António Bugalho

Background: Hypoxemia is common during EBUS-TBNA under sedation. Whether HFNC improves oxygenation when compared with conventional nasal cannula (CNC) under matched nominal FiO ₂ and standardized sedation remains uncertain. Methods: In this prospective multicenter randomized trial across four centers, adults undergoing oral EBUS-TBNA under moderate-to-deep sedation received HFNC (set FiO ₂ 45%, 60 L·min⁻ ¹ ) or CNC (6 L·min⁻ ¹ ; nominal FiO ₂ ∼45%). The primary endpoint was the proportion of patients without any desaturation, with desaturation defined as SpO ₂ 10 s. Secondary outcomes included severe desaturation, nadir SpO ₂ , saturation decline, escalation after airway-opening maneuvers, and exploratory post hoc associations with desaturation. Results: Of 126 randomized patients, 120 were analyzed. Any desaturation occurred in 36/63 (57%) CNC and 25/57 (44%) HFNC patients (p=0.20). Severe desaturation (SpO ₂ 60 s) was less frequent with HFNC (3/57 [5%] versus 11/63 [17%]; p=0.048). HFNC was associated with a higher nadir SpO ₂ (p=0.01) and a smaller saturation fall (p=0.02). Persistent desaturation after the initial airway-opening maneuver, assessed as an exploratory analysis derived from the prespecified escalation algorithm, was more frequent with CNC (13/63 [21%]) than HFNC (4/57 [7%]; p=0.038). All procedures were completed without advanced airway support. Exploratory post hoc modelling showed associations of higher STOP-Bang score and longer procedure duration with desaturation. Conclusion: Under matched nominal FiO ₂ and standardized sedation, HFNC did not increase the proportion of patients without any desaturation during EBUS-TBNA, but it was associated with fewer severe and persistent desaturation events and better oxygenation stability.

Introduction: Atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) manifest differently in men and women, which may influence treatment decisions and adherence. The aim of our study was to investigate clinical, polysomnographic, and biological characteristics of AF-OSAS patients and to compare gender differences in this specific population. Methods: In a prospective single center study, the authors analyzed a population of consecutive patients with AF (paroxysmal or persistent). Anthropometric measurements, clinical and polysomnographic parameters were collected and evaluated. Soluble ST2, a serum biomarker of myocardial fibrosis, was measured. Results: The study included 89 consecutive participants with AF, 67% were male (n = 60), with a mean age of 63 years (31–76 years), and mean body mass index (BMI) of 30 kg/m2. All patients had an apnea-hypopnea index (AHI) ≥5 events/hour. No significant differences were observed between men and women regarding BMI, hypersomnolence or snoring. Women had a lower arousal threshold (p = 0.04), lower hypoxic burden (p = 0.03), and lower ventilatory burden (p = 0.006), whereas men had elevated ST2 serum levels (p = 0.02) and a higher AHI (p = 0.01). Conclusion: This study highlights the importance of systematically evaluating patients with atrial fibrillation for obstructive sleep apnea, due to its high prevalence, even in the absence of classic symptoms. The observed gender differences in clinical, laboratory, and polysomnographic parameters among AF patients emphasize the need for personalized diagnostic and management approaches.

Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed sleep disorder with significant cardiovascular implications, namely in atrial fibrillation (AF) patients. Despite its clinical relevance, OSA prevalence among AF patients and the diagnostic strategies used remain heterogeneous across studies, complicating screening, and treatment pathways. Our aim was to synthesize recent evidence on OSA prevalence in AF populations and to critically evaluate the diagnostic methods and screening strategies employed in clinical studies, by conducting a systematic review using PubMed and Google Scholar to identify original clinical studies published between January-2019 and December-2024. Inclusion criteria targeted adult AF populations assessed for OSA or sleep-disordered breathing. The results were analyzed by two independent reviewers. Non-concordances were resolved by consensus. Data extracted included study characteristics, population profiles, diagnostic approaches, prevalence rates, symptom profiles, and clinical correlates. Thirty-eight studies were included, comprising predominantly observational studies. Prevalence estimates of OSA in AF populations ranged from 5% to 90%, with most studies reporting rates > 60%. A consistent burden of moderate-to-severe OSA was observed. Diagnostic methods varied widely, from polysomnography (PSG) and home sleep apnea testing to pacemaker-derived monitoring and questionnaires such as STOP-Bang and Epworth Sleepiness Scale (ESS). Underdiagnosis was attributed to minimal symptomatology, lack of physician awareness, and reliance on subjective tools. Several studies highlighted the limited sensitivity of standard screening instruments in AF populations and advocated for objective testing even in asymptomatic patients. Marked heterogeneity in study designs, diagnostic methods, and populations precluded quantitative synthesis and limited direct comparisons. Objective diagnostic testing, particularly PSG, is essential to improve OSA detection rates and guide individualized management. Integration of structured screening protocols into AF care—especially for high-risk patients—and interdisciplinary collaboration are critical.

Additive manufacturing or 3D printing applying polycaprolactone (PCL)-based medical devices represents an important branch of tissue engineering, where the sterilization method is a key process for further safe application in vitro and in vivo. In this study, the authors intend to access the most suitable gamma radiation conditions to sterilize PCL-based scaffolds in a preliminary biocompatibility assessment, envisioning future studies for airway obstruction conditions. Three radiation levels were considered, 25 kGy, 35 kGy and 45 kGy, and evaluated as regards their cyto- and biocompatibility. All three groups presented biocompatible properties, indicating an adequate sterility condition. As for the cytocompatibility analysis, devices sterilized with 35 kGy and 45 kGy showed better results, with the 45 kGy showing overall improved outcomes. This study allowed the selection of the most suitable sterilization condition for PCL-based scaffolds, aiming at immediate future assays, by applying 3D-customized printing techniques to specific airway obstruction lesions of the trachea.

Additive manufacturing or 3D printing applying polycaprolactone-(PCL)-based medical devices represents an important branch of tissue engineering, where the sterilization method is a key process for further safe application in vitro and in vivo. In this study, the authors intend to access the most suitable gamma radiation conditions to sterilize PCL-based scaffolds in a preliminary biocompatibility assessment, envisioning future studies for airway obstruction conditions. Three radiation levels were considered, 25 kGy, 35 kGy and 45 kGy and evaluated as to their cyto- and biocompatibility. All three groups presented biocompatible properties, indicating an adequate sterility condition. As for the cytocompatibility analysis, devices sterilized by 35 kGy and 45 kGy showed better results, with the 45 kGy showing overall improved outcomes. This study allowed to select the most suitable sterilization condition for PCL-based scaffolds, aiming at immediate future assays, by applying 3D-customized printing techniques to specific airway obstruction lesions of the trachea.

Background: Pleural effusion (PE) is common in advanced-stage lung cancer patients and is related to poor prognosis. Identification of cancer cells is the standard method for the diagnosis of a malignant PE (MPE). However, it only has moderate sensitivity. Thus, more sensitive diagnostic tools are urgently needed. Methods: The present study aimed to discover potential protein targets to distinguish malignant pleural effusion (MPE) from other non-malignant pathologies. We have collected PE from 97 patients to explore PE proteomes by applying state-of-the-art liquid chromatography-mass spectrometry (LC-MS) to identify potential biomarkers that correlate with immunohistochemistry assessment of tumor biopsy or with survival data. Functional analyses were performed to elucidate functional differences in PE proteins in malignant and benign samples. Results were integrated into a clinical risk prediction model to identify likely malignant cases. Sensitivity, specificity, and negative predictive value were calculated. Results: In total, 1689 individual proteins were identified by MS-based proteomics analysis of the 97 PE samples, of which 35 were diagnosed as malignant. A comparison between MPE and benign PE (BPE) identified 58 differential regulated proteins after correction of the p-values for multiple testing. Furthermore, functional analysis revealed an up-regulation of matrix intermediate filaments and cellular movement-related proteins. Additionally, gene ontology analysis identified the involvement of metabolic pathways such as glycolysis/gluconeogenesis, pyruvate metabolism and cysteine and methionine metabolism. Conclusion: This study demonstrated a partial least squares regression model with an area under the curve of 98 and an accuracy of 0.92 when evaluated on the holdout test data set. Furthermore, highly significant survival markers were identified (e.g., PSME1 with a log-rank of 1.68 × 10⁻⁶).