How to Sample the Unreachable: Transbronchial Biopsy

Transbronchial biopsy (TBBx) or bronchoscopic lung biopsy (BLBx) should be a diagnosis tool for focal peripheral lesions and for diffuse lung disease in every bronchoscopic suite around the world. The main advantage of this procedure is that it avoids open lung surgery for peripheral lung biopsy. The procedure is usually safe and can be done in an outpatient setting with moderate sedation, but life-threatening complications can occur, so a proper evaluation of the risk benefits ratio should be carefully analyzed before the intervention. There is no need for guidance in diffuse peripheral lesions, but for localized peripheral lesions, the diagnostic yield of TBBx is significantly higher with fluoroscopic guidance. In this chapter, we assess the utility, indications, and contraindication of this technique, as well as its clinical applications and complications

Characterization of sepsis inflammatory endotypes using circulatory proteins in patients with severe infection:a prospective cohort study

Background Sepsis is a heterogeneous syndrome due to a variable range of dysregulated processes in the host immune response. Efforts are made to stratify patients for personalized immune-based treatments and better prognostic prediction. Using gene expression data, different inflammatory profiles have been identified. However, it remains unknown whether these endotypes mirror inflammatory proteome profiling, which would be more feasible to assess in clinical practice. We aim to identify different inflammatory endotypes based on circulating proteins in a cohort of moderately ill patients with severe infection (Sepsis-2 criteria). Methods In this prospective study, 92 inflammatory plasma markers were profiled using a targeted proteome platform and compared between patients with severe infection (Sepsis-2 criteria) and healthy controls. To identify endotypes with different inflammatory profiles, we performed hierarchical clustering of patients based on the differentially expressed proteins, followed by clinical and demographic characterization of the observed endotypes. Results In a cohort of 167 patients with severe infection and 192 healthy individuals, we found 62 differentially expressed proteins. Inflammatory proteins such as TNFSF14, OSM, CCL23, IL-6, and HGF were upregulated, while TRANCE, DNER and SCF were downregulated in patients. Unsupervised clustering identified two different inflammatory profiles. One endotype showed significantly higher inflammatory protein abundance, and patients with this endotype were older and showed lower lymphocyte counts compared to the low inflammatory endotype. Conclusions By identifying endotypes based on inflammatory proteins in moderately ill patients with severe infection, our study suggests that inflammatory proteome profiling can be useful for patient stratification

The Dimension Of The Socio-Cultural Brand Of Coca-Cola

Today, advertising is undoubtedly one of the most fascinating social phenomena, a fundamental factor influencing individuals, attitudes or lifestyles. It is an important element of contemporary culture, deeply anchored in our cultural heritage. In this framework encompasses our article, aiming to demonstrate influential aspects of the Coca-Cola advertising slogan as an instrument of culture and ideology, in a few words, a merciless mirror of our society

Synthesis of Pyrrolo[2,1-a]isoquinolines by Multicomponent 1,3-Dipolar Cycloaddition

Pyrrolo[2,1-a]isoquinoline derivatives were synthesized by one-pot three-component reactions starting from isoquinoline, 2-bromoacetophenones and different non-symmetrical acetylenic dipolarophiles using 1,2-epoxypropane as solvent. The structure of the compounds was assigned by IR and NMR spectroscopy