Skaidrius Miliauskas

Peculiarities of clinical profile of snoring and mild to moderate obstructive sleep apnea–hypopnea syndrome patients

PurposeThe purpose of this study is to perform comprehensive evaluation of the snoring and mild to moderate obstructive sleep apnea–hypopnea syndrome (OSAHS) patients for their anatomical, functional, and psychoemotional clinical properties.MethodsSeventy-four snoring patients, aged 24 to 64 (mean 41.83 ± 11.01) years underwent full-night polysomnography, nasopharyngoscopy, and Mueller maneuver. Clinical tests battery consisting of visual analogue scales (VAS) scales, Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg’s State-Trait Anxiety Inventory (STAI), Beck Depression Inventory—Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess their distinctive clinical properties.ResultsThe total group of snoring and mild to moderate OSAHS patients presented with considerably enlarged VAS snoring and daytime sleepiness scores (mean 66.32 ± 19.07 and 35.03 ± 27.83 points), mild BDI-II scores (mean 10.96 ± 9.42 points), and moderate trait anxiety scores (mean 41.51 ± 8.62 points). All the scores of daytime complaints measured with the VAS correlated statistically significantly with the mean scores of the ESS, SAQLI-LT, trait anxiety, and BDI-II. Both groups, of snoring and mild to moderate OSAHS patients, indicated similar intensity of the major complaints according to the VAS, same as similar BDI-II, STAI, and SAQLI-LT scores. A higher Friedman’s score of palatal tonsils was found in the group of snoring patients, comparing to that of the group of mild to moderate OSAHS patients (p < 0.05).ConclusionsSnoring and mild to moderate OSAHS patients have resemblances in their distinctive anatomical and clinical properties. This group of the patients revealed mild depression and moderate trait anxiety scores when measured with the BDI-II and STAI, which correlated significantly with the severity of the patients’ daytime complaints measured with the VAS.

Distribution of CD4+ and CD8+ T cells in tumor islets and stroma from patients with non-small cell lung cancer in association with COPD and smoking

BACKGROUND AND OBJECTIVE The immune system plays an important role in non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the infiltration patterns of CD4(+) and CD8(+) T cells in NSCLC and to analyze their relation to COPD, smoking status and other clinicopathologic variables. MATERIALS AND METHODS Lung tissue specimens from 50 patients who underwent surgery for NSCLC (stages I-III) and 10 control group subjects were analyzed immunohistochemically. RESULTS NSCLC patients had a greater number of CD4(+) and CD8(+) T cells infiltrating the lung tissue than the control group (P=0.001) with predominant infiltration in the tumor stroma. We found a significant association between the number of total and tumor stroma-infiltrating CD4(+) and CD8(+) T cells, and smoking status (P<0.05). There were more CD8(+) T cells in the tumor stroma and fewer in the tumor islets in NSCLC patients with COPD as compared to NSCLC patients without COPD (P<0.05). However, there was no such association between CD4(+) T cells and COPD status. A high level of CD8(+) T cell infiltration in the tumor stroma was independently associated with the coexistence of COPD in multivariate analysis (P<0.05). CONCLUSIONS According to our data, COPD but not smoking seems to be associated with higher infiltration of CD8(+) T cells in the tumor stroma of patients with NSCLC. It allows us to hypothesize that NSCLC patients with coexisting COPD may have a more favorable outcome due to anticancer properties of stromal CD8(+) T cells.

Reactive Oxygen Species Production in Peripheral Blood Neutrophils of Obstructive Sleep Apnea Patients

Obstructive sleep apnea (OSA) as well as obesity is associated with increased production of reactive oxygen species (ROS). Neutrophils produce great amounts of ROS. The aim was to evaluate peripheral blood neutrophils ROS production in men with OSA and to establish relations with disease severity and obesity. Methods. Forty-six men with OSA and 10 controls were investigated. OSA was confirmed by polysomnography (PSG), when apnea/hypopnea index was >5/h. Body mass index (BMI) was evaluated. Neutrophils were isolated from peripheral blood in the morning after PSG. Dihydrorhodamine-123 was used for ROS detection. Data is presented as median (25th and 75th percentiles). All subjects were divided into four groups: nonobese mild-to-moderate OSA, obese mild-to-moderate OSA, nonobese severe OSA, and obese severe OSA. Results. Neutrophil ROS production was higher in nonobese severe OSA group compared to nonobese mild-to-moderate OSA (mean fluorescence intensity (MFI) 213.4 (89.0–238.9) versus 44.5 (20.5–58.4), P < 0.05). In obese patient groups, ROS production was more increased in severe OSA compared to mild-to-moderate OSA group (MFI 74.5 (47.9–182.4) versus 31.0 (14.8–53.8), P < 0.05). It did not differ in the groups with different BMI and the same severity of OSA. Conclusion. Increased neutrophil ROS production was related to more severe OSA but not obesity.

Malignant Pleural and Peritoneal Mesothelioma: Incidental Diagnosis and Excellent Treatment Results

To the Editor: Patients with malignant pleural and peritoneal mesothelioma usually present with advanced symptomatic disease.1 Prognosis is poor. During our practice we had an exceptional mesothelioma case. During cholecystectomy peritoneal biopsy was done due to infiltration of omentum for 56-year-old man. The biopsy analysis showed that patient had peritoneal mesothelioma (Figure 1). The second mesothelioma marker WT-1 was positive and other markers (CEA, CD-15, and TTF-1) were negative. There were no respiratory symptoms or history of asbestos exposure. The patient (former smoker) was in good functional status. Chest computed tomography (CT) scan revealed multinodal lesions of left pleura (Figure 2). Malignant pleural and peritoneal mesothelioma was diagnosed and treatment with permetrexed 500 mg/m day 1 and cisplatin 80 mg/m day 1 (for 1 cycle) every 21 day was prescribed. The patient was assessed regularly with chest and abdomen CT (according to the modified RECIST criteria2). The pleural signs of mesothelioma disappeared completely after six cycles. No pleural or peritoneal changes were seen on CT scan 6 months after completion of chemotherapy (Figure 3). The patient is still alive with no signs of disease progression 3 years later. Early retrospective studies reported 5-year survival rates of 1% and overall median survivals of 7.6 months for patients not receiving chemotherapy. Eight randomized clinical trials concerning the mesothelioma chemotherapy have been published. Vogelzang et al.3 treated 448 eligible patients with either permetrexed and cisplatin or cisplatin alone. Response rates (41%versus 17%, p was 0.001), time to progression (5.7 versus 3.9 months, p was 0.001), and survival (median, 12.1 versus 9.3 months; hazard ratio 0.77, p was 0.020) all favored the combination treatment. In another large phase III trial,4 250 patients were randomized to receive either raltitrexed and cisplatin or cisplatin alone. Overall response rates (24% versus 14%, p was 0.056) was greater in the combination treatment arm. Now permetrexed combined with platinum compound is the only recommended treatment for extensive mesothelioma. According to the data of clinical trials the complete response during first line chemotherapy in malignant pleural mesothelioma is extremely rare. Furthermore, we could not find any reported data concerning the complete response rate in randomized clinical trials with permetrexed treatDisclosure: The authors declare no conflicts of interest. Copyright

Distribution of M1 and M2 macrophages in tumor islets and stroma in relation to prognosis of non-small cell lung cancer

BackgroundNon-small cell lung cancer (NSCLC) remains the most common cause of cancer related death worldwide. Tumor-infiltrating macrophages are believed to play an important role in growth, progression, and metastasis of tumors. In NSCLC, the role of macrophages remains controversial; therefore, we aimed to evaluate the distribution of macrophages (M1 and M2) in tumor islets and stroma and to analyze their relations to patients’ survival.MethodsLung tissue specimens from 80 NSCLC patients who underwent surgical resection for NSCLC (pathological stage I-III) and 16 control group subjects who underwent surgery because of recurrent spontaneous pneumothorax were analyzed. Immunohistochemical double staining of CD68/iNOS (markers for M1 macrophages) and CD68/CD163 (markers for M2 macrophages) was performed and evaluated in a blinded manner. The numbers of M1 and M2 macrophages in tumor islets and stroma were counted manually.ResultsPredominant infiltration of M1 and M2 macrophages was observed in the tumor stroma compared with the tumor islets. M2 macrophages predominated over M1 macrophages in the tumor tissue. Tumor islets-infiltrating M1 macrophages and the number of total tumor-infiltrating M2 macrophages were independent predictors of patients survival: high infiltration of M1 macrophages in tumor islets was associated with increased overall survival in NSCLC (P < 0.05); high infiltration of total M2 macrophages in tumor (islets and stroma) was associated with reduced overall survival in NSCLC (P < 0.05).ConclusionsThis study demonstrated that high infiltration of M1 macrophages in the tumor islets and low infiltration of total tumor-infiltrating M2 macrophages were associated with improved NSCLC patients’ survival.Trial registrationClinicalTrials.gov NCT01955343, registered on September 27, 2013

Vascular adhesion molecules in men with obstructive sleep apnea: associations with obesity and metabolic syndrome

IntroductionMechanisms linking obstructive sleep apnea (OSA) to vascular diseases as well as obesity and metabolic syndrome are not clear. The purpose of the study was to evaluate levels of vascular adhesion molecules (soluble vascular cell adhesion molecules-1 (sVCAM-1) and E-selectin) in men with obstructive sleep apnea and control subjects and to determine their relations with obesity and metabolic syndrome.MethodsMen with OSA and controls matched for age were included in the study. Overnight polysomnography was performed. Body mass index (BMI) and all the components of metabolic syndrome were evaluated. Serum levels of sVCAM-1 and E-selectin were measured by enzyme-linked immunosorbent assay. Data presented as median (25th and 75th percentiles).ResultsLevels of sVCAM-1 (698.2 (627.6–798.2) vs 565.5 (518.8–678.1) ng/ml, p = 0.003) and E-selectin (64.9 (50.1–83.1) vs 49.7 (39.8–59.5) ng/ml, p = 0.017) were higher in the OSA group compared to the controls. Half of OSA patients had metabolic syndrome. Serum levels of sVCAM-1 and E-selectin did not differ in OSA patients with and without metabolic syndrome. Concentrations of both vascular adhesion molecules correlated with oxygen desaturation index (ODI), but the relation was no more significant after adjustment for all the components of metabolic syndrome. After adjustment for BMI, sVCAM-1 levels positively correlated with oxygen desaturation index (r = 0.331, p = 0.009).ConclusionsSerum levels of sVCAM-1 and E-selectin were increased in the OSA patient group compared to the controls. sVCAM-1 showed relation with ODI after adjustment for BMI suggesting that it could contribute to development of cardiovascular consequences in OSA patients.

Use of interferon-gamma release assay and tuberculin skin test in diagnosing tuberculosis in Lithuanian adults: A comparative analysis

BACKGROUND AND OBJECTIVE Lithuania belongs to the group of countries with a high-incidence of tuberculosis (TB). Some scientific studies show that the interferon-gamma release assay is more accurate and correlates more highly with TB exposure as compared to the tuberculin skin test (TST). This study aimed at comparing the efficacy between the T SPOT TB and TST for diagnosing TB among Lithuanian adults. MATERIALS AND METHODS Individuals with diagnosed TB, healthcare workers with known risk for TB and individuals without any known risk for TB underwent clinical examinations, interviews about their history of TB exposure and chest radiography. Then the TST and the T SPOT TB were performed on patients. RESULTS A positive T SPOT TB was more common in the group with diagnosed TB compared to healthcare workers and the low risk for TB groups (97.5%, 36.4%, and 0%, respectively, P<0.01). Positive TST results did not differ between the groups with diagnosed TB and the healthcare workers (92.5% vs. 95.5%, P>0.05). Agreement between TST and T SPOT TB was poor (kappa 0.14, P>0.05). T SPOT TB had higher specificity and sensitivity compared to TST (area under the ROC 0.9±0.04, P<0.01, vs. 0.5±0.06, P>0.05). CONCLUSIONS The T SPOT TB showed greater accuracy in diagnosing TB than TST did. Positive T SPOT TB result but not the TST was more common in patients with diagnosed TB.

Multidrug-resistant tuberculosis in Lithuania – Still a long way ahead

Despite the recent advances in the diagnosis of tuberculosis, treatment of the disease, for the most part, remains the same as it was half a century ago. In recent years only two new anti-tuberculosis drugs have been approved by the European Medicines Agency and Food and Drug Administration. Though the prevalence of this disease is slowly decreasing all over Europe, new challenges appear. One of them is multidrug-resistant tuberculosis (MDR-TB). This problem is especially prominent in Lithuania, which is one of the 27 high MDR-TB burden countries in the world and falls behind neighboring countries in terms of the prevalence of the disease. The objective of this paper was to review the situation of tuberculosis and MDR-TB in Lithuania, and current available methods of treatment, control and diagnosis of this disease.

Pseudoaneurysm of brachiocephalic artery mimicking the mediastinal tumor

58 year-old male admitted to the Hospital of Lithuanian University of Health Sciences due to suspicion of mediastinal tumor for diagnostic endobronchial ultrasound procedure (EBUS). The main patients complain was progressive dyspnea. Objective investigation revealed no major findings: normal breath sounds, heart rate – 96 bpm, blood pressure – 120/80 mmHg. Chest CT scan showed the mediastinal tumor of 3.8 × 3.5 cm. During bronchoscopy smooth intratracheal nodule of 5 mm was found. Superficial biopsy showed normal airway mucosa. During EBUS procedure no clear lymph node structure or blood flow was detected. It was decided to observe the patient clinically. One month later massive hemoptysis started. Urgent bronchoscopy revealed large right-sided mass and intratracheal wall dislocation due to the possible mediastinal tumor in the same location as the polyp in the previous investigation. Repeated chest CT scan showed increasing tumor of size 4.0 × 3.2 × 4.0 cm in the mediastinum and pseudoaneurysm of brachiocephalic artery was suspected. The diagnosis was later confirmed by aortography. The patient underwent successful aneurysmectomy.