Cryotherapy in the paediatric airway: Indications, success and safety

Airway obstruction; Cryobiopsy; Paediatric bronchoscopyObstrucción de las vías respiratorias; Criobiopsia; Broncoscopia pediátricaObstrucció de les vies respiratòries; Criobiòpsia; Broncoscòpia pediàtricaBackground and objective Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. Methods Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. Results A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. Conclusion In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.Open Access funding enabled and organized by Projekt DEAL

Die neogene Entwicklung des zentralen Tien Schan, Kasachstan. Erste Ergebnisse von Apatit-Spaltspurdatierungen und morphotektonischer Analyse von Satellitendaten

Der Tien Schan ist ein etwa E–W erstrecktes, rund 2500km langes und bis 250km breites Gebirge in Zentralasien. Einzelne Gipfel sind über 7000m hoch. Obwohl durch die Kollision Indiens mit Asien entstanden, ist der Tien Schan ein Intraplatten-Orogen, dessen Hebung lange nach dem Beginn der Kollision vor 50Ma und weit nördlich der Sutur einsetzte (Sobel & Dumitru 1997). Von Tibet ist der Tien Schan durch das kaum deformierte Tarim-Becken getrennt. Hohe und schroffe Topographie, starke Seismizität (Molnar & Ghose 2000) und GPS-Daten zeigen, dass das Orogen auch heute sehr aktiv ist (Abdrakhmatov et al. 1996, Reigber et al. 2001). Der Tien Schan nimmt gegenwärtig etwa 40% der Gesamtkonvergenz Indiens mit Asien auf. Die Struktur des Tien Schan wird dominiert von E–Wstreichenden, nach N und S gerichteten Überschiebungen (Avouac et al. 1993, Yin et al. 1998), die sich meist deutlich in der Morphologie äußern. Auffallend ist die großräumige Gliederung des Orogens durch NW–SE-streichende dextrale Blattverschiebungen, die auch in das nördliche Vorland reichen (Tapponnier & Molnar 1979). Den Unterbau des Tien Schan bildet ein paläozoisches Akkretionsorogen (Zonenshajn et al. 1990). Im Mesozoikum entstand eine ausgedehnte Fastebene. In der späten Kreide oder dem frühen Tertiär setzte die Ablagerung kontinentaler Serien ein, die im jüngeren Känozoikum sehr mächtig werden. Die synorogenen Sedimente liegen manchmal konkordant, oft aber auch deutlich winkeldiskordant auf dem paläozoischen Sockel. In beiden Fällen bilden sie häufig asymmetrische Falten, die oft mit Störungen verknüpft sind. Geländestufen und ein starker Einfluss auf die Entwicklung des Entwässerungsnetzes weisen viele Störungen als gegenwärtig aktiv aus. Unser Untersuchungsgebiet liegt im Südosten Kasachstans. Es umfasst die Nordflanke des Tien Schan und seinen zentralen Teil mit den höchsten Erhebungen. Im Untersuchungsgebiet liegt das nach E propagierende Ende eines seismisch aktiven Störungssystems, das weiter westlich die nördliche Randstörung des Gebirges bildet, wo es unter der Millionenstadt Almaty (Alma- Ata) verläuft und eine ernste Bedrohung darstellt. Die Entwicklung dieses Störungssystems soll über verschiedene Zeitskalen mit verschiedenen Methoden untersucht werden...conferenc

ERS International Congress 2021: highlights from the Paediatric Assembly

In this review, Early Career Members of the European Respiratory Society (ERS) and the Chairs of the ERS Assembly 7: Paediatrics present the highlights in paediatric respiratory medicine from the ERS International Congress 2021. The eight scientific Groups of this Assembly cover respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway development. We here describe new developments in lung function testing and sleep-disordered breathing diagnosis, early life exposures affecting pulmonary function in children and effect of COVID-19 on sleep and lung function. In paediatric asthma, we present the important role of the exposome in asthma development, and how biologics can provide better outcomes. We discuss new methods to assess distal airways in children with CF, as some details remain blind when using the lung clearance index. Moreover, we summarise the new ERS guidelines for bronchiectasis management in children and adolescents. We present interventions to reduce morbidity and monitor pulmonary function in newborns at risk of bronchopulmonary dysplasia and long-term chronic respiratory morbidity of this disease. In respiratory epidemiology, we characterise primary ciliary dyskinesia, identify early life determinants of respiratory health and describe the effect of COVID-19 preventive measures on respiratory symptoms. Also, we describe the epidemiology of interstitial lung diseases, possible consequences of tracheomalacia and a classification of diffuse alveolar haemorrhage in children. Finally, we highlight that the characterisation of genes and pathways involved in the development of a disease is essential to identify new biomarkers and therapeutic targets

Stabilizing mandibular complete dentures by a single midline implant-influence on quality of life: 2-year results from a randomized clinical trial comparing different loading protocols.

OBJECTIVES The knowledge about the influence of dental treatment on health-related quality of life (HRQoL) is still limited. The aim of this multicenter randomized controlled clinical trial was to assess the effect of stabilizing an existing complete denture, by means of a single mandibular implant, on HRQoL. Furthermore, the impact of the loading protocol, i.e., immediate or delayed loading, in edentulous patients was evaluated. METHODS One hundred fifty-eight participants aged 60-89 years were randomly assigned to study group A (immediate loading; n = 81) and to group B (delayed loading; n = 78). All participants received a single midline implant in the mandible. The implants were either immediately loaded (group A) or after a closed healing period of 3 months (group B) by connecting the existing mandibular complete dentures to ball attachments. HRQoL was assessed with the Short Form-36 questionnaire of health (SF-36) at baseline, 4 months, and 24 months after implant loading. RESULTS Improvement of HRQoL by means of a single implant-retained mandibular overdenture could not be demonstrated after 4 and 24 months of implant loading. Furthermore, the application of two different loading protocols did not influence HRQoL ratings of study participants. CONCLUSION The loading protocol is not a factor, influencing HRQoL in patients treated by a single midline implant in the edentulous mandible. CLINICAL RELEVANCE A single midline implant in the edentulous mandible, stabilizing a mandibular complete denture, cannot be recommended for improving HRQoL

Are uterine natural killer and plasma cells in infertility patients associated with endometriosis, repeated implantation failure, or recurrent pregnancy loss?

Purpose!#!Infertility is a debilitating situation that millions of women around the world suffer from, but the causal relationship between infertility and endometriosis is still unclear. We hypothesize that the immune cell populations of uterine natural killer cells (uNK) and plasma cells (PC) which define chronic endometritis could differ in patients with or without endometriosis and therefore be the link to endometriosis-associated infertility.!##!Methods!#!Our retrospective study includes 173 patients that underwent an endometrial scratching in the secretory phase of the menstrual cycle and subsequently immunohistochemical examination for uNK cells and PC. Sixty-seven patients were diagnosed with endometriosis, 106 served as the control cohort.!##!Results!#!The risk for an elevated number of uNK cells in women with endometriosis is not increased as compared to the control group. Our findings suggest that patients with endometriosis are 1.3 times more likely to have chronic endometritis (CE) as compared to those without and that the treatment with doxycycline might increase pregnancy rates. Endometriosis and an increased number of uNK cells seem to be unrelated.!##!Conclusions!#!In contrast to the lately published connection between endometriosis, infertility and increased uNK cells, we could not find any evidence that patients with endometriosis are more prone to elevated uterine uNK cells. Counting of PC in endometrial biopsies might be a new approach in the search of biomarkers for the nonsurgical diagnosis of endometriosis since our findings suggest a connection

ERS International Congress 2020: highlights from the Paediatric Assembly

In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies

Effectiveness of a specialist palliative home care nurse–patient consultation followed by an interprofessional telephone case conference compared with usual care among patients with non-oncological palliative care needs: protocol for the multicentre KOPAL cluster-randomised controlled trial

Introduction Progressive chronic, non-malignant diseases (CNMD) like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are of growing relevance in primary care. Most of these patients suffer from severe symptoms, reduced quality of life and increased numbers of hospitalisations. Outpatient palliative care can help to reduce hospitalisation rate by up to 50%. Due to the complex medical conditions and prognostic uncertainty of the course of CNMD, early interprofessional care planning among general practitioners who provide general palliative care and specialist palliative home care (SPHC) teams seems mandatory. The KOPAL study (a concept for strenghtening interprofessional collaboration for patients with palliative care needs) will test the effectiveness of a SPHC nurse–patient consultation followed by an interprofessional telephone case conference.Methods and analysis Multicentre two-arm cluster randomised controlled trial KOPAL with usual care as control arm. The study is located in Northern Germany and aims to recruit 616 patients in 56 GP practices (because of pandemic reasons reduced to 191 participants). Randomisation will take place on GP practice level immediately after inclusion (intervention group/control group). Allocation concealment is carried out on confirmation of participation. Patients diagnosed with CHF (New York Heart Association (NYHA) classification 3–4), COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage classification 3–4, group D) or dementia GDS stage 4 or above). Primary outcome is a reduced hospital admission within 48 weeks after baseline, secondary outcomes include symptom burden, quality of life and health costs. The primary analysis will follow the intention-to-treat principle. Intervention will be evaluated after the observation period using qualitative methods.Ethics and dissemination The responsible ethics committees of the cooperating centres approved the study. All steps of data collection, quality assurance and data analysis will continuously be monitored. The concept of KOPAL could serve as a blueprint for other regions and meet the challenges of geographical equity in end-of-life care.Trial registration number DRKS00017795; German Clinical Trials Register