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  • 1
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    Online Resource
    Serum and Bronchoalveolar Lavage Fluid Levels of Cytokines in Patients with Lung Cancer and Chronic Lung Disease: A Prospective Comparative Study
    MDPI AG ; 2023
    In:  Journal of Personalized Medicine Vol. 13, No. 6 ( 2023-06-14), p. 998-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 13, No. 6 ( 2023-06-14), p. 998-
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm13060998
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662248-8
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  • 2
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    Impact of CPAP Therapy Adherence on Global Cognition in Patients with Moderate to Severe Obstructive Sleep Apnea: A One-Year Follow-Up
    MDPI AG ; 2023
    In:  Medicina Vol. 59, No. 5 ( 2023-04-27), p. 846-
    Details
    In: Medicina, MDPI AG, Vol. 59, No. 5 ( 2023-04-27), p. 846-
    Abstract: Background: Obstructive sleep apnea increases (OSA) cognitive impairment risk. The objective of this study was to determine the impact of continuous positive airway pressure (CPAP) adherence on global cognition using the Montreal Cognitive Assessment questionnaire (MoCA). Materials and Methods: Thirty-four new patients diagnosed with moderate or severe OSA (apnea-hypopnea index AHI ≥ 15 events/h) from the CPAP group were compared with thirty-one moderate to severe OSA patients from the no-CPAP group. In addition, all patients completed the MoCA test, a patient health questionnaire (PHQ-9) for depressive symptoms, and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms, at baseline, after 6 months, and after 1 year. Results: At baseline, there were no significant differences between the two groups regarding total MoCA scores, 20.9 ± 3.5 CPAP group to 19.7 ± 2.9 no-CPAP group (p = 0.159), PHQ-9 (p = 0.651), and GAD-7 (p = 0.691). After one year, improvement was observed for a total MoCA score of 22.7 ± 3.5 (p 〈 0.001) for the CPAP group, and significant variance of score between groups was more accentuated for delayed recall and attention (p 〈 0.001) sub-topic. Moreover, PHQ-9, GAD-7 scores, and the Epworth Sleepiness Scale (ESS) decreased significantly (p 〈 0.001) after CPAP therapy. The MoCA score was significantly correlated with years of education (r = 0.74, p 〈 0.001) and had a negative correlation with body mass index (BMI) (r = −0.34), ESS (r = −0.30) and PHQ-9 (r = −0.34). Conclusions: One year of CPAP adherence improved global cognition associated with OSA.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina59050846
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2088820-X
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  • 3
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    CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome
    MDPI AG ; 2022
    In:  Medicina Vol. 58, No. 10 ( 2022-10-06), p. 1402-
    Details
    In: Medicina, MDPI AG, Vol. 58, No. 10 ( 2022-10-06), p. 1402-
    Abstract: Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the impact of continuous positive airway pressure (CPAP) on depression and anxiety scores. Materials and Methods: Ninety-nine consecutive new patients diagnosed with moderate or severe (apnea-hypopnea index AHI ≥ 15 events/h) OSA were accepted for the CPAP therapy. Patients completed a patient health questionnaire (PHQ-9) for depressive symptoms and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms before the CPAP treatment, after 6 months, and after 1 year of CPAP therapy with compliance. For both scores (PHQ-9 and GAD-7), a cut point ≥10 was used to indicate the presence of clinically depressive and anxiety symptoms. Results: Forty-eight individuals (48.48%) had PHQ-9 scores above the cut-off point ≥ 10, and twenty-seven participants (27.27%) had GAD-7 scores above the cut-off point ≥10. A significant correlation has been shown between PHQ-9 score and BMI (p 〈 0.0001), AHI (p 〈 0.0001), ODI (p 〈 0.001), ESS (p 〈 0.001), GAD-7 score (p 〈 0.0001), and [t90] (p 〈 0.0001), while GAD-7 was correlated with AHI (p 〈 0.030), ODI (p 〈 0.006), and [t90] (p 〈 0.001). The PHQ-9 and GAD-7 scores decreased significantly after 6 months of CPAP therapy in all groups and after 1 year of CPAP use. Conclusions: OSA patients should be screened for depression and anxiety. Furthermore, CPAP should be the first choice of treatment before starting other treatments for depression and anxiety symptoms.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina58101402
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 4
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    Post-Infection Oscillometry and Pulmonary Metrics in SARS-CoV-2 Patients: A 40-Day Follow-Up Study
    MDPI AG ; 2023
    In:  Diseases Vol. 11, No. 3 ( 2023-08-05), p. 102-
    Details
    In: Diseases, MDPI AG, Vol. 11, No. 3 ( 2023-08-05), p. 102-
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2079-9721
    URL: Article
    DOI: 10.3390/diseases11030102
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2720869-2
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  • 5
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    A Retrospective Analysis Comparing VATS Cost Discrepancies and Outcomes in Primary Lung Cancer vs. Second Primary Lung Cancer Patients
    MDPI AG ; 2023
    In:  Healthcare Vol. 11, No. 12 ( 2023-06-14), p. 1745-
    Details
    In: Healthcare, MDPI AG, Vol. 11, No. 12 ( 2023-06-14), p. 1745-
    Abstract: This study aimed to compare the outcomes and cost differences between primary lung cancer (PLC) and second primary lung cancer (SPLC) patients who underwent video-assisted thoracoscopic surgery (VATS). This was a retrospective analysis of 124 patients with lung cancer stages I, II, and III who underwent VATS between January 2018 and January 2023. The patients were divided into two groups based on their cancer status that was matched by age and gender: the PLC group (n = 62) and the SPLC group (n = 62). The results showed that there was no significant difference in the clinical characteristics between the 2 groups, except for the Charlson Comorbidity Index (CCI), with a score above 3 in 62.9% of PLC patients and 80.6% among SPLC patients (p = 0.028). Regarding the surgical outcomes, the operative time for the VATS intervention was significantly higher in the SPLC group, with a median of 300 min, compared with 260 min in the PLC group (p = 0.001), varying by the cancer staging as well. The average duration of hospitalization was significantly longer before and after surgery among patients with SPLC (6.1 days after surgery), compared with 4.2 days after surgery in the PLC group (0.006). Regarding the cost analysis, the total hospitalization cost was significantly higher in the SPLC group (15,400 RON vs. 12,800 RON; p = 0.007). Lastly, there was a significant difference in the survival probability between the two patient groups (log-rank p-value = 0.038). The 2-year survival was 41.9% among PLC patients and only 24.2% among those with SPLC. At the 5-year follow-up, there were only 1.6% survivors in the SPLC group, compared with 11.3% in the PLC group (p-value = 0.028). In conclusion, this study found that VATS is a safe and effective surgical approach for both PLC and SPLC patients. However, SPLC patients have a higher VATS operating time and require more healthcare resources than PLC patients, resulting in higher hospitalization costs. These findings suggest that careful pre-operative evaluation and individualized surgical planning are necessary to optimize the outcomes and cost-effectiveness of VATS for lung cancer patients. Nevertheless, the 5-year survival remains very low and concerning.
    Type of Medium: Online Resource
    ISSN: 2227-9032
    URL: Article
    DOI: 10.3390/healthcare11121745
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2721009-1
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  • 6
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    Is Lung Ultrasound Helpful in COVID-19 Neonates?—A Systematic Review
    MDPI AG ; 2021
    In:  Diagnostics Vol. 11, No. 12 ( 2021-12-08), p. 2296-
    Details
    In: Diagnostics, MDPI AG, Vol. 11, No. 12 ( 2021-12-08), p. 2296-
    Abstract: Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics11122296
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
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  • 7
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    Predictors for COVID-19 Complete Remission with HRCT Pattern Evolution: A Monocentric, Prospective Study
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 6 ( 2022-06-05), p. 1397-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 6 ( 2022-06-05), p. 1397-
    Abstract: There are growing concerns that some COVID-19 survivors may acquire fibrosis and other irreversible lung abnormalities. The purpose of this prospective study was to assess the rate and predictors of complete resolution of COVID-19 pneumonia by pursuing a hypothetical relation between time and imaging pattern evolution using HRCT findings. A monocentric prospective cohort study with a consecutive-case enrolment design was implemented during a five-month period, having a total of 683 post-COVID patients eligible for inclusion and 635 evaluations with complete follow-up for chest HRCT. The target for post-COVID evaluations consisted of performing HRCT 90 days after a confirmed SARS-CoV-2 infection. The studied patients had an average age of 54 years, ranging between 18 and 85 years old, and an average duration from the first symptoms until HRCT was performed of 74 days. At the post-COVID follow-up, 25.8% had a complete imagistic remission. The most common appearance with HRCT was “ground glass” in 86.6% in patients with persistent COVID-19, followed by reticulations, present in 78.8%, and respectively pleural thickening in 41.2% of cases. The mean total HRCT scores were statistically significantly higher in patients older than 65 years (10.6 ± 6.0) compared to the 40–65 group (6.1 ± 6.1) and the 18–40 age group (2.7 ± 4.8) (p 〈 0.001). Chest HRCT is a “time window” in documenting temporal persistent radiologic features of lung injury 90 days after SARS-CoV-2 infection, determining the pathologic basis of so-called “long COVID”. The complete remission was associated with a significantly higher average follow-up period and a significantly lower average patient age. Persistent HRCT features of ground glass, reticulation, and pleural thickening are associated with a higher total CT score and older age.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12061397
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 8
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    Lung Ultrasound in Children with Cystic Fibrosis in Comparison with Chest Computed Tomography: A Feasibility Study
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 2 ( 2022-02-01), p. 376-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 2 ( 2022-02-01), p. 376-
    Abstract: Background: Cystic fibrosis (CF) lung disease determines the outcome of this condition. For lung evaluation processes, computed tomography (CT) is the gold standard, but also causes irradiation. Lately, lung ultrasound (LUS) has proven to be reliable for the diagnosis of consolidations, atelectasis, and/or bronchiectasis. The aim of our study was to evaluate the value of a newly conceived LUS score by comparing it to the modified Bhalla CT score. A further aim was to evaluate the correlation between the score and the lung clearance index (LCI). Methods: Patients with CF were screened by LUS, followed by a CT scan. Spearman’s test was used for correlations. Results: A total of 98 patients with CF were screened, and 57 were included in the study; their mean age was 11.8 ± 5.5 (mean ± SD) years. The mean LUS score was 5.88 ± 5.4 SD. The LUS CF score had a very strong correlation with the CT score of rs = 0.87 (p = 0.000). LUS showed a good sensibility for detecting atelectasis (Se = 83.7%) and consolidations (Se = 94.4%). A lower Se (77.7%) and Sp (9%) were found for cylindrical bronchiectasis. Conclusion: Our study shows that LUS and the lung CF score are parameters that can be used with a complementary role in the diagnosis and monitoring of CF lung disease in children.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12020376
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 9
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    The Utility of Laboratory Parameters for Cardiac Inflammation in Heart Failure Patients Hospitalized with SARS-CoV-2 Infection
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 4 ( 2022-03-27), p. 824-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 4 ( 2022-03-27), p. 824-
    Abstract: COVID-19 has been associated with cardiovascular consequences, including myocardial infarction, thromboembolic events, arrhythmia, and heart failure. Numerous overlapping mechanisms, such as the IL-6 dependent cytokine storm and unopposed angiotensin II stimulation, could be responsible for these consequences. Cardiac damage is hypothesized to be a consequence of the direct viral infection of cardiomyocytes, resulting in increased metabolic demand, immunological activation, and microvascular dysfunction. Patients with pre-existing chronic heart failure are therefore at increased risk of decompensation, further heart damage, and significant health deterioration. Based on the aforementioned assumptions, we developed a study aiming to provide a detailed description of changes in biological parameters and cardiac injury markers of patients with heart failure and SARS-CoV-2 infection by correlating them with the clinical presentation and COVID-19 vaccination status, to predict the probability of ICU admission based on their initial hospital presentation. A two-year retrospective study was performed on heart failure patients with a history of SARS-CoV-2 infection and detailed records of biological biomarkers; a total of 124 eligible patients with COVID-19 and 236 without COVID-19 were recruited. Patients with heart failure and SARS-CoV-2 infection had significantly elevated baseline biological parameters and cardiac markers compared to those without COVID-19. Several cardiac injury markers were identified as significant independent risk factors for ICU admission: CK-MB (HR = 4.1, CI [2.2–6.9]), myoglobin (HR = 5.0, CI [2.3–7.8] ), troponin-I (HR = 7.1 [4.4–9.6]), troponin-T (HR = 4.9, CI [1.7–7.4] ). The elevation of a basic panel of acute inflammation markers (CRP, IL-6, fibrinogen), D-dimers, and BNP was also a significant risk factor. The follow-up of survivors at four weeks after viral clearance determined a worsened clinical picture by NYHA classification, worsened cardiac ultrasound findings, and a mild improvement in cardiac and inflammatory markers. Increased levels of myocardial damage parameters in association with cardiac ultrasound findings and basic inflammatory markers may enable early risk assessment and triage in hospitalized heart failure patients infected with SARS-CoV-2.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12040824
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 10
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    The Impact of Air Pollution on Frequent Exacerbations among COPD Patients: An Observational Study on the Population of Western Romania
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 15 ( 2022-07-27), p. 4352-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 15 ( 2022-07-27), p. 4352-
    Abstract: Patients with respiratory pathologies are the risk group most affected by air pollution, being directly exposed, especially those diagnosed with chronic obstructive pulmonary disease (COPD). In this observational study, which included 79 patients, we evaluated whether COPD patients with the frequent exacerbating phenotype or the infrequent exacerbating phenotype live in residences with higher values of air pollution. An air quality monitoring station was installed in each patient’s house for at least 24 h and PM 1.0, PM 2.5, and PM 10 were measured. Average PM 1.0, PM 2.5, and PM 10 values were lower in the group of infrequently exacerbating patients compared to the frequently exacerbating ones. For every 1 µg/m3 increase in the average values of PM 1.0, PM 2.5, and PM 10, there is an increase of 1.7%, 1.8% and 1%, respectively, in the risk of developing exacerbations. More importantly, an average value of PM 1.0, PM 2.5, and PM 10 above 32.21 µg/m3, 82.32 µg/m3 and 42.89 µg/m3 increases the probability of developing an exacerbation by 3.83, 10.14, and 4.12 times, respectively. Our analysis showed that COPD patients with a frequently exacerbating phenotype live in residences with high levels of air pollution compared to infrequently exacerbating ones.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11154352
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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