Chest
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Chronic thromboembolic pulmonary hypertension (CTEPH) is a treatable form of pulmonary hypertension and right heart failure. CTEPH (group 4 pulmonary hypertension) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved acute pulmonary embolism. CTEPH also may present without prior VTE history, which can contribute to its underrecognition. ⋯ Diagnosis of CTEPH should be considered in all patients with suspicion of pulmonary hypertension. Treatments for CTEPH have advanced with improvements in outcomes for both operable and inoperable patients. Therapy should be tailored based on multidisciplinary team evaluation to ensure optimal treatment response.
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OSA is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent upper airway obstruction and hypoxia, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition, and subsequent transplantation of fecal matter to other animals induced changes in BP and glucose metabolism. ⋯ OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.
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Multicenter Study
Polysomnographic Assessment of Sleep Disturbances in Cancer Development: A Historical Multicenter Clinical Cohort Study.
Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk. ⋯ In a large cohort, we confirmed the importance of polysomnographic phenotypes and highlighted the role that PLMS and oxygenation desaturation may play in cancer. Using this study's findings, we also developed an Excel (Microsoft) spreadsheet (polysomnography cluster classifier) that can be used to validate the identified clusters on new data or to identify which cluster a patient belongs to.
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Randomized Controlled Trial Multicenter Study
The OaSiS Trial (WF-20817CD): Multi-Center Randomized Effectiveness Implementation Trial to Increase Smoking Cessation for Individuals Undergoing Lung Screening.
One-half of all people who undergo lung cancer screening (LCS) currently use tobacco. However, few published studies have explored how to implement effective tobacco use treatment optimally during the LCS encounter. ⋯ The OaSiS trial participants showed a significant reduction in tobacco use over time, but no difference by trial arm was found.
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Precapillary pulmonary hypertension is characterized by elevated mean pulmonary artery pressure from increased pulmonary vascular resistance. Lack of respiratory variation in right atrial pressure can be viewed as a surrogate for severe pulmonary hypertension and inability of the right ventricle to tolerate preload augmentation during inspiration. ⋯ Lack of respiratory variation in right atrial pressure is associated with poor clinical outcomes, adverse hemodynamic parameters, and right ventricular dysfunction in patients with precapillary pulmonary hypertension. Larger studies are needed to further evaluate its utility in prognosis and potential risk stratification in patients with precapillary pulmonary hypertension.