The use of bronchoscopy with endobronchial ultrasound (EBUS) to aid in lymph node and lung biopsy is relatively new. This review will summarize the literature surrounding the efficacy of bronchoscopy with EBUS. Safety of bronchoscopy with EBUS is not markedly different that procedure with EBUS and is impacted by patient features including co-morbidities as well as different sedation modalities. This paper reviews the impact on both safety and diagnostic yield. The yield from using EBUS guided biopsy varies with the diagnosis but is high with linear EBUS. Recent data incorporating other technologies (electromagnetic navigation, robotic assistance) with bronchoscopy has potential to increase diagnostic yields, appears to be equivalent to transthoracic needle biopsies performed by radiology. Different sedation modalities are utilized, including the use of dedicated anesthesia providers, for bronchoscopy with EBUS but do not appear to significantly affect the diagnostic yield. Bronchoscopy with EBUS (both linear and radial) is a safe procedure with acceptable yields. The type of sedation does not appear to affect the diagnostic yield or the safety of the procedure. Further research into incorporation of other technologies may provide for higher diagnostic yields.
Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD) and has been implicated in adverse cardiovascular outcomes through multiple pathophysiological pathways. The Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Sleep Apnea (RICCADSA) project was initiated to investigate the prevalence, clinical significance, and treatment implications of OSA in patients with revascularized CAD. This review summarizes the major scientific contributions of the RICCADSA project over the past two decades and discusses their impact on contemporary cardiovascular sleep medicine. RICCADSA demonstrated that OSA is highly prevalent among participants with CAD and provided important mechanistic insights linking OSA to systemic inflammation, myocardial dysfunction, autonomic dysregulation, endothelial and vascular biology, and adverse cardiovascular outcomes. Although the primary randomized trial did not demonstrate a significant reduction in cardiovascular events with routine continuous positive airway pressure (CPAP) treatment in nonsleepy participants, subsequent analyses identified treatment-responsive subgroups based on adherence, excessive daytime sleepiness, physiological traits, autonomic responses, hypoxic burden, and endothelial phenotypes. More recent investigations have highlighted the limitations of conventional severity metrics such as the apnea–hypopnea index and supported the emerging role of biological and physiological phenotyping in cardiovascular risk stratification. Over the past twenty years, the RICCADSA project has evolved from a randomized clinical trial into a comprehensive research platform that has helped shape current understanding of OSA and cardiovascular disease. Its findings have contributed to a transition from an AHI-centered approach toward precision sleep cardiology, emphasizing the biological heterogeneity of OSA and the need for individualized treatment strategies to optimize cardiovascular outcomes.
Bedside evaluation of shock often relies on isolated hemodynamic variables such as arterial pressure or cardiac output, which provide incomplete insight into circulatory function. We review a physiology-based framework that conceptualizes shock as failure of energy transfer across key circulatory interfaces, guided by echocardiographic assessment. Recent work highlights the increasing recognition of mixed shock phenotypes and the limitations of traditional classification based on single parameters. Point-of-care ultrasound has emerged as a central bedside tool, enabling noninvasive evaluation of ventricular–arterial and right ventricular–pulmonary arterial coupling. Integration of echocardiographic metrics with perfusion markers such as capillary refill time allows dynamic reassessment of circulatory constraints. The four-interface model provides a structured framework to interpret shock as a system-level disturbance of circulatory coupling. Echocardiographic assessment of the ventricular interfaces supports a mechanistic bedside approach to identifying dominant hemodynamic bottlenecks and guiding individualized resuscitation.
Workplace respiratory hazards are changing as new materials, intensified cleaning practices, deployment-related exposures, and expanding cannabis and vaping industries alter the clinical spectrum of occupational lung disease. This review provides a case-based, clinician-facing approach to four emerging or re-emerging hazards: engineered stone silicosis, cleaning/disinfectant-related airway disease, deployment-related respiratory disease, and cannabis and vaping industry exposures. Recent reports describe accelerated silicosis and progressive massive fibrosis in young engineered-stone workers; deployment-related respiratory disease with small-airways phenotypes despite normal or near-normal spirometry; cannabis-associated rhinitis and work-related asthma, including sentinel fatal cases; and cleaning/disinfectant exposures associated with irritant- and sensitizer-induced asthma. Direct occupational evidence for vaping-industry respiratory disease remains more limited, but worker exposure to flavorings, solvents, nicotine, tetrahydrocannabinol products, and aerosols warrants targeted history-taking. Clinicians should ask about tasks, materials, controls, respiratory protection, coworker symptoms, and temporal symptom patterns. Early physiologic testing, high-resolution computed tomography when indicated, objective work-related asthma assessment, exposure reduction, and occupational medicine referral are central to diagnosis and prevention.
We summarized current evidence on occupational lung diseases (OLDs) in low- and middle-income countries (LMICs). Research on OLDs in LMICs remains limited and unevenly distributed. Of the 29 included studies (≈ 47,000 workers), most were from Africa and South Asia. Majority were cross-sectional (n = 25) and only two each of cohort and interventional studies; and were categorized into: manufacturing and industrial processing (n = 17), mining and extraction (n = 4), agriculture and farming (n = 5), and services and waste management (n = 4) sectors. We found a high prevalence of respiratory conditions across different settings. Important gaps include the scarcity of interventional research, lack of data from several LMIC regions, limited exposure assessment, and limited inclusion of women and informal-sector workers. Our review reveals a substantial gap in high-quality evidence on OLDs in LMICs. There is a need to strengthen surveillance, monitor exposure, and conduct interventional studies in LMICs.
