Diagnostic and prognostic values of serum Selenoprotein P and soluble St2 levels in pulmonary embolism.

AIM: Pulmonary Thromboembolism (PTE) occurs as a result of occlusion of one or more of the pulmonary artery branches by thrombus and is an important cause of right heart failure and pulmonary hypertension. Selenoprotein P (SePP) and soluble suppression of tumorigenicity 2 protein (sST2) are two new biomarkers that have previously been the subject of various studies in heart failure. The aim of this study was to determine the diagnostic and prognostic potential of SePP and soluble sST2 levels in patients with acute PTE. MATERIALS AND METHODS: The study included 135 patients diagnosed with acute non-massive PTE and 43 healthy volunteers. Clinical, laboratory, and radiological patient data were recorded. SePP and sST2 levels were measured in the patient and control groups. Patients were followed at 1, 3, and 6 months of treatment via the death notification system and telemedicine. RESULTS: SePP and sST2 levels were significantly lower in the patient group compared with the control group (SePP: 17.65 ng/ml vs. 43.06 ng/ml and sST2: 10.86 ng/ml vs. 16.20 ng/ml, both p < 0.001). No correlation was found at 1, 3, and 6 months of follow-up with prognosis and mortality. CONCLUSION: SePP and sST2 values were significantly lower in patients with acute PTE compared with the control group. Low levels of these biomarkers may be diagnostically valuable.

Diagnostic and Therapeutic Role of Electrocautery Snare Use in Endobronchial Polypoid Lesions.

INTRODUCTION: Electrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. METHODS: This retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. RESULTS: The mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. CONCLUSION: Our results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.

The impact of deep venous thrombosis on 90 day mortality in chronic obstructive pulmonary disease patients presenting with pulmonary embolism.

BACKGROUND: There are a limited number of studies investigating the effect of deep venous thrombosis (DVT) in patients presenting with both pulmonary embolism and chronic obstructive pulmonary disease. The aim of this study is to investigate the prevalence and prognostic significance of DVT in patients with PE-COPD. METHODS: COPD patients admitted with a diagnosis of PE to our tertiary hospital between January 2016 and January 2021 were retrospectively evaluated with an electronic hospital database. Univariate and multivariate Cox regression analyses were performed to reveal independent prognostic factors. RESULTS: Two hundred thirty-three patients (mean age 65.1 ± 12.2, 158 men (67.5 %)) were included. DVT was present at the time of diagnosis in 45 (19.31 %) of the patients. Patients with DVT tend to have more comorbidities, central pulmonary embolism, higher CRP and d-dimer levels, and SPESI score (p<0.05). After performing multivariate analyses, the presence of DVT (HR=3.48, CI: 1.02- 11.88, p = 0.046), ischemic heart disease (HR=3.82, CI: 1.38- 10.80, p = 0.01), and malignancy (HR=4.85, CI: 1.53- 15.41, p = 0.007) were found to be independent factors in predicting 90-day mortality. CONCLUSIONS: In PE-COPD patients, co-existing DVT may predict a worse outcome.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors.

OBJECTIVE: We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. METHODS: This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. RESULTS: Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. CONCLUSION: The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

OBJETIVO: Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. MéTODOS: Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. RESULTADOS: A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606­0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. CONCLUSãO: O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Correlation between Pulmonary Embolism and Sleep Apnea.

Introduction: It has been shown that there is a correlation between Obstructive Sleep Apnea Syndrome (OSAS) and pulmonary thromboembolism (PTE); OSAS is a risk factor for PTE. We aimed to evaluate the frequency of OSAS in PTE patients, the correlation of OSAS with the severity of PTE, and its effect on 1-month mortality in PTE patients. Methods: This single-center, prospective, comparative case control study contains 198 patients diagnosed with non-massive PTE in our hospital between the dates of 01/07/2018-04/01/2020 who were confirmed by imaging methods. Daytime sleepiness was assessed with Epworth questionnaires, and OSAS risk was assessed with Berlin, STOP, STOP-BANG sleep questionnaires. Alongside demographic and clinical data, comorbidities, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), WELLS scores, troponin, D-dimer values, echocardiyography (ECHO) findings were also examined. Epworth, Berlin, STOP, STOP-BANG sleep groups were compared in terms of PTE parameters. Results: A hundred and thirty-eight patients (69.6%) was assesed as high risk group according to Berlin, meanwhile STOP-BANG defined 174 patients (87.8%), furthermore STOP has considered 152 patients in the high risk group (76.7%) and Epworth questionnaire determined this number as 127 (64.1%). As a result of the logistic regression analysis, statistically significant correlation was found between Berlin score and heart failure, PESI, sPESI and troponin values; between Epworth score and WELLS score; between STOP-BANG score and PESI score (p<0.05). During the 1-month follow-up period, 9 of the patients were exitus and mortality was 4.5%. Conclusion: OSAS risk is more common in patients with PTE and it may be a risk factor for PTE. It has been shown that the risk of OSAS may aggravate PTE severity and prognosis.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors / Índice de triglicerídeos-glicose como preditor de gravidade da apneia obstrutiva do sono na ausência de fatores de risco tradicionais

Abstract Objective We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. Methods This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. Results Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. Conclusion The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

Resumo Objetivo Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. Métodos Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. Resultados A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606-0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. Conclusão O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Developing lung cancer in COPD: Possible role of carrying Alpha-1 antitrypsin deficiency variants.

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and airway inflammation, with a prevalence of 10.1%. Among the many causes of COPD, Smoking is the leading and another big cause is (AATD α1-antitrypsin deficiency)' an inherited disorder. Prevalence of COPD patients is 1.9%. World Health Organization (WHO) advice all COPD patients' AATD rate to be screened at least once during their life.The prevalence of AATD in the general population ranges from 1:2,000-5,000 in parts of Europe and from 1 to 5,000-10,000 in the United States and Canada. Case 1: An 81-year-old male patient with COPD. In computed tomography (CT) of the thorax, mass in the right lower lobe and a nodule in the right upper lobe were detected. The biopsy from right bronchial entrance via fiberoptic bronchoscopy (FB) yielded squamous cell carcinoma (SCC). AAT level was 169 mg/dL (ref. range: 90-200 mg/dL). M/P lowell allele was detected in genetic analysis. Case 2: A 45-year-old male patient with COPD. Conglomerated lymhadenomegaly in the paratracheal area was detected in CT. The biopsy from mucosal infiltrates initiating from the entrance of the right upper lobe to the anterior segment revealed SCC. His AAT level was 190 mg/dL (ref. range: 90-200 mg/dL) and the genetic analysis demonstrated M/I mutation. Case 3: A 64-year-old male COPD patient. In thorax CT, a 24 mm diameter parenchymal nodule in the left lower lobe was detected. Transthoracic fine needle aspiration biopsy from the left lung nodule showed SCC. His AAT level was 196 mg/dL (ref. range: 90-200 mg/dL) and M/P lowell allele was detected in the genetic analysis. Discussion: AAT deficiency can cause early-onset of COPD, manifested with emphysema and chronic bronchitis. It has been suggested that AATD is associated with an increased risk of many types of cancer. Although the relationship between AATD or variant carriage and LC histopathology is not clear in the literature, it was detected as squamous cell carcinoma in our cases. We infer that unmeasurable lung damage is more prevalent in heterozygous patients and we believe that sharing our results may draw more attention in this regard.

Management of recurrent hemoptysis: a single-center experience.

BACKGROUND: A successful planning methodology for patients with hemoptysis promises overall improvement in patient care. Conducted in a reference center for chest diseases, the present study aims to analyze characteristics and predictors of interventional methods in patients with recurrent hemoptysis. METHODS: The present study is a single-center, retrospective observational study. Between 2015 and 2018, 5973 patients with follow-up data until 2021 requiring more than one hospitalization due to recurrent hemoptysis were investigated. Patient characteristics, the amount of hemoptysis, baseline admission parameters, interventional procedures of bronchial artery embolization (BAE), fiberoptic bronchoscopy, rigid bronchoscopy, and surgical resections applied were analyzed according to number of hospitalizations and outcome. RESULTS: : Hospital admission numbers were higher in patients with sequela of tuberculosis, bronchiectasis and lung cancer. While lung cancer was the most frequent underlying reason in recurrent admissions, it was determined that as the amount of bleeding increased, the number of admissions also increased to the hospital, and BAE and rigid bronchoscopy were performed more frequently in the groups with less frequent admissions. There was no statistically significance between the amount of bleeding, and the interventional procedure alone or in combination with another procedure (p > 0.05). DISCUSSION: In conclusion, patients with certain diseases may experience frequent hospital admissions due to hemoptysis. Recurrent admissions may get better results with BAE and rigid bronchoscopy. We think that these procedures should be preferred in the foreground of suitable patient selection in line with available facilities and experience.

Could ferritin level be an indicator of COVID-19 disease mortality?

While the number of coronavirus disease-2019 (COVID-19) cases is increasing day by day, there is limited information known about the hematological and laboratory findings of the disease. We aimed to investigate whether serum ferritin level predicts mortality is a marker for rapid progression for inpatients. Our study included 56 patients who were died due to COVID-19 as the study group, and 245 patients who were hospitalized and recovered as the control group. The laboratory data of the patients were evaluated from the first blood tests (pre) taken from the first moment of admission to the hospital and the blood tests taken from before the patient's discharge or exitus (post) were evaluated retrospectively. The mean age of the nonsurvivor group was 62.0 ± 15.7 and the mean age of the control group was 54.34 ± 13.03. Age and length of stay are significantly higher in the nonsurvivor group. When comparing the pre- and postvalues of ferritin, according to the two groups separately, there was no significant difference in the control group and a high level of significance was observed in the nonsurvivor group (p < .01). COVID-19 disease caused by severe acute respiratory syndrome coronavirus-2 causes high mortality with widespread inflammation and cytokine storm. Ferritin is a cheap and widespread available marker, ferritin, which can be used for its predictivity of the mortality and hope it would be a useful marker for clinicians for the management of the disease.

Uric acid as a marker of severity of obstructive sleep apnoea syndrome in older patients.

OBJECTIVE: Uric acid has been shown to be related to the severity of obstructive sleep apnoea syndrome (OSAS) in adults. We assessed the role of uric acid in OSAS in a cohort of older patients. METHODS: A total of 164 patients aged >65 years, admitted to our sleep laboratory between January 1st, 2016 and July 1st, 2018 with a complaint of snoring, underwent overnight polysomnography and were retrospectively evaluated. RESULTS: A total of 126 patients who fulfilled the inclusion criteria (mean age 69.16±3.68 years, 56% men) were included. The control group was comprised of 14 patients, while the OSAS group consisted of 112 patients (31 mild, 44 moderate and 37 severe cases). No differences were observed in age, sex, hip circumference, waist/hip ratio or comorbidities between the groups. The Epworth Sleepiness Scale score, body mass index (BMI), and waist circumference were significantly higher in OSAS patients than in controls (p=0.001, p=0.02, and p=0.36, respectively). Uric acid was not correlated with any of the sleep parameters, and no significant differences were detected between the groups. Hyperuricemic patients were similar in terms of sleep parameters and comorbidities in comparison with the other patients. CONCLUSIONS: No relationship was observed between uric acid level and OSAS severity, as defined by the apnoea-hypopnea index. Further studies are needed to determine the value of uric acid as a marker of OSAS, after controlling for cardiovascular comorbidities, in older patients with this syndrome.

Uric acid as a marker of severity of obstructive sleep apnoea syndrome in older patients / Ácido úrico como marcador de gravidade da síndrome da apneia obstrutiva do sono em pacientes idosos

ABSTRACT Objective: Uric acid has been shown to be related to the severity of obstructive sleep apnoea syndrome (OSAS) in adults. We assessed the role of uric acid in OSAS in a cohort of older patients. Methods: A total of 164 patients aged >65 years, admitted to our sleep laboratory between January 1st, 2016 and July 1st, 2018 with a complaint of snoring, underwent overnight polysomnography and were retrospectively evaluated. Results: A total of 126 patients who fulfilled the inclusion criteria (mean age 69.16±3.68 years, 56% men) were included. The control group was comprised of 14 patients, while the OSAS group consisted of 112 patients (31 mild, 44 moderate and 37 severe cases). No differences were observed in age, sex, hip circumference, waist/hip ratio or comorbidities between the groups. The Epworth Sleepiness Scale score, body mass index (BMI), and waist circumference were significantly higher in OSAS patients than in controls (p=0.001, p=0.02, and p=0.36, respectively). Uric acid was not correlated with any of the sleep parameters, and no significant differences were detected between the groups. Hyperuricemic patients were similar in terms of sleep parameters and comorbidities in comparison with the other patients. Conclusions: No relationship was observed between uric acid level and OSAS severity, as defined by the apnoea-hypopnea index. Further studies are needed to determine the value of uric acid as a marker of OSAS, after controlling for cardiovascular comorbidities, in older patients with this syndrome.

RESUMO Objetivo: o ácido úrico mostrou estar relacionado à gravidade da síndrome da apneia obstrutiva do sono (SAOS) em adultos. Avaliamos o papel do ácido úrico na SAOS em uma coorte de pacientes idosos. Métodos: Um total de 164 pacientes com idade >65 anos, admitidos em nosso laboratório do sono entre 1º de janeiro de 2016 e 1º de julho de 2018 com queixa de ronco, foram submetidos à polissonografia durante a noite e avaliados retrospectivamente. Resultados: Foram incluídos 126 pacientes que preencheram os critérios de inclusão (média de idade 69,16±3,68 anos, 56% homens). O grupo controle foi composto por 14 pacientes, enquanto o grupo SAOS foi composto por 112 pacientes (31 leves, 44 moderados e 37 graves). Não foram observadas diferenças na idade, sexo, circunferência do quadril, relação cintura/quadril ou comorbidades entre os grupos. O escore da Escala de Sonolência de Epworth, o índice de massa corporal (IMC) e a circunferência da cintura foram significativamente maiores nos pacientes com SAOS do que nos controles (p=0,001, p=0,02 e p=0,36, respectivamente). O ácido úrico não se correlacionou com nenhum dos parâmetros do sono e não foram detectadas diferenças significativas entre os grupos. Os pacientes hiperuricêmicos não apresentaram diferença em termos de parâmetros de sono ou comorbidades dos demais pacientes. Conclusões: Não foi observada relação entre o nível de ácido úrico e a gravidade da SAOS, definida pelo índice de apneia-hipopneia. Mais estudos são necessários para determinar o valor do ácido úrico como marcador de SAOS, após controle de comorbidades cardiovasculares, em pacientes idosos com SAOS.

Comparison of silicon and metallic bifurcated stents in patients with malignant airway lesions.

INTRODUCTION AND OBJECTIVE: Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas. METHODS: Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files. RESULTS: Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively). CONCLUSIONS: No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Association Between Titration Method and Outcomes of First Night Satisfaction and CPAP Compliance.

INTRODUCTION: The gold standard therapy for obstructive sleep apnoea syndrome (OSAS) is continuous positive airway pressure (CPAP). Our study evaluated the relationship between first night satisfaction and CPAP compliance, and the effect of using the titration method in this relationship. METHODS: Between January 2012 and December 2012, 40 patients with the diagnosis of OSAS and without comorbidities, who had undergone CPAP titration, were included. Of these, 20 patients had undergone manual titration (MT) with polysomnography, whereas 20 patients had undergone auto-adjusted CPAP (APAP) titration. Questionnaires were administered during the morning of the titration night. The first-year adherence to treatment and patient compliance were evaluated. RESULTS: Forty patients were randomised in two groups; 35 patients who could procure the CPAP and were available at the end of the first year completed the study. From the 35 patients, 20 (6 males; 40%) were in the MT group while 15 (6 males; 30%) were in the APAP group. No significant difference was detected between the mean titration pressure levels obtained with the MT or APAP group. There was no difference in terms of responses to the questions on the questionnaire between the two groups. At the first-year evaluation, no significant difference was detected between the groups. CONCLUSIONS: The titration method used to detect CPAP pressure, MT, or APAP does not affect patient satisfaction on the day following the titration night, and does not affect first-year compliance.

Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?

INTRODUCTION: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. MATERIALS AND METHODS: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. RESULT: The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. CONCLUSIONS: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Bronchoscopic Treatment of Benign Endoluminal Lung Tumors.

Background and Aim: Endobronchial benign tumors are a rarely seen clinical entity but may cause significant symptoms. Endobronchial treatment has the potential for relieving symptoms while saving the patient from invasive surgical procedures. No trials have been published that present and compare the various endobronchial treatment modalities for endobronchial benign tumors. The aim of the present study is to define safety and efficacy of endobronchial treatment in patients with benign endobronchial tumors from the point of complications and success rate. Methods: This study is a retrospective cohort study from a review of medical charts. Eligibility criteria included diagnosis of a benign endobronchial tumor. Our institution's bronchoscopy and pathology database was searched for specific benign tumors, and the results were further detailed based on the endobronchial location. Results: Forty-four patients with pathologically confirmed benign endobronchial tumors were included. Tumor regression was achieved in all patients with diode laser and argon plasma coagulation in combination with or without cryotherapy and without any major complication. There were no significant differences between the use of either diode laser or of argon plasma coagulation as a modality with immediate effect from the occurrence of residual tissue that needed cryotherapy (P > 0.05). There were no major complications. Eight patients had minor complications including minor bleeding (6 patients) and hypertension (2 patients) that were controlled medically. Thirty-one patients (70%) had very good response, and 13 patients (30%) had good response as defined in literature before. Conclusion: Diode laser and argon plasma coagulation in combination with or without cryotherapy are safe and effective methods for endobronchial treatment of benign endobronchial tumors.

T wave peak-to-end interval in COPD.

Introduction: The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp-Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias. Objectives: In this study, we aimed to define a new ECG parameter in patients with COPD. Methods: This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients' demographic features, history, spirometry, and electrocardiographs were analyzed. Results: We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp-Te results in all precordial leads in the COPD group compared with the control group (p<0.05). Precordial V4 lead has the most extensive area under the curve (0.831; sensitivity 76.5%, specificity 89.6%). Conclusion: We present strong evidence that Tp-Te intervals were increased in patients with COPD, which suggests that there may be an association between COPD and ventricular arrhythmias and cardiac morbidity.

Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach.

PURPOSE: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. METHODS: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. RESULTS: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. CONCLUSION: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

Reduced Peripheral Blood Mononuclear Cell ROCK1 and ROCK2 Levels in Obstructive Sleep Apnea Syndrome.

BACKGROUND/AIM: Obstructive sleep apnea syndrome (OSAS) is associated with intermittent episodes of hypoxia, endothelial dysfunction and associated cardiovascular problems. Our aim was to investigate whether OSAS-related hypoxia alters the expression of rho-associated protein kinase (ROCK), a marker of chronic hypoxia and endothelial dysfunction. MATERIALS AND METHODS: ROCK1 and ROCK2 levels were measured by immunoblotting in peripheral blood mononuclear cells (PBMC) of 47 OSAS patients and 17 healthy controls. RESULTS: OSAS patients showed significantly lower PBMC ROCK1 and ROCK2 levels than healthy controls in the morning, but not in the evening. ROCK1/2 levels were correlated with blood triglyceride, visceral adiposity index, minimum oxygen saturation, C-reactive protein concentration, lymphocyte levels and sleep efficiency. CONCLUSION: Intermittent hypoxia induced by OSAS does not permanently alter ROCK protein expression levels. OSAS appears to be associated with endothelial dysfunction through inflammation and lipid metabolism pathways.