Non-Pharmacological Intervention for Personalizing Sleep Quality through Gentle Rocking Motion

INTRODUCTION

Achieving restorative sleep is crucial for overall well-being, yet sleep difficulties affect a substantial portion of the adult population. Sleep disturbances are associated with diminished quality of life, physical complaints, cognitive impairment, and emotional regulation challenges.

OBJECTIVE

This study explores the influence of an innovative experimental bed designed to generate rocking motions on sleep parameters.

METHODS

A prospective observational study enrolled 60 adult participants, assessing their sleep on a regular stationary bed and the Inoveris bed, providing gentle rocking movements. Polysomnography was conducted, recording electroencephalography, electrooculogram, electromyogram, respiratory effort, and other parameters.

RESULTS

The rocking bed significantly increased total sleep time (TST) and reduced N1 sleep stage duration (p < 0.001). Participants also experienced a quicker transition to the N2 sleep stage (p = 0.01), indicative of a faster shift from wakefulness to deeper sleep. Additionally, rocking led to a higher percentage of N1 sleep stages (p = 0.01) and a significant increase in N3 sleep stage duration (p = 0.004). While some results lacked statistical significance, notable trends in the rocking bed group have clinical relevance, consistently improving sleep parameters, including increased TST. The rocking bed also showed a trend towards higher sleep efficiency (SE) and sleep duration percentage, hinting at a potential overall enhancement in sleep quality.

CONCLUSION

This study contributes valuable insights into the potential benefits of rocking motions on sleep architecture. Despite variations in outcomes across studies, our results underscore the potential of rocking beds as a non-pharmacological intervention for enhancing sleep quality. Notable improvements in total sleep time (TST), N1 sleep stage reduction, and accelerated transitions to deeper sleep stages highlight the clinical relevance of rocking interventions. Further research, collaboration, and addressing the identified limitations will advance our understanding of the therapeutic applications of rocking motions in sleep science.

Laboratory Diagnostics Accuracy for COVID-19 versus Post-COVID-19 Syndrome in Lung Disease Patients with Multimorbidity

The laboratory tests and identification of risk factors such as comorbidities are essential in the management, treatment and prognosis of patients with chronic respiratory diseases. Performing rigorous monitoring among patients with post-COVID-19 syndrome and early identification of risk factors associated with poor prognosis are crucial in improving patient outcomes. In the present study, 182 patients diagnosed with COVID-19 and PCI during 2020-2022 were included. A clinical and epidemiological evaluation was performed for each patient. Laboratory tests at admission included complete blood count, Erythrocyte Sedimentation Rate (ESR) and biochemical tests. Receiver operating curve (ROC) and area under the curve (AUC) were calculated to compare the diagnostic performance of each parameter. Regarding comorbidities, arterial hypertension, diabetes mellitus and obesity were the most frequent ones. In the case of chronic lung diseases, asthma and Chronic Obstructive Pulmonary Disease (COPD) were the most frequent. Pleurisy was found especially in patients with PCI Variations in serum LDH values were observed, especially in severe forms of COVID-19 in 2020, with a mean value of 481.44 U/L, compared to patients with PCI, whose mean values (122 U/L) were within the biological range of reference. High neutrophil/lymphocyte ratio (NLR) values quantified in this study were especially associated with moderate and severe forms of COVID-19 and also PCI. The Spearman correlation coefficient was determined to measure the correlations between the clinical parameters of all investigated subjects. A value of p < 0.05 was considered statistically significant. The statistical results indicated that serum lactate dehydrogenase (LDH), glucose and C-reactive protein (CRP) are sensitive markers with a diagnostic role in COVID-19, and lymphocyte (Ly) count, CRP, ESR and glucose were evidenced to be target markers in PCI. LDH values were observed to be statistically significant (p < 0.005) in patients with COVID-19 and obesity evaluated in 2021, while Ly count was statistically significant (p = 0.05) in patients with PCI and arterial hypertension. Regarding comorbidities, it has been observed that obesity, arterial hypertension and cardiovascular diseases represent risk factors in COVID-19/PCI, associated especially with the severe forms of the disease.

Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review

Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated pneumonia (VAP), remain two significant causes of morbidity and mortality worldwide, despite the better understanding of pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle of care principles) and supportive care. Prior detection of the risk factors combined with a clear clinical judgement based on clinical scores and dosage of different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed on myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide) represent the cornerstones of a well-established management plan by improving patient's outcome. This review article provides an overview of the newly approved terminology considering nosocomial pneumonia, as well as the risk factors, biomarkers, diagnostic methods and new treatment options that can guide the management of this spectrum of infections.

Assessment of Some Risk Factors and Biological Predictors in the Post COVID-19 Syndrome in Asthmatic Patients

Long COVID-19 or post-COVID infection (PCI) refers to the prolongation of symptoms in people who have been infected with the SARS-CoV-2 virus. Some meta-analysis studies have shown that patients with comorbidities, such as diabetes, obesity or hypertension, have severe complications after infection with the SARS-CoV-2 virus. The presence of chronic respiratory diseases such as bronchial asthma, COPD, pulmonary hypertension or cystic fibrosis increases the risk of developing severe forms of the COVID-19 disease. The risk of developing the severe form of COVID-19 was observed in patients with bronchial asthma being treated with corticosteroids, but also in those hospitalized with severe asthma. The biological variables determined in patients with PCI infection showed changes, especially in the hematological parameters, but also in some inflammatory markers. The aim of this study was to investigate some biological predictors in post-COVID-19 infection in patients with asthma and various comorbidities. In the case of patients diagnosed with moderate and severe forms of COVID-19, the variation in biological tests has shown high concentrations for serum glucose, lactate dehydrogenase and C-reactive protein. Additionally, the calculation of the relative risk (RR) based on the associated comorbidities in patients with PCI points to higher values for patients with asthma, hypertension, diabetes and obesity (RR moderate/severe form = 0.98/1.52), compared to patients with PCI and asthma (RR moderate/severe form = 0.36/0.63). Based on the statistical results, it can be concluded that the alanine aminotransferase (ALT) activity (p = 0.006) and the age of patients (p = 0.001) are the variables that contribute the most to the separation of the four classes of comorbidities considered.

Nanomedicine to modulate immunotherapy in cutaneous melanoma (Review)

Cancer immunotherapy has shifted the paradigm in cancer treatment in recent years. Immune checkpoint blockage (ICB), the active cancer vaccination and chimeric antigen receptor (CAR) for T-cell-based adoptive cell transfer represent the main developments, achieving a surprising increased survival in patients included in clinical trials. In spite of these results, the current state-of-the-art immunotherapy has its limitations in efficacy. The existence of an interdisciplinary interface involving current knowledge in biology, immunology, bioengineering and materials science represents important progress in increasing the effectiveness of immunotherapy in cancer. Cutaneous melanoma remains a difficult cancer to treat, in which immunotherapy is a major therapeutic option. In fact, enhancing immunotherapy is possible using sophisticated biomedical nanotechnology platforms of organic or inorganic materials or engineering various immune cells to enhance the immune system. In addition, biological devices have developed, changing the approach to and treatment results in melanoma. In this review, we present different modalities to modulate the immune system, as well as opportunities and challenges in melanoma treatment.

MiRNA and LncRNA as Potential Biomarkers in Triple-Negative Breast Cancer: A Review

Noncoding RNAs (ncRNAs) include a diverse range of RNA species, including microRNAs (miRNAs) and long noncoding RNAs (lncRNAs). MiRNAs, ncRNAs of approximately 19-25 nucleotides in length, are involved in gene expression regulation either via degradation or silencing of the messenger RNAs (mRNAs) and have roles in multiple biological processes, including cell proliferation, differentiation, migration, angiogenesis, and apoptosis. LncRNAs, which are longer than 200 nucleotides, comprise one of the largest and most heterogeneous RNA families. LncRNAs can activate or repress gene expression through various mechanisms, acting alone or in combination with miRNAs and other molecules as part of various pathways. Until recently, most research has focused on individual lncRNA and miRNA functions as regulators, and there is limited available data on ncRNA interactions relating to the tumor growth, metastasis, and therapy of cancer, acting either on mRNA alone or as competing endogenous RNA (ceRNA) networks. Triple-negative breast cancer (TNBC) represents approximately 10%-20% of all breast cancers (BCs) and is highly heterogenous and more aggressive than other types of BC, for which current targeted treatment options include hormonotherapy, PARP inhibitors, and immunotherapy; however, no targeted therapies for TNBC are available, partly because of a lack of predictive biomarkers. With advances in proteomics, new evidence has emerged demonstrating the implications of dysregulation of ncRNAs in TNBC etiology. Here, we review the roles of lncRNAs and miRNAs implicated in TNBC, including their interactions and regulatory networks. Our synthesis provides insight into the mechanisms involved in TNBC progression and has potential to aid the discovery of new diagnostic and therapeutic strategies.

Therapy of Respiratory Complications in Myasthenia Gravis

Myasthenia gravis is responsible for damaging the neurosurgical structures in charge of producing and supporting the breathing process. Plasmapheresis is the procedure that non selectively removes the potentially pathological elements from the blood.It is done extracorporeally, and has multiple clinical applications, especially in situations when intensive care is required. In patients with moderate or severe forms, or with no favourable therapeutic response to cholinesterase inhibitors, corticosteroids and / or immunosuppressive therapy are administered.

Value of Autopsies in the Study of Diagnostic Errors in Respiratory Medicine

Diagnostic errors are real and are causing harm to patients on a global scale. However, the methods for measuring diagnostic errors are underdeveloped. One very important tool in this regard is the use of autopsies, in order to point out the cases where the actual affliction was missed and to quantify the incidence of such mistakes. We have carried out a study to compare the clinical diagnostic with the post mortem autopsy report in 119 patients who have died at the Pulmonology Hospital in Iasi, Romania, between January 2nd 2016 and January 2nd 2017. The purpose of this research is to determine the incidence of diagnostic errors and to identify the most missed or overlooked respiratory diseases.

Reducing the Duration and Improving Hospitalisation Time by Using New Surgical Tehniques and Psychotherapy

As far as surgical techniques are concerned, video-assisted thoracoscopy comes with lot of improved results compared to classical surgical techniques. This technique seems to reduce the parameters reflecting the period of hospitalization, exposure to analgesics, patient�s recovery rate, and the level of pain felt. Studies have been conducted that have demonstrated that, hypnosis can significantly improve the duration of pain exposure as well as the intensity perceived by the patient. In domain literature report cases in which hypnosis has been proven effective is in the preoperative preparation of surgical patients. furthermore, by applying hypnosis, positive results are found during the postoperative care of patients. This study aims at the results of video-assisted surgical techniques, and at the opportunity of integrating complementary therapeutic elements such as hypnosis to improve the parameters interested in perioperative care of the surgical patient.

Contribution of Imaging Techniques in the Management of Cutaneous Pathology

The management of skin pathology of tumors and inflammatory disorders is difficult due to the existence of constantly changing diagnostic and treatment algorithms. The incidence of cutaneous melanoma and other melanocytic or non-melanoma tumors is currently increasing. Melanoma is difficult to treat in advanced stages due to its aggressiveness, and early diagnosis is required to improve the prognosis of these patients. Imaging techniques, such as classical and digital dermatoscopy can provide information on structure, vascular pattern, prognostic factors and detailed morphological analysis that can lead to improved individual management. This article presents a retrospective study that aims to analyze the contribution of imaging techniques to clinical and histological data.

Bioactive Compounds from Artemisia campestris L. Subsp. Campestris

Artemisia campestris L. (field wormwood) is a known medicinal plant used mainly in Asian medicine and most often overlooked in the western world, despite its cosmopolitan distribution. The aim of this study was to investigate the phytochemical composition of A. campestris from Romanian spontaneous flora in order to determine the bioactive molecules and to assess the antioxidant effect of the plant extract. For this purpose, we applied LC-MS methods for the analysis of phytosterols and polyphenols and developed new methods for the analysis of methoxylated flavones and sesquiterpene lactones, specific compounds in Artemisia genus. The paper is the first to report the concentration of these compounds in the indigenous plant and also to identify some new compounds, previously not reported in this species, such as eupatorin, casticin, and acacetin. The plant extract showed significant antioxidant activity in both radical scavenging and reducing power assay, well correlated with the polyphenolic profile.

Roflumilast in patients with advanced chronic obstructive pulmonary disease: towards a better-targeted use

INTRODUCTION

For patients with chronic obstructive pulmonary disease (COPD), one of the main goals in its management is to reduce the number of disease exacerbations. Roflumilast is an anti-inflammatory compound used in patients with advanced COPD and chronic bronchitis in order to fulfill this objective. However, this is not always easily achieved due to the heterogeneity of the population. Clinical trial data can allow more in-depth analysis in order to identify predictors for maximal efficacy in different patient populations. Areas covered: A post hoc pooled data analysis derived from two large-scale randomized controlled trials helped to better define the disease subsets in which roflumilast would exert the maximal therapeutic effect. These are represented by patients with prior hospitalizations for COPD exacerbations and by patients with higher values for eosinophil blood count. This analysis is the focus of our key paper evaluation. Expert opinion: This pooled data analysis suggests that a phenotype/endotype guided therapy has the potential to be impactful on overall survival by reducing the number of exacerbations and increase the life span of patients.

Use of Immunohistochemistry to Establish Ethiology in the Case of Primary Spontaneous Pneumotorax Patients

Primary spontaneous pneumothorax has a complex morphopathological substrate, in which active smoking plays an essential etiopathogenic role. Inflammation of the distal airways, bronchial anomalies, perivascular eosinophilic infiltrate associated with hereditary factors and physiognomy (longilli patients) lead to obstruction of distal airwayswhich is the essential element in the emergence of emphysematous changes. Immunohistochemistry (IHC) is a technique used to identify cellular or tissue (antigens) constituents by Ag-Ac, the Ac link site being identified either by direct labeling of the antibody or by a secondary labeling method. IHC reactions are based on tissue-antibody antigen binding, the latter being evidenced by direct conjugation to tracer molecules (direct reaction) or by another chain of other labeled free antibody linkages. We can consider the immunohistochemical method as having a potential utility, especially in selected patients, where there are sufficient clinical and epidemiological reasons to suspect a pneumothorax-causing disease but where the classical investigations did not provide diagnostic performance.

Influence of Environmental Factors on the Primary Spontaneous Pneumotorax

Pneumothorax is the presence of air between the two pleural effusions, making the pleural space from a virtual cavity to a real one. At present, we are facing a particular phenomenon: trying to establish with certainty the mechanisms underlying the occurrence of primary spontaneous pneumothorax and how to find and implement the best strategies for the application of treatment methods. Considering the classical conception that the incidence of spontaneous pneumothorax has a seasonal variability, we followed its distribution after the season, calendar month, by checking the statistical significance of the data obtained. Regardless of the dynamics factor involved and the likely mechanism of action, it seems to have an influence on the average duration of hospitalization and the length of time elapsed from intervention to discharge.

Characterization of the Serum a1-Antitripsine Level in Primary Spontaneous Pneumotorax Patients

Diagnosis of primary or idiopathic spontaneous pneumothorax is one of exclusion, and in fact defines an entity that may have a difficult or impossible cause to be highlighted by current means, we consider it appropriate to study these etiopathogenic aspects. There is a definite association between alpha-1 antitrypsin deficiency and pulmonary emphysema and indirect spontaneous pneumothorax secondary to an emphysematous pulmonary lesion. Dose of alpha-1 antitrypsin is an immunoturbinimetric method for in vitro determination of alpha-1 antitrypsin in human serum and plasma. This product is calibrated to be used for the Daytona RX analyzer. The serum level of alpha-1-antitrypsin is not a determining factor in the postoperative evolution characterized by the interval until air loss disappears, but certainly exerts some influence, the exact level of which remains to be determined.

The Influence of Thymectomy Over Acetylcoline Antibody Anti-receptor Concentration and Over the Clinical Manifestations on Myasthenia Gravis Patients

Myasthenia gravis is an autoimmune disorder which presents a series of clinical manifestations which are generally motor. The hallmark of the disorder is muscle weakness, which typically worsens during physical exercise and improves upon rest. Approximatively 80% of the patients presenting this affection test positive for Acetylcholine antibody anti-receptor (AChR-ab).Treatment of patients with myasthenia gravis consists of:administration of oral medica-tion, immunomodulating treatment by removal of AChR-ab through plasmapheresis or surgical intervention (thymectomy).This article presents a retrospective study in which the authors attempted to identify factors which can influence the effect of thymectomy on AChR-ab titration and on the clinical presentation of the patients suffering with myasthenia gravis.

Surgical and Anatomical Particularities and Difficulties in Histopathological Sampling for Superior Vena Cava Syndrome

The superior vena cava syndrome is due to the increased venous pressure in the upper torso, neck and head, caused by the obstruction of the superior vena cava. Both external and internal factors cause obstruction (95% are malign causes), and the most severe manifestation is represented by cerebral edema that can even lead to coma. The diagnostic algorithm for the superior vena cava syndrome is widely known. There are many controversies and discussions about the safety of histopathological sampling. The purpose of this paper is to assess such risks, the complication rate and the diagnostic yield of surgical sampling, by analyzing the 26 interventions performed in our clinic. Although the complication rate was higher than that observed in the absence of the superior vena cava syndrome, surgery remains mandatory for a rapid histopathological diagnosis, therefore demanding a protocol that must include a mandatory extemporaneous exam of the biopsy.

Incidental finding of a sclerosing hemangioma in a Caucasian woman

Sclerosing hemangioma of the lung is a rare and mostly benign lung tumor, which affects especially Asian middle-age women (median age of 48 years). We report the case of a 27-year-old woman in which, a premarital routine chest X-ray investigation revealed a 2 cm well-defined opaque nodule in the lower left pulmonary lobe, confirmed by CT scan. Microscopically, the surgically enucleoresected nodule was represented by a heterogenic tumor (papillary, solid, sclerotic, hemorrhagic patterns), containing two cell populations: cuboidal surface epithelial cells lining the papillary structures and round stromal cells in solid areas, with distinct immunoprofile and low mitotic activity, consistent with sclerosing hemangioma. This case is particular because, being rare in Caucasian persons, intraoperative diagnosis on frozen sections is extremely difficult, and routine histopathological diagnosis needs immunohistochemical tests to set the correct diagnosis, hence the correct therapeutic attitude.

Assessment of preoperative and postoperative prealbumin in thoracic surgery – a two months experience in a Romanian university hospital / Evaluarea preoperatorie şi postoperatorie a prealbuminei în chirurgia toracică - experiența de 2 luni a unui spital universitar din România

Malnutrition is a frequent and serious finding in surgical departments. Although its consequences include postoperative complications and higher costs, nutritional assessment is not part of the routine preoperative protocols. Nutritional assessment involves clinical and biological parameters and is vital in order to start treatment and improve outcome. Prealbumin is currently recognized as a faithful marker of malnutrition being introduced in practice guidelines. One of the most important aspects about prealbumin is the fact that its variations in time are more valuable than the absolute values. The aim of this study was to assess and compare the perioperative nutritional evolution of patients requiring thoracic surgery, with and without cancer, using prealbumin - preoperative and postoperative - as main marker. Thirty six patients from the Thoracic Surgery Department were assessed prior to surgery by body mass index, Subjective Global Assessment nutrition risk score and routine biochemical parameters. Prealbumin was assessed prior to surgery and 3 days after surgery. The age, length of postoperative stay and the presence was complications was noted. Patients with cancer (n=19) were significantly older than patients without cancer (p=0.007) and were more frequently, but not significantly, evaluated as malnourished through SGA (42.1% compared to 11.6%). Preoperative prealbumin and other parameters did not differ significantly between groups. However, there was a significant postoperative decrease in prealbumin only in patients with cancer. Therefore, prealbumin has been found to be valuable in assessing acute malnutrition in cancer patients, especially if variations are monitored in time, which could be useful in planning nutritional treatment

[Lymphangioleiomyomatosis (LAM)--an uncommon cause of bilateral spontaneous pneumothorax]

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.

[Thoracoscopic pleurodesis in malignant pleural effusions]

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

[Up-to-date indications for surgery in pleural and pulmonary tuberculosis]

Tuberculosis is an "old disease" but still remains a threat in modern days life. Despite human and material efforts, despite the improvements in drug therapy, the treatment of tuberculosis continue to consume a great amount of health care worldwide. A certain percentage among the patients with pleuro-pulmonary tuberculosis represents failures of DOTS therapy. Among them, paraclinical investigations will select candidates eligible for thoracic surgery. In our study we are reviewing the main surgical options and we present our experience regarding surgery in pleuro-pulmonary tuberculosis--what to operate and when is the best moment.