There is increasing evidence that inflammation plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnoea (OSA).No previous works have studied levels of soluble tumour necrosis factor-a receptor (sTNFR)-1 in patients with OSA. The aims of the present study were to examine serum levels of sTNFR-1 and the effect of nasal continuous positive airway pressure (CPAP) in patients with OSA.A prospective, randomised, placebo-controlled crossover study was performed. In total, 30 consecutive newly diagnosed OSA patients (apnoea/hypopnoea index 43.8¡27.0 events?h -1 ) and 15 healthy obese patients were selected. Urinary levels of norepinephrine and epinephrine, as well as plasma sTNFR-1, tumour necrosis factor (TNF)-a, interleukin (IL)-6 and leukotriene (LT)B 4 levels were obtained at baseline and after 3 months of CPAP or sham CPAP.Nocturnal urinary levels of norepinephrine, epinephrine and sTNFR-1 (1,053¡269 versus 820¡166 pg?mL -1 ) were significantly higher in OSA patients. There were no significant differences in plasma levels of IL-6, LTB 4 , or TNF-a between the two study groups. There were no significant differences in blood pressure, urinary catecholamine levels, or plasma IL-6, LTB 4 and TNF-a levels after both treatment modalities. However, after 3 months of effective CPAP usage, sTNFR-1 levels were significantly reduced (1,053¡269 versus 899¡254 pg?mL -1 ). Obstructive sleep apnoea patients have higher levels of soluble tumour necrosis factor-a receptor 1 than individuals without OSA; soluble tumour necrosis factor-a receptor 1 levels are lowered by continuous positive airway pressure therapy. These findings further corroborate a potential role of inflammation in the natural history of obstructive sleep apnoea.

Bronchogenic cysts are the most common primary cysts in the mediastinum. However, intracardiac bronchogenic cysts are uncommon. The present case represents a unique situation, in which an intracardiac bronchogenic cyst at the region of the atrioventricular node presented as permanent complete atrioventricular block (AVB) and was associated with the presence of an ostium secundum atrial septal defect.

This paper reports 6 cases of patients affected by coronavirus disease 2019 bilateral pneumonia with associated acute respiratory distress associated and signs of acute right ventricular hypertrophy on electrocardiography despite the absence of acute pulmonary embolism or signs of severe pulmonary hypertension on transthoracic echocardiography. These cases suggest a possible connection between acute elevated right ventricular afterload and acute respiratory distress in patients affected by SARS-CoV-2.

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