Chest
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There has been growing interest in understanding how neighborhoods may be related to cardiovascular risk. Neighborhood effects on sleep apnea could be one contributing mechanism. We investigated whether neighborhood walking environment and personal activity levels are related to OSA. ⋯ Living in neighborhoods with a low walking environment score is associated with greater severity of sleep apnea, especially in male and obese individuals. In men, greater activity level is associated with less severe sleep apnea, independent of BMI, comorbidities, and socioeconomic status. Neighborhood-level interventions that increase walkability and enable increased physical activity may potentially reduce the severity of sleep apnea.
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Case Reports
A 32-Year-Old-Man With a Severe Headache, Visual Loss, and Nodular Pulmonary Opacities.
A 32-year-old man presented with severe headache, vomiting, and painless loss of vision of 5 days' duration. He had no seizures, other neurologic deficits, or fever. Two months prior to presentation, he had an episode of hemoptysis of 30 to 50 mL, which resolved spontaneously; there was no recurrence. ⋯ He had no known comorbid illness, prior surgeries, dental procedures, or blood transfusions. He denied any history of substance abuse. He observed that his father and brother also had recurrent self-limited episodes of epistaxis.
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Case Reports
Endobronchial Ultrasound: A New Technique of Pericardiocentesis in Posterior Loculated Pericardial Effusion.
Diagnostic and therapeutic pericardiocentesis is traditionally carried out via the transthoracic route under ultrasound or echocardiographic guidance. Posteriorly located loculated pericardial effusion cannot be safely drained using the standard subxiphoid or apical, intercostal approach. In the presence of clinically significant loculated effusion or effusion requiring diagnostic pericardiocentesis where an echocardiographic approach is not feasible, patients are usually referred for surgery. We here present a novel minimally invasive endobronchial ultrasound-guided approach for the aspiration of posteriorly loculated pericardial effusion that may obviate the need for surgery and its related complications.
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OSA is associated with increased cancer incidence and mortality. Exosomes are vesicles secreted by most cells. They are released into the bloodstream and play a role in tumor progression and metastasis. We evaluated whether the chronic intermittent hypoxia (IH) that characterizes OSA leads to release of tumor-promoting exosomes in the circulation. ⋯ Circulating exosomes released under IH conditions in vivo selectively enhance specific properties of lung tumor cell cultures. Thus, plasma exosomes participate in the increased tumor aggressiveness observed in patients with OSA.
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Editorial Biography Historical Article
Giants in Chest Medicine: Bartolome Celli, MD, FCCP.