Predicción en tiempo real de la malignidad de ganglios linfáticos mediastínicos mediante ecografía endobronquial / Real-Time Prediction of Mediastinal Lymph Node Malignancy by Endobronchial Ultrasound

Objetivo: Evaluar la utilidad de diferentes características ecográficas para diferenciar los ganglios linfáticos (GL) benignos y malignos mediante ecografía endobronquial (EBUS) y validar una puntuación para una aplicación clínica en tiempo real. Métodos: Se analizaron 208 GL mediastínicos procedentes de 141 pacientes. Dos observadores evaluaron de manera independiente 6 criterios ecográficos diferentes (eje menor ≥ 10 mm, forma, margen, ecogenicidad y estructura hiliar central [EHC] y presencia de densidad hiperecogénica). Se generó una puntuación simplificada en la que a la presencia de márgenes bien definidos, la forma redondeada y el eje menor ≥ 10 mm se les asignaba una puntuación de 1 y a la ecogenicidad heterogénea y la ausencia de EHC se les asignaba una puntuación de 1,5. La puntuación se evaluó prospectivamente para la aplicación clínica en tiempo real en 65 GL durante la EBUS llevada a cabo por 2 operadores experimentados en 39 pacientes. Estos criterios se correlacionaron con los resultados histopatológicos, y se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN). Resultados: La heterogeneidad y la ausencia de EHC fueron los parámetros que mostraron la máxima sensibilidad y VPN (≥ 90%) en la predicción de la malignidad de los GL, con una coincidencia interobservadores aceptable (92 y 87%, respectivamente). En la aplicación en tiempo real, la sensibilidad y la especificidad de la puntuación > 5 fueron del 78 y del 86%, respectivamente; tan solo la ausencia de EHC, la forma redondeada y el tamaño de los GL mostraron una asociación significativa con la malignidad de estos. Conclusiones: La combinación de diferentes criterios ecográficos puede ser útil en la predicción de la malignidad de los GL mediastínicos y válida para una aplicación clínica en tiempo real

Objective: To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. Methods: A total of 208 mediastinal LNs acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥ 10 mm, shape, margin, echogenicity, central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥ 10 mm were scored as 1, and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LNs during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results: Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥ 90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score > 5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. Conclusions: A combination of different US criteria can be useful for the prediction of mediastinal LN malignancy and valid for real-time clinical application

Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound.

OBJECTIVE: To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. METHODS: 208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS: Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. CONCLUSIONS: Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.

Molecular mechanisms of inflammation during exacerbations of chronic obstructive pulmonary disease.

INTRODUCTION: Exacerbations of chronic obstructive pulmonary disease (COPD) are characterised by an inflammatory and systemic response that persists for some time after their clinical resolution. The mechanisms of this inflammatory process are not well known. OBJECTIVES: To explore the inflammatory changes and possible mechanisms during COPD exacerbation. METHODS: We determined the inflammatory cell concentrations in blood and sputum, nitric oxide in exhaled air (FeNO), C-reactive protein (CRP) in plasma, cytokines (IL-6, 8, 1ß, 10, 12, TNF-α) and SLPI (leukocyte protease inhibitor) and total antioxidant status (TAS) in blood and sputum, the activity of nuclear kappa B factor (NF-κ B) and of the histone deacetylase enzyme (HDAC) in 17 patients during COPD exacerbation and in stable phase, as well as in 17 smoker and 11 non-smoker controls. RESULTS: COPD exacerbations are characterised by high levels of FeNO (p<0.05), plasma CRP (p<0.001) and IL-8, IL-1B, IL-10 in sputum (p<0.05) greater activation of NF-κ appaB in sputum macrophages compared with stable COPD and controls. During the stable phase, there continue to be high levels of oxidative stress, SLPI, IL-8, IL-6 and TNF-alfa, with no observed changes in either HDAC activity or in the amount of neutrophils in sputum, despite presenting a significant improvement (p<0.05) in lung function. CONCLUSIONS: Changes were observed in different pulmonary and systemic inflammatory markers during COPD exacerbation, which did not completely resolve during stable phase. However, current treatment does not allow for HDAC activity to be modified, which limits its anti-inflammatory effects.

Mecanismos moleculares de inflamación durante las agudizaciones de la enfermedad pulmonar obstructiva crónica / Molecular Mechanisms of Inflammation During Exacerbations of Chronic Obstructive Pulmonary Disease

Introducción: Las agudizaciones de la enfermedad pulmonar obstructiva crónica (AEPOC) se caracterizanpor una respuesta inflamatoria pulmonar y sistémica, que persiste tiempo después de la resolución clínica.Los mecanismos de este proceso inflamatorio no son bien conocidos.Objetivos: Investigar los cambios inflamatorios y sus mecanismos durante las agudizaciones de la EPOC.Métodos: Se determinaron las concentraciones de células inflamatorias en sangre y esputo, óxido nítricoen aire exhalado (FeNO), proteína C reactiva (PCR) en plasma, citocinas (interleucinas [IL] 6, 8, 1 , 10,12, TNF- ) y SLPI (inhibidor de la leucoproteasa), marcadores de estrés oxidativo, la actividad del factornuclear kappa B (NF- B) y de la enzima histona deacetilasa (HDAC) a 17 pacientes durante una AEPOC,en fase estable y a 17 controles fumadores y 11 no fumadores.Resultados: Las AEPOC se caracterizaron por presentar niveles elevados de FeNO (p < 0,05), PCR en plasma(p < 0,001) e IL-8, IL-1 , IL-10 en esputo (p < 0,05) y mayor activación de NF- B en macrófagos de esputoen comparación con EPOC estable y controles. Durante la fase estable persisten niveles elevados de estrésoxidativo, SLPI, IL-8, IL-6 y TNF-alfa, sin objetivarse cambios en la actividad HDAC ni en la cantidad deneutrófilos en esputo a pesar de presentar una mejoría significativa (p < 0,05) de la función pulmonar.Conclusiones: Durante las AEPOC se observan cambios en marcadores inflamatorios pulmonares y sistémicosque no se resuelven por completo en fase estable. El tratamiento actual no permite modificar laactividad HDAC lo que limita sus efectos antiinflamatorios(AU)

Introduction: Chronic obstructive pulmonary disease (COPD) is characterised by an inflammatory andsystemic response that increases during exacerbations of the disease (ECOPD), although the mechanismsof this inflammatory process are not well known.Objectives: To explore the inflammatory changes and possible mechanisms during ECOPD.Methods: We determined the inflammatory cell concentrations in blood and sputum, nitric oxide inexhaled air (FeNO), reactive C-reactive protein (CRP) in plasma, cytokines (IL-6, 8, 1 , 10, 12, TNF- )and SLPI and total antioxidant activity (TAS) in blood and sputum, the activity of nuclear kappa B factor(NF-kB) and of the histone deacetylase enzymes (HDAC) in 17 patients during ECOPD, in stable phase andin 17 smoking controls and 11 non- smoking.Results: ECOPD is characterised by higher levels of FeNO (P<.05), plasma CRP (P<.001) and IL-8, IL-1B,IL-10 in sputum (P<.05) compared with stable COPD and controls. The TAS levels in sputum were lowerin the exacerbated than in stable phase (P<.05) although significantly higher than the controls (P<.05). These findings were accompanied by a greater activation of NF-kB in sputum macrophages during theECOPD with no changes in the HDAC activity or in the number of neutrophils in sputum, and a statisticallysignificant deterioration (P<.05) of lung function.Conclusions: Changes were observed in different pulmonary and systemic inflammatory markers duringECOPD, that were not completely resolved during stability. However, current treatment does not allowthe modification of HDAC activity, which limits its anti-inflammatory effects(AU)

Tactical skills and ball speed during a field simulation of penalty kick strategies in soccer.

This study investigates the efficacy of intermediate penalty kickers by comparing the effect of applying an automated WiFi system on the field of play to simulate a strategy that takes account of goalkeeper action (dependent) with another for which goalkeeper strategy is irrelevant (independent). Intermediate penalty kickers (n=12) took a pretreatment test of 32 kicks in a "real-play" situation with intermediate goalkeepers (n=3). Two groups of kickers underwent 11 treatment sessions using different strategies and then were administered a posttreatment test. The variables measured were the number of goals scored, whether the direction of the shot was the same or different from the direction of the goalkeeper's move (DDG), ball speed, and the duration of the kicking movement. Data suggested the goalkeepers had a greater capacity to identify advance cues when faced with independent strategy kickers and that dependent strategy kickers achieved lower ball speeds.