drug and the isonitrile radiotracer quickly efflux from the cell. This paper present, based both on the literature and personal authors research work, the principle of the method, radiotracers structural characteristics and cellular uptake mechanism, practical protocol details from the acquisition untill the qualitative and quantitative image processing and results interpretation. Quantification indexes are proposed for the radiotracer cellular uptake quantitative evaluation on the scintigraphic image. The results could bring the possibility to make MDR positive patient diagnosis and further selection for the MDR modulators drug therapy.

[The influence of nCPAP therapy on the autonomic nervous system dysfunction in OSA patients]. / Influenta terapiei nCPAP asupra sistemului nervos autonom la pacientii cu SAOS.

UNLABELLED: Obstructive sleep (OSA) can induce severe arrhythmias, including prolonged periods of asystole and heart block. Heart rate variability (HRV) has gained importance as a technique employed to explore the autonomic nervous system (ANS) which plays an important role in arrythmogenesis. AIMS: Our aim was to investigate nocturnal HRV by spectral analysis of RR intervals before and after continuous positive airway pressure (nCPAP) therapy. METHODS: To confirm the relation between OSA and ANS dysfunction, we prospectively investigated ANS function in 24 patients (18 males, mean age 53 years) with moderate or severe OSA. Overnight polysomnography was performed before and after nCPAP therapy. We analyzed apnea/hypopnea index (AHI), desaturation index, mean arterial oxygen saturation, mean and standard deviation (SD) for nocturnal HRV triangular index and pNN50 before and after initiating CPAP treatment. RESULTS: AHI decreased markedly from 51 to 3 events/h, desaturation index decreased from 45.9 to 3.62 events/h, and mean arterial oxygen saturation improved from 92.15% to 94.8%. Nocturnal HRV triangular index decreased from 18.3 to 12.85 as well as nocturnal pNN50 in all patients after initiating nCPAP therapy, suggesting that efficient nCPAP therapy may restore nocturnal autonomic defects, characteristic of severe and moderate OSA, as proven in previous studies. CONCLUSIONS: Abnormalities in cardiovascular variability may be implicated in the subsequent development of cardiovascular diseases in patients with OSA. These results suggest that impaired ANS function is present in patients with OSA and can be improved by successful nCPAP therapy.

Sleep disorders: a systematic review of an emerging major clinical issue in renal patients.

The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients' perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.

[Lymphangioleiomyomatosis (LAM)--an uncommon cause of bilateral spontaneous pneumothorax]. / Limfangioleiomiomatoza cauza rara de pneumotorax spontan bilateral.

LAM, a rare lung disease typically affecting women of reproductive age, is characterized by abnormal proliferation of smooth--muscle cells and progressive loss of pulmonary function due to destruction of lung parenchyma. Two cases of bilateral successive recurrent spontaneous pneumothorax and haemoptysis are presented. Repeated conventional and video-assisted surgery was required in both cases, for drainage of the recurrent pneumothorax and resection of subpleural bulla, with good immediate postoperative evolution. Immunohistochemical studies of resected specimens revealed LAM cells in the lung parenchyma with receptors for oestrogen and progesterone. HMB45 monoclonal antibodies in the LAM cells were identified in one case. The follow-up of the patients revealed no signs of recurrence at 84 and 18 months respectively, although pulmonary transplantation should be considered in case of further deterioration of respiratory function.

99mTc isonitrils biophysical aspects in pulmonary tuberculosis. Part I. In vivo evaluation of 99mTc MIBI and 99mTc Tetrofosmin biophysical localization mechanisms.

UNLABELLED: The aim of our study was to compare the role of lung perfusion scintigraphy with 1mTc MIBI and 99mTc Tetrofosmin (Mw) for the initial diagnostic evaluation of pulmonary tuberculosis-PTB). MATERIAL AND METHOD: Two groups of new PTB diagnosed patients, without treatment, were studied: group I--41 patients were imaged with 99mTc MIBI (sex ratio men:women = 17:24, mean age 25 years, 26 positive Mycobacterium Tuberculosis (MT) smears, 15 negative MT smears), group II--40 patients were imaged with 99mTc Mw (sex ratio men:women = 21:19; mean age: 32.5 years; 31 positive MT smears, 9 negative MT smears. Both groups received a 7.4 MBq (0.2 mCi)/kg radiotracer i.v. dose. Two anterior planar 3000000 counts/image on the thorax, one at 15 minutes and the other at 60 minutes after radiotracer administration and a SPECT acquisition were performed. For 99mTc Mw, three extra images were, in addition, performed, at 5, 90 and 120 minutes, in order to compare its kinetic with the known 99mTc MIBI kinetic. Clinical, radiological (Rx) and bacteriologic assessments of the patients were also done. RESULTS: Qualitatively, radiotracer uptake classification was coded: without uptake (-); low uptake (+); moderate uptake (++); high uptake (+++). Three identical interest regions were drawn: on the pathologic site, on a homolateral normal pulmonary field and on a myocardial field. The quantification has been assessed using three indexes (counts/pixel): I1= lesion/ normal; I2 = lesion/heart; I3 = normal/heart. We have found a significant difference between the mean value of I1:1.484, in the case of 99mTc MIBI versus 1.95 in the case of 99mTc Mw. The sensibility of the method was 96% for 99mTc MIBI versus 94% for 99mTc Mw, the specificity being 86 % for 99mTc MIBI versus 88% for 99mTc Mw. CONCLUSION: Both radiotracers are useful for the imaging evaluation of PTB, and can give evidence of new sites, related to radiology. The contrast between pathologic and normal uptake is more evident in 99rTc Mw images than in 99mTc MIBI images, how it was demonstrated by the index quantification. The in vivo uptake kinetic for 99mTc Mw seems to be similar with that of 99mTc MIBI for the first 60 minutes but, at 120 minutes showed delayed washout. This can be useful in the differential diagnosis from other lung disease where the radiotracer kinetic is different.

Biosynthesis and physio-pharmacological actions of angiotensin peptides: 2. Physio-pharmacological properties.

The classic concept of the renin-angiotensin system being substantially accomplished by the new cognitive and applicative acquisitions, a natural reconsideration and completion is imposed. In consequence, ample referrals are made to the main central and peripheral actions of Angiotensins through specific receptors. Emphasis is given to the effects of Angiotensin IV and Angiotensin 1-7 which are different of those of Angiotensin II, underlining their possible role as counteracting factors to its actions, in order to remove the imbalances created by the predominating stimulation of vasoconstricting AT, receptors. There are also taken into account the mainly central neural actions of Angiotensin IV, while Angiotensin 1-7 seems to be active only in the periphery. At the end are mentioned the results of our own research on the vasodilating effects of Angiotensin 1-7 and its interrelations with Angiotensin II. New experimental proofs are brought both in favor of the endocrine, paracrine and autocrine role of the circulating and tissue renin-Angiotensin system and of the counteracting of the effects of Angiotensin II by a part of its metabolism products.

Comparative study of the inhibitory effects of adrenomedullin on angiotensin II contraction in rat conductance and resistance arteries.

Adrenomedullin (ADM), a ubiquitous vasoactive peptide, has been the target of a multitude of studies concerning its effect on the vascular tone. The present work aims at clarifying a series of its interactions with the renin-angiotensin system. The study uses the rat aorta ring as a model of conductance vessels, with or without vascular endothelium, and the second order branch of rat mesenteric arteries as a model of resistance arteries. Interactions between various concentrations of ADM and angiotensin II (Ang II) were studied, in the presence of L-NAME (a nitric oxide [NO] synthase inhibitor) and methylene blue (MB; a soluble guanylate cyclase inhibitor). Results point out differences in the mechanism of the inhibitory action of ADM upon Ang II effects in the two vessel types studied. Inhibition of Ang II contraction by ADM involves guanylate cyclase in both cases. However, NO is involved in ADM-induced inhibition of angiotensinergic vasoconstriction only in the conductance arteries, not in the resistance ones.

[New data about neuroimmunomodulation and its functional implications]. / Date noi privind neuroimunomodularea si implicatiile ei functionale.

After a brief presentation of the immune system as sensorial and effector organ, which recognizes and defends against cellular aggressions, the main psychoneuroendocrine components of immune reaction regulation and modulation are shown. Both central nervous structures that control the hormonal emissions, the vegetative innervation of the lymphoid organs as wells as the afferent neurohumoral pathways involved in the making of the self-regulating and neuromodulating circuits of the humoral and cellular immune responses are mentioned. An important position is held by the interrelations between the hypothalamus-pituitary-corticoadrenal gland, the sympathetic-parasympathetic efferent pathways and the chemical messengers (hormones, neurotransmitters, interleukins, neurotrophins) which make possible the bi-directional neuroimmune communication for maintaining the homeostatic balances on this third effector pathway, too. Also experimental proof concerning the ability of central neurons to secrete neuromodulator cytokines and the presence of specific receptors for the various neuroactive molecules within lymphoid organs and circulating lymphocytes are presented. To close, the psychoemotional components of the neuroimmunomodulator circuits are mentioned, using as examples the changes induced by stress generally and oxidative stress in particular.

Actual data concerning the brain--immune system interface.

After a brief presentation of the immune system as sensorial and effector organ, which recognizes and defends against cellular aggressions, the main psycho-neuro-endocrine components of immune reaction regulation and modulation will be shown. Both central nervous structures that control the hormonal emissions, the vegetative innervation of the lymphoid organs as well as the afferent neurohumoral pathways involved in the making of the self-regulating and neuromodulating circuits of the humoral and cellular immune responses will be mentioned. An important position will be held by the interrelations between the hypothalamus-pituitary-corticoadrenal gland, the sympathetic-parasympathetic efferent pathways and the chemical messengers (hormones, neurotransmitters, interleukins, neurotrophins) which make possible the bi-directional neuroimmune communication for maintaining the homeostatic balances on this third effector pathway, too. Also will be presented experimental proof concerning the ability of central neurons to secrete neuromodulator cytokines and the presence of specific receptors for the various neuroactive molecules within lymphoid organs and circulating lymphocytes. To close, the psychoemotional components of the neuro-immunomodulator circuits will be mentioned, using as examples the changes induced by stress generally and oxidative stress in particular.