European Respiratory Society International Congress 2017:highlights from the Clinical Assembly

This article contains highlights and a selection of the scientific advances from the European Respiratory Society's Clinical Assembly (Assembly 1 and its six respective groups) that were presented at the 2017 European Respiratory Society International Congress in Milan, Italy. The most relevant topics from each of the groups will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data as well as award-winning abstracts and highlight sessions will be discusse

Clinical highlights from the 2016 European Respiratory Society International Congress

This article contains highlights and a selection of the scientific advances from the European Respiratory Society (ERS) Clinical Assembly (Assembly 1) and its six respective groups (Groups 1.1–1.6) that were presented at the 2016 ERS International Congress in London, UK. The most relevant topics for clinicians will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data will be discussed and put into perspective

European Respiratory Society International Congress, Paris, 2018:highlights from the Clinical Assembly

This article contains highlights and a selection of the scientific advances from the European Respiratory Society’s Clinical Assembly (Assembly 1 and its five respective groups) that were presented at the 2018 European Respiratory Society International Congress in Paris, France. The most relevant topics from each of the groups will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, and general practice and primary care. The newest research, actual data and highlight sessions will be discussed

Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study

AIMS: To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. METHODS AND RESULTS: A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. CONCLUSION: In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Diferenças entre tela de movimento funcional e somatotipo em jovens jogadores de handebol e voleibol

Introduction. Handball and volleyball are among the world's popular sports, which are played practically in every country at different levels of competition. The aim of this study was to determine the differences in somatotype and morphological characteristics between young handball players and volleyball players as well as the differences in the results of functional body mobility tests between the tested groups. Material and Methods. The research included a sample of 23 female athletes who were divided into two subsamples, as follows. A total of 12 athletes were from the Handball team and a total of 11 athletes were from the Volleyball team.  The following anthropometric measurements were conducted: Height and body mass, four skinfolds (triceps, subscapular, supraspinal and calf), breadths (humerus and femur diameters) and girths (arm and calf). Body mass (kg) and body fat (%) of the subjects were measured by the method of bioelectrical impedance (TANITA 545N) with an accuracy of 0.1 kg. Functional Movement Score is a scanning system which includes seven steps (i.e., deep squat, hurdle step, in-line lunge, shoulder mobility, active leg raise, trunk stability push-up, and rotary stability). Results. The results of the study in female handball players recorded a higher percentage of body fat and body mass index compared to female volleyball players (p <.05), while no statistically significant difference was recorded in body weight and height. Analyzing the somatotype of players, it is noticeable that handball players have higher values of endomorphism and mesomorphism, while volleyball players have higher values of ectomorphism. Statistically significant differences were observed in mesomorph and ectomorph (p <.001). In the Functional Movement Screen test, it was noticeable that statistically significant differences were recorded in the two variables (Shoulder mobility and trunk stability push up) in favor of the volleyball players, as well as in the overall standings, while in the other variables no statistically significant difference was recorded. Conclusions. Determining somatotype must occupy the attention of coaches who work with young athletes. Movement-based assessment serves to pinpoint functional deficits (or bio-markers) related to proprioceptive, mobility and stability weaknesses.Introducción. El balonmano y el voleibol se encuentran entre los deportes populares del mundo, que se juegan prácticamente en todos los países en diferentes niveles de competencia. El objetivo de este estudio fue determinar las diferencias en el somatotipo y las características morfológicas entre los jóvenes jugadores de balonmano y voleibol, así como las diferencias en los resultados de las pruebas de movilidad corporal funcional entre los grupos evaluados. Material y métodos. La investigación contó con una muestra de 23 mujeres atletas que fueron divididas en dos submuestras, de la siguiente manera. Un total de 12 atletas eran del equipo de Balonmano y un total de 11 atletas eran del equipo de Voleibol. Se realizaron las siguientes medidas antropométricas: altura y masa corporal, cuatro pliegues cutáneos (tríceps, subescapular, supraespinal y pantorrilla), anchos (diámetros de húmero y fémur) y perímetros (brazo y pantorrilla). El peso corporal (kg) y la grasa corporal (%) de los sujetos se midieron mediante el método de impedancia bioeléctrica (TANITA 545N) con una precisión de 0,1 kg. La puntuación de movimiento funcional es un sistema de escaneo que incluye siete pasos (es decir, sentadilla profunda, paso de obstáculos, estocada en línea, movilidad del hombro, elevación activa de la pierna, flexión de estabilidad del tronco y estabilidad rotatoria). Resultados. Los resultados del estudio en jugadoras de balonmano registraron un mayor porcentaje de grasa corporal e índice de masa corporal en comparación con las jugadoras de voleibol (p < 0,05), mientras que no se registró diferencia estadísticamente significativa en peso corporal y talla. Analizando el somatotipo de los jugadores, se destaca que los jugadores de balonmano tienen valores más altos de endomorfismo y mesomorfismo, mientras que los jugadores de voleibol tienen valores más altos de ectomorfismo. Se observaron diferencias estadísticamente significativas en mesomorfo y ectomorfo (p <.001). En el test Functional Movement Screen, se notó que se registraron diferencias estadísticamente significativas en las dos variables (Movilidad de hombros y estabilidad del tronco) a favor de las jugadoras de voleibol, así como en la clasificación general, mientras que en las demás variables no se registró una diferencia estadísticamente significativa. Conclusiones. La determinación del somatotipo debe ocupar la atención de los entrenadores que trabajan con atletas jóvenes. La evaluación basada en el movimiento sirve para identificar los déficits funcionales (o biomarcadores) relacionados con las debilidades propioceptivas, de movilidad y de estabilidad.Introdução. O handebol e o vôlei estão entre os esportes mais populares do mundo, praticados em praticamente todos os países em vários níveis de competição. O objetivo deste estudo foi determinar as diferenças nas características somatotípicas e morfológicas entre jovens jogadores de handebol e voleibol, bem como as diferenças nos resultados dos testes funcionais de mobilidade corporal entre os grupos avaliados. Material e métodos. A pesquisa contou com uma amostra de 23 atletas do sexo feminino que foram divididas em duas subamostras, conforme segue. Um total de 12 atletas eram da equipe de Handebol e um total de 11 atletas da equipe de Voleibol. Foram realizadas as seguintes medidas antropométricas: estatura e massa corporal, quatro dobras cutâneas (tríceps, subescapular, supraespinal e panturrilha), larguras (diâmetros do úmero e do fêmur) e perímetros (braço e panturrilha). O peso corporal (kg) e a gordura corporal (%) dos sujeitos foram medidos pelo método de bioimpedância elétrica (TANITA 545N) com precisão de 0,1 kg. A pontuação do movimento funcional é um sistema de escaneamento que inclui sete etapas (ou seja, agachamento profundo, passo com barreira, estocada em linha, mobilidade do ombro, elevação ativa da perna, flexão de estabilidade do tronco e estabilidade rotacional). Resultados. Os resultados do estudo em jogadores de handebol registraram maior percentual de gordura corporal e índice de massa corporal em comparação com jogadores de voleibol (p < 0,05), enquanto não houve diferença estatisticamente significativa no peso corporal e na altura. Analisando o somatotipo dos jogadores, destaca-se que os jogadores de andebol apresentam valores mais elevados de endomorfismo e mesomorfismo, enquanto os jogadores de voleibol apresentam valores mais elevados de ectomorfismo. Diferenças estatisticamente significativas foram observadas em mesomorfo e ectomorfo (p <.001). No teste Functional Movement Screen, notou-se que foram registradas diferenças estatisticamente significativas nas duas variáveis ??(mobilidade do ombro e estabilidade do tronco) a favor dos jogadores de voleibol, bem como na classificação geral, enquanto nas demais variáveis ??não foram . uma diferença estatisticamente significativa foi registrada. conclusões. A somatotipagem deve ocupar a atenção dos treinadores que trabalham com jovens atletas. A avaliação baseada em movimento é usada para identificar déficits funcionais (ou biomarcadores) relacionados a fraquezas proprioceptivas, de mobilidade e de estabilidade

Progression of Fibrosis in Usual Interstitial Pneumonia: Serial Evaluation of the Native Lung after Single Lung Transplantation

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Usual interstitial pneumonia (UIP) is the histopathological pattern identifying patients with the clinical entity of IPF. Despite aggressive immunosuppressive therapy the clinical course is usually dismal. For selected patients only lung transplantation improves prognosis and quality of life. After lung transplantation patients often receive a potent cyclosporine-based immunosuppressive therapy. Some reports suggest that cyclosporine has the potential to prevent progression of fibrosis. Objective: In patients with single lung transplantation (sLTx) for UIP we evaluated the effect of cyclosporine-based immunosuppressive therapy on progression of fibrosis using a high-resolution computed tomography (HRCT) scoring system. Methods: This retrospective observational study included 13 patients (24–64 years old) with histologically confirmed UIP who had HRCT scans preceding and following sLTx and who survived at least 6 months after sLTx. All pa- tients were initially treated with cyclosporin A, prednisone and azathioprine. Three radiologists analyzed HRCT scans by setting a score regarding fibrosis [fibrosis score (FS); range 0–5 for each lobe] and ground-glass opacity [ground-glass score (GGS); range 0–5 for each lobe]. A comparison of serial changes (interval: 12–96 months posttransplant, 2–4 HRCT examinations/patient) was performed with the sign test. Results: Mean pretransplant FS and GGS of the nontransplanted lung were 1.80 and 1.61, respectively. Comparing pre- and posttransplant HRCT scans, mean lung FS significantly increased (0.35 8 0.15/year; p = 0.00024), while GGS tended to decrease (0.06 8 0.26/year; p = 0.5). Conclusion: A cyclosporin A based triple immunosuppressive regimen following sLTx does not seem to prevent progression of the fibrotic changes of the native lung in patients with IPF

<i>In Silico Oncology</i>: Quantification of the <i>In Vivo</i> Antitumor Efficacy of Cisplatin-Based Doublet Therapy in Non-Small Cell Lung Cancer (NSCLC) through a Multiscale Mechanistic Model

<div><p>The 5-year survival of non-small cell lung cancer patients can be as low as 1% in advanced stages. For patients with resectable disease, the successful choice of preoperative chemotherapy is critical to eliminate micrometastasis and improve operability. <i>In silico</i> experimentations can suggest the optimal treatment protocol for each patient based on their own multiscale data. A determinant for reliable predictions is the a priori estimation of the drugs’ cytotoxic efficacy on cancer cells for a given treatment. In the present work a mechanistic model of cancer response to treatment is applied for the estimation of a plausible value range of the cell killing efficacy of various cisplatin-based doublet regimens. Among others, the model incorporates the cancer related mechanism of uncontrolled proliferation, population heterogeneity, hypoxia and treatment resistance. The methodology is based on the provision of tumor volumetric data at two time points, before and after or during treatment. It takes into account the effect of tumor microenvironment and cell repopulation on treatment outcome. A thorough sensitivity analysis based on one-factor-at-a-time and latin hypercube sampling/partial rank correlation coefficient approaches has established the volume growth rate and the growth fraction at diagnosis as key features for more accurate estimates. The methodology is applied on the retrospective data of thirteen patients with non-small cell lung cancer who received cisplatin in combination with gemcitabine, vinorelbine or docetaxel in the neoadjuvant context. The selection of model input values has been guided by a comprehensive literature survey on cancer-specific proliferation kinetics. The latin hypercube sampling has been recruited to compensate for patient-specific uncertainties. Concluding, the present work provides a quantitative framework for the estimation of the <i>in-vivo</i> cell-killing ability of various chemotherapies. Correlation studies of such estimates with the molecular profile of patients could serve as a basis for reliable personalized predictions.</p></div