Hyperinflation and reduced diffusing capacity predict prognosis in SCLC: value of extended pre-therapeutic lung function testing.

BACKGROUND: Small cell lung cancer (SCLC) is characterized by aggressive growth and poor prognosis. Although SCLC affects nearly exclusively heavy smokers and leads to frequent respiratory symptoms, the impact of pre-therapeutic lung function testing in SCLC is sparely investigated until now. Therefore, we sought to examine whether we could find prognostic markers in pre-therapeutic lung function testing of SCLC patients. PATIENTS AND METHODS: We retrospectively analysed a cohort of 205 patients with the diagnosis of SCLC between 2010 and 2018. Pre-therapeutic values of spirometry, body plethysmography and measurement of diffusing capacity was extracted from patients' charts. Comparisons between groups were performed using the Mann-Whitney U-test or by chi-square tests as appropriate. Kaplan-Meier analyses and COX-regression models were performed to correlate lung function parameters with patients' outcome. RESULTS: Airway obstruction itself, or the diagnosis chronic obstructive pulmonary disease (COPD) based on GOLD definitions did not correlate with survival in SCLC patients. Hyperinflation measured by increased residual volume and residual volume to total lung capacity ratio (log-rank p < 0.001) and reduced diffusing capacity (log-rank p = 0.007) were associated with reduced survival. Furthermore, patients with hyperinflation as well as impairments in gas exchange representing an emphysematic phenotype had the worst outcome (log-rank p < 0.001). CONCLUSION: We recommend including body plethysmography and measurement of diffusing capacity in the pre-therapeutic assessment of SCLC patients. Our findings suggest that reduction of hyperinflation may lead to better outcome in SCLC patients. Thus, in addition to effective tumour therapy, adequate therapy of the comorbidity of COPD should also be provided. In particular, measures to reduce hyperinflation by means of dual bronchodilation as well as respiratory physiotherapy should be further assessed in this setting.

[Not a pneumothorax again! Birt-Hogg-Dubé syndrome: a case report]. / "Nicht schon wieder ein Pneumothorax" ­ Fallbericht Birt-Hogg-Dubé-Syndrom.

Case discussion of a 40-year-old male patient with a history of recurrent pneumothoraces due to Birt-Hogg-Dubé syndrome. In addition to conservative treatment of a pneumothorax on the left side, a subtotal parietal pleurectomy on the right side was performed after recurrence of a pneumothorax 6 years later. CT of the thorax showed high-grade structural remodelling of the lung parenchyma with cystic lung lesions on both sides with a diameter of up to 7.5 cm. After exclusion of alpha-1 antitrypsin deficiency, underlying immunological disease, unremarkable family and occupational history, Birt-Hogg-Dubé syndrome was suspected based on the morphological distribution pattern of the cystic lung lesions. Genetic examination helped detect a heterozygous pathogenic variant in the FLCN gene, namely c.1294_1298del;p.(Ser432Argfs*22). Birt-Hogg-Dubé syndrome is a rare genetic disorder clinically characterized by pulmonary cysts, fibrofolliculomas of the skin and occurrence of clustered renal tumors. In particular, the increased risk of renal malignancies and the risk of spontaneous pneumothoraces underlines the importance of early diagnosis and screening of affected patients and their families.

Myeloid-related protein 8/14 and high-sensitivity cardiac troponin I to differentiate type 2 myocardial infarction.

Myocardial infarction (MI) not only defines acute MI with obstructed coronary arteries (T1MI) but also myocardial necrosis caused by myocardial oxygen supply/demand mismatch as type 2 MI (T2MI); only T1MI patients benefit from an early invasive management. Myeloid-related protein(MRP)-8/14 is a biomarker described in various inflammatory diseases and in MI patients. Here we evaluate the potential of MRP-8/14 and high-sensitivity troponin I (hs-cTnI) to differentiate T2MI from T1MI. Patients with final diagnosis NSTEMI (n = 254; 33.1% female) enrolled in a prospective biomarker registry between 08/2011 and 10/2016 were analysed. Median baseline MRP-8/14 levels were higher in T2MI (n = 55; 3.37(1.88-6.48)µg/mL) than in T1MI (n = 199; 2.4 [1.4-3.79]µg/mL) (p = .013) patients, in contrast to hs-cTnI (T2MI:52[11.65-321.4]ng/L vs. T1MI:436.5 [61.25-1973.8]ng/L; p < .001). To detect the strength of this association odds ratios(OR) were calculated with MRP-8/14 yielding 2.13(1.16-3.92; p = .015) to predict T2MI and 0.47(0.26-0.87; p = .015) for T1MI. As expected, hs-cTnI yielded an OR of to predict T2MI 0.34(0.17-0.65; p = .001) and 2.98(1.53-5.81; p = .001) for T1MI. Both markers show comparable and independent results if adjust to hs-cTnI/MRP-8/14, TIMI risk score and CRP. T2MI is associated with higher MRP-8/14 and lower hs-cTnI concentrations than T1MI. Our data suggest that MRP-8/14 as a marker of inflammation might provide usable discriminatory information complementing hs-cTnI in a diagnostic procedure evaluating the type of MI directly upon hospital admission.

Identifying Heart Failure in ECG Data With Artificial Intelligence-A Meta-Analysis.

Introduction: Electrocardiography (ECG) is a quick and easily accessible method for diagnosis and screening of cardiovascular diseases including heart failure (HF). Artificial intelligence (AI) can be used for semi-automated ECG analysis. The aim of this evaluation was to provide an overview of AI use in HF detection from ECG signals and to perform a meta-analysis of available studies. Methods and Results: An independent comprehensive search of the PubMed and Google Scholar database was conducted for articles dealing with the ability of AI to predict HF based on ECG signals. Only original articles published in peer-reviewed journals were considered. A total of five reports including 57,027 patients and 579,134 ECG datasets were identified including two sets of patient-level data and three with ECG-based datasets. The AI-processed ECG data yielded areas under the receiver operator characteristics curves between 0.92 and 0.99 to identify HF with higher values in ECG-based datasets. Applying a random-effects model, an sROC of 0.987 was calculated. Using the contingency tables led to diagnostic odds ratios ranging from 3.44 [95% confidence interval (CI) = 3.12-3.76] to 13.61 (95% CI = 13.14-14.08) also with lower values in patient-level datasets. The meta-analysis diagnostic odds ratio was 7.59 (95% CI = 5.85-9.34). Conclusions: The present meta-analysis confirms the ability of AI to predict HF from standard 12-lead ECG signals underlining the potential of such an approach. The observed overestimation of the diagnostic ability in artificial ECG databases compared to patient-level data stipulate the need for robust prospective studies.

Effects of enamel sealing on shear bond strength and the adhesive remnant index : Study of three fluoride-releasing adhesives in combination with metal and ceramic brackets.

OBJECTIVES: Selected combinations of materials were used to create tooth-adhesive-bracket complexes to evaluate shear bond strength (SBS) and the adhesive remnant index (ARI) with regard to enamel sealing. METHODS: Four adhesive systems also appropriate for use as enamel sealants were combined with four bracket types, resulting in 16 adhesive-bracket combinations, each of which was tested on 15 permanent bovine incisors. Sealant-adhesives included two recently introduced fluoride-releasing systems (Riva bond LC® and go!®), one established primer (Opal® Seal™), and one commonly used adhesive as control (Transbond™ XT). Brackets included two metal (discovery® by Dentaurum and Sprint®) and two ceramic (discovery® pearl and GLAM®) systems. After embedding the bovine teeth, bonding the brackets to their surface, and storing the resultant samples as per DIN 13990-2 with modifications, an SBS test was performed by applying the shear force directly at the bracket base in an incisocervical direction. Then the ARI scores were determined. RESULTS: Discovery® + Transbond™ XT yielded the highest (47.2 MPa) and GLAM® + go!® the lowest (17.0 MPa) mean SBS values. Significant differences (p < 0.0001) were found between metal and ceramic brackets of the same manufacturers (Dentaurum and Forestadent). Our ratings of the failure modes upon debonding predominantly yielded ARI 0 or 1. The high SBS values and low ARI scores observed with discovery® + Transbond XT™ were reflected in a high rate of enamel fracture, which occurred on 11 of the 15 tooth specimens in this group. CONCLUSIONS: All sealant-bracket combinations were found to yield levels of SBS adequate for clinical application. SBS values and ARI scores varied significantly depending on which sealant-brackets were used.

Shear bond strength of brackets on restorative materials: Comparison on various dental restorative materials using the universal primer Monobond® Plus.

OBJECTIVE: The purpose of this work was to analyze surfaces consisting of different restorative materials for shear bond strength (SBS) and failure patterns of metal and ceramic brackets. Bonding involved the use of a universal primer (Monobond® Plus, Ivoclar Vivadent). MATERIALS AND METHODS: Six restorative materials were tested, including one composite resin (Clearfil Majesty™ Posterior, Kuraray Noritake Dental), one glass-ceramic material (IPS Empress® Esthetic, Ivoclar Vivadent), one oxide-ceramic material (CORiTEC Zr transpa Disc, imes-icore), two base-metal alloys (remanium® star, Dentaurum; Colado® CC, Ivoclar Vivadent), and one palladium-based alloy (Callisto® 75 Pd, Ivoclar Vivadent). Bovine incisors served as controls. Both metal and ceramic brackets (discovery®/discovery® pearl; Dentaurum) were bonded to the restorative surfaces after sandblasting and pretreatment with Monobond® Plus. A setup modified from DIN 13990-2 was used for SBS testing and adhesive remnant index (ARI)-based analysis of failure patterns. RESULTS: The metal brackets showed the highest mean SBS values on the glass-ceramic material (68.61 N/mm(2)) and the composite resin (67.58 N/mm(2)) and the lowest mean SBS on one of the base-metal alloys (Colado® CC; 14.01 N/mm(2)). The ceramic brackets showed the highest mean SBS on the glass-ceramic material (63.36 N/mm(2)) and the lowest mean SBS on the palladium-based alloy (38.48 N/mm(2)). Significant differences between the metal and ceramic brackets were observed in terms of both SBS values and ARI scores (p < 0.05). Under both bracket types, fractures of the composite-resin and the glass-ceramic samples were observed upon debonding. Opaque restorative materials under metal brackets were found to involve undercuring of the adhesive. CONCLUSIONS: Monobond® Plus succeeded in generating high bond strengths of both bracket types on all restorative surfaces. Given our observations of cohesive fracture (including cases of surface avulsion) of the composite-resin and the glass-ceramic samples, we recommend against using these material combinations in clinical practice.