Tezepelumab in a case of severe asthma exacerbation and influenza-pneumonia on VV-ECMO.

We present a case of 43-year-old male patient with broadly by Omalizumab, Mepolizumab and Benralizumab pretreated allergic asthma, who suffered a near fatal exacerbation, triggered by an influenza A infection. Due to massive bronchoconstriction with consecutive hypercapnic ventilatory failure veno-venous ECMO therapy had to be implemented. Hence, guideline directed asthma therapy a substantial bronchodilatation could not be achieved. After administration of a single dose Tezepelumab, a novel TLSP-inhibitor, and otherwise unchanged therapy we documented a significant reduction in intrinsic PEEP measured via a naso-gastric balloon catheter and a narrowing in the expiratory flow curve of the ventilator within 24 hours. The consecutive ventilatory improvement allowed the successful weaning from veno-venous ECMO therapy and invasive ventilation.

¿Es necesaria la realización de ecocardiograma en la valoración de hipertensión pulmonar previa a una criobiopsia transbronquial? / Transbronchial cryobiopsy, is essential to rule out pulmonary hypertension?

INTRODUCCIÓN: El objetivo de nuestro estudio fue valorar la posibilidad de diagnosticar la Hipertensión Pulmonar (HP) mediante signos en la tomografía computarizada (TC), en pacientes con EPID que van a ser sometidos a criobiopsia transbronquial (CBxTb) sin necesidad de realizar ecocardiograma transtoracico (EcoC) sistemático y si la existencia de HP en TC influye de manera relevante en el riesgo de complicaciones de sangrado y en las demoras de realización de la técnica. MATERIAL Y MÉTODOS: Estudio prospectivo de casos controles de todos los pacientes en los que se realizó CBxTb en un período de 20 meses. Los controles fueron los pacientes en los que se realizó CBxTb con EcoC previa protocolizada y los casos los pacientes en los que se realizó EcoC pre CBxTb sólo sin había signos de HP en la TC. Analizamos la correlación entre los datos de HP de la TC y EcoC, las complicaciones por sangrado y la demora al procedimiento entre los grupos. RESULTADOS: Se han realizado 40 CBxTb. Se incluyeron 16 controles; 12 (75%) sin signos de HP en la TC con una especificidad de ésta en relación al EcoC del 85%, sensibilidad 71% y VPN 82%. Se incluyeron 24 casos y, tras los hallazgos de la TC, sólo se solicitó EcoC preCBxTb a 4 pacientes, de los que 3 resultaron falsos positivos. No hubo diferencias entre grupo de controles y casos en cuanto al sangrado (18,7% vs. 16,7%; p= 0,54) pero si en la demora diagnóstica (62 vs. 37; p= 0,03). CONCLUSIÓN: En nuestra serie de pacientes con EPID y CBxTb consideramos indicada la realización de EcoC sólo en casos con signos de HP en la TC, permitiendo acortar la demora diagnóstica sin aumento de sangrados

INTRODUCTION: Our objective was to assess whether the performance of EcoC only in those patients in which the caliper measurement of the PA on CT suggested the existence ofPAH, relevant influence on the risk of bleeding complications and delays CbxTb conducting. MATERIAL AND METHODS: It has been conducted prospective, case-control, of all patients who underwent CbxTb in our unit over a period of 20 months. Defining control group those patients who EcoC was done protocolised, before CbxTb, and cases all patients who EcoC was made only in cases where there were signs of PAH in CT. We analized the correlation in HP diagnosis signs between CT and EcoC data, risk of bleeding and delays in the procedure. RESULTS: We were performed 40 patients. In the control group include 16 patients, CTdetected no signs of HP in 12 (75%) cases, with a specificity of 85%, sensitivity of 71% and negative predictive value of 82%. In our cases group, we include 24 patients, and EcoC was only made before the procedure in 4 cases, 3 of them false positives. No differences in bleeding was found between control and cases groups (18.7% vs. 16.7%; p= 0.54) but for the delays in the procedure was lower in the cases group (62 days vs. 37; p= 0.03) .Conclusion. In our study with interstitial lung disease and CbxTb we conclude that EcoC was indicated only in the cases with PH findings on CT reducing the delays in the procedure without bleeding rate increase

[Semen analysis in involuntary childlessness. What information does it provide?]. / Spermiogramm bei unerfülltem Kinderwunsch. Was sagt es aus?

Involuntary childlessness is a common problem. In about 50% of cases, inadequate semen quality plays a relevant role. A semen analysis provides information regarding exocrine function of the male reproductive organs of the testes, epidydimis, seminal vesicles, prostate gland, and vas deferens. These parameters can only be interpreted in conjunction with medical history and physical examination. Then they can be useful to identify relevant disorders or the causes of these disturbances. The fundamental principles for the interpretation of a semen analysis are easily learned and traditionally belong to the field of dermatology. This article explains the variables which are examined in a routine semen analysis as well as the reference values. Furthermore, common causes for deviations from the normal values are discussed to allow decision-making for further diagnostic workup. The interpretation of these values must always take into account the situation of the couple.

Effectiveness and efficacy of minimally invasive lung volume reduction surgery for emphysema.

Lung emphysema is a chronic, progressive and irreversible destruction of the lung tissue. Besides non-medical therapies and the well established medical treatment there are surgical and minimally invasive methods for lung volume reduction (LVR) to treat severe emphysema. This report deals with the effectiveness and cost-effectiveness of minimally invasive methods compared to other treatments for LVR in patients with lung emphysema. Furthermore, legal and ethical aspects are discussed. No clear benefit of minimally invasive methods compared to surgical methods can be demonstrated based on the identified and included evidence. In order to assess the different methods for LVR regarding their relative effectiveness and safety in patients with lung emphysema direct comparative studies are necessary.

The role of the nose in obstructive sleep apnea: a short review.

A variety of causes may result in nasal obstruction including allergic and non-allergic rhinitis, anatomic abnormalities, and postoperative nasal packing. There is both an epidemiological and clinical relationship between nasal obstruction and sleep disordered breathing. Subsequently, improving nasal patency via surgical or non-surgical means is expected to relieve sleep disordered breathing. The present review will discuss and review some of the literature related to the pathophysiological interaction of the human nose and sleep disordered breathing and provide a summary of the effects of related intervention trials.

The Comparative Evaluation of the Performance of Two Phytoremediation Systems for Domestic Wastewater Treatment.

The constructed wetlands as well engineered techniques have been used effectively for phytoremediation of wastewater and pollution control during the last decades. In these technologies, the naturally occurring processes of plants alongside micro-organisms present in the bio-film attached to the roots, soil substrate and water column degrade the organic pollutants. The study seeks to compare the potential use of Phragmites sp. reed bed and floating macrophyte water hyacinth (Eichhornia crassipes) system for domestic wastewater treatment. The sewage treatment performance is evaluated as 80% & 76% chemical oxygen demand (COD), 90% & 87% biological oxygen demand (BOD5), 24% & 18% total dissolved solids (TDS), 69% & 67% total suspended solids (TSS), 12% & 5% Chlorides, 73% & 69% ammonia nitrogen (NH3-N), 42% & 31% phosphate (PO4-P), 93% & 91% most probable number (MPN) and 95% & 92% total viable count (TVC) reduction at optimum hydraulic retention time (HRT) of 24 & 43 h in Phragmites sp. and water hyacinth systems, respectively. Likewise, the floating macrophyte pond contrary to reed bed process shows insignificant pollutant diminution at 24 h HRT. This paper also highlights the microbial population present through the wetland systems by estimation of total viable count (TVC). The botanical aspect with reference to the plant growth is shown a significant increase in vegetation yield. The overall studies indicate the better treatment efficiency by preferred Phragmites sp. root zone system at low foot print area for domestic wastewater.

Endobronchial valve-induced pneumatocele: a case report.

We report a 75-year old female patient with advanced emphysema. After endoscopic lung volume reduction with endobronchial valves (EBV), a huge pneumatocele has occured and resolved spontaneously within a few weeks. Albeit rare, pneumatoceles should be considered in patients with relapsing dyspnoe after EBV treatment.

A case of tracheobronchial amyloidosis treated with endoscopic debulking and external beam radiation therapy.

We report on a 55-year-old patient who was admitted to hospital because of recurrent pneumonia. CT imaging provided airway narrowing and mural thickening of the distal trachea and mainstem bronchi, compatible with endobronchial polypoid, toric-shaped changes of the distal tracheal wall spreading into both the left and right bronchial system. Bronchoscopy was performed and biopsies revealed the diagnosis of tracheobronchial amyloidosis. We performed a combination of bronchoscopic debulking and consecutive external beam radiation therapy with the result of no further progression of the disease, stable endobronchial situation, and functional improvements at a follow up at 6 months.

Synthesis of Cu/CuO nanoparticles in mesoporous material by solid state reaction.

The Mobil Composition of Matter No. 41 (MCM-41) containing 1.0 and 5.0 wt.% of Cu was synthesized under solid state reaction. The calcinations of samples were done at two different temperatures, 500 and 300°C. X-ray diffraction (XRD), UV-Vis diffuse reflectance spectroscopy (UV-Vis DRS), Fourier transform infrared spectroscopy (FTIR) and transmission electron microscopy (TEM) were used for samples characterization. Powder X-ray diffraction showed that when Cu(CH3COO)2 content is about 1.0 wt.% in Cu/MCM-41, the guest CuO-NPs and copper ions is formed on the silica channel wall, and more exists in the crystalline state. When Cu(CH3COO)2 content exceeds this value (5.0 wt.%), CuO nanoparticles and Cu(2+) ions can be observed in low crystalline state. From the diffuse reflectance spectra it was confirmed that 5 wt.% Cu/MCM-41 sample calcined at 500°C show plasmon resonance band due to Cu nanoparticles in the range between 500 and 600 nm and small copper clusters Cun in 450 nm. It also shows that some of the Cu(2+) ions are present octahedrally in extraframework position in all samples. Both fourier transform infrared and diffuse reflectance spectra indicate that some of Cu(2+) ions are tetrahedrally within the framework position in 1 wt.% Cu/MCM-41 samples. TEM images indicated that nanoparticles size of CuO is in range of 30-40 nm.

Gender-related differences in the obstructive sleep apnea syndrome.

The obstructive sleep apnea syndrome (OSAS) is associated with increased morbidity and mortality. Epidemiological studies suggest a two-fold higher prevalence of OSAS in men than in women. Differences in pharyngeal collapsibility and central respiratory drive may play a significant role in the gender-specific pathogenesis. Compared with their male counterparts, female patients experience OSAS at an older age (postmenopausal) and with higher body-mass-index. Female OSAS patients furthermore more frequently report atypical symptoms, such as insomnia, depression, and/or restless legs, and thus are less likely to be referred for the evaluation of sleep disordered breathing. Knowledge about these distinct gender-related differences in clinical features of OSAS may contribute to an increased awareness, improved diagnosis and its therapeutic consequences.

[A leak in the lung: endobronchial one-way valve placement as treatment for a persistent bronchopleural fistula]. / Das Leck in der Lunge: Bronchoskopische Ventilimplantation zur Behandlung einer persistierenden bronchopleuralen Fistel.

Patients with bronchopleural fistula are at an increased risk of morbidity and mortality. Treatment of the air leak includes intrathoracic drainage, antibiotic therapy and closure of the fistula, which conventionally has been performed via surgical means. In patients with limited respiratory capacity, less-invasive alternatives are required. Here we report on a 62-year-old patient with underlying severe COPD, who was admitted with a lung abscess and consecutively developed a persistent bronchopleural fistula. Treatment involved antibiotic therapy and endobronchial one-way valve placement, which resulted in termination of the air leak and full recovery.

Comparative evaluation on the performance of bio-rack and shallow pond systems for domestic wastewater treatment.

Constructed wetlands have been used successfully for treatment of wastewater during the last decades. The bio-rack and shallow pond systems are well engineered wetland process in wastewater treatment. The aim of this study is to compare the potential use of bio-rack and shallow pond systems for domestic wastewater treatment either in presence of high total dissolved solids (TDS) or heavy metal salts. The sewage treatment performance indicates 75.15% & 80.93% chemical oxygen demand (COD), 86.59% & 90.90% biological oxygen demand (BOD5), 27.54% & 15.98% total dissolved solids (TDS), 73.13% & 70.31% total suspended solids (TSS), 8.86% & 3.61% Chlorides, 70.22% & 74.18% ammonia nitrogen (NH3-N), 31.71% & 41.24% phosphate (PO4-P), 92.11% & 96.45% most probable number (MPN) and 93.05% & 98.24% total viable count (TVC) reduction at 10 & 21 h hydraulic retention time (HRT) in bio-rack and shallow pond system respectively. Likewise, the Phragmites sp. and water hyacinth can tolerate TDS up to 9000 and 2000 mg/L. The reduction in TDS is minor (14 & 19%) at the highest tolerable limit whereas the heavy metal reduction is 68 & 65%, 69 & 67%, 67 & 63%, 71 & 69% for Cd, Cu, Ni and Zn in bio-rack and shallow pond system respectively. The overall studies indicate the better treatment efficiency in bio-rack system at low foot print area (91 m2) compared to shallow pond system.

Non-CPAP therapies in obstructive sleep apnoea.

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

Some factors affecting cerebral tissue saturation during obstructive sleep apnoea.

Measurement of cerebral tissue saturation during obstructive sleep apnoea (OSA) may provide additional information to conventional peripheral oxygen saturation. Thirteen subjects with OSA (mean apnoea/hypopnoea index 65.7+/-27.9) were monitored using full polysomnography and monitoring of near-infrared cerebral tissue oxygenation index (TOI). One-thousand and thirty-six apnoeas and hypopnoeas were analysed, in terms of duration, sleep stage, arterial oxygen saturation (Sa,O2) dip, minimum Sa,O2, TOI dip and minimum TOI. Cerebral TOI is a measure of cerebral tissue saturation of haemoglobin with oxygen, calculated using near-infrared spatially resolved spectroscopy, which has been shown to have a high specificity for intracranial changes. Decreases in cerebral oxygenation were observed during apnoeas and hypopnoeas. Baseline TOI ranged from 50.1-73.0% and mean apnoea/hypopnoea related TOI dips ranged from 1.43-6.85%. Mean Sa,O2 dips varied from 3.8-21.7%. In regression analysis, factors significantly predicting the magnitude of the TOI dip were Sa,O2 dip, minimum Sa,O2, apnoea duration and rapid eye movement sleep stage. The effect of apnoea duration and sleep stage remained significant after Sa,O2 was included in the regression equation. Near-infrared spectroscopy provides a noninvasive technique for monitoring cerebral tissue saturation during obstructive sleep apnoea.