bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of spectral computed tomography for evaluation of intestinal activity and severity in ileocolonic Crohn’s disease
Authors: Peng Jiang Chen , Feng Qi , Zhu Jiong , Shen Jun , Qiao Yu Qi , Xu Jian Rong , Ran Zhi Hua
Published: September 2016

Background:

Assessment of intestinal activity and severity of Crohn’s disease (CD) is crucial to guide treatment. In this study, we aimed to investigate the accuracy of spectral computed tomography (CT) in this assessment and make a comparison with conventional CT.

Methods:

A total of 50 patients with ileocolonic CD underwent spectral CT scanning. Conventional CT and spectral CT images were reconstructed. Endoscopic lesions were classified as absent, mild lesions and severe lesions. Qualitative and quantitative findings in CT images were compared in these segments. Logistic regressions were established, based on conventional and spectral CT parameters, to predict intestinal activity and severity. Comparisons were made by receiver operating characteristic (ROC) curve.

Results:

The results showed that bowel wall hyperenhancement, ulcers on CT images, comb sign, bowel wall thickness, normalized iodine concentration (NIC) and slope of HU curve (λHU) increased significantly ( p < 0.01) with endoscopic severity. In predicting intestinal activity, spectral CT demonstrated higher accuracy (99.6% versus 94.7%), sensitivity (99.1% versus 93.4%) and specificity (99.9% versus 94.4%) than conventional CT. In predicting intestinal severity, spectral CT also had higher accuracy (96.5% versus 91.9%), sensitivity (96.5% versus 92.1%) and specificity (95.8% versus 89.8%) than conventional CT. Besides, both NIC and λHU correlated significantly with Simple Endoscopic Score for CD ( r = 0.833 and r = 0.771; both p < 0.001), but their correlations with C-reactive protein ( r = 0.578 and r = 0.513; both p < 0.01) and Harvey–Bradshaw Index ( r = 0.545 and r = 0.522; both p < 0.01) were moderate.

Conclusions:

Compared with conventional CT, spectral CT had higher accuracy in detecting intestinal activity and severity of CD, which could be an alternative choice in evaluation of CD.
Do travel clinic visitors read information on sexual risk abroad in travel health brochures?
Authors: Croughs Mieke , de Gouw Annemarie , Remmen Roy , Van den Ende Jef
Published: September 2016

Background:

A substantial proportion of travel clinic visitors have sexual encounters while abroad. Hence, guidelines on travel health recommend discussing sexual risk in a pre-travel consultation. However, previous studies showed that it often is not discussed. Although travel clinic visitors usually do receive written information on sexual risk abroad, few data are available on whether this information is read. Therefore, this prospective cohort study in travel clinic visitors was performed.

Methods:

Travel clinic visitors were invited to complete a questionnaire after return from their journey.

Results:

A total of 130 travellers (55%) responded. Half of them recorded they read the information on sexual risk. Male gender (OR 9.94 95% CI 3.12 – 31.63) and ‘travelling with others’ (OR 2.7 95% CI 1.29 – 5.78) were significant independent predictors of reading the information on sexual risk. High risk travellers, i.e. those travelling without a steady partner, were less likely to have read it. Although websites and apps were mentioned as better methods of providing information, none of the participants visited the websites on sexual behaviour and sexually transmitted infections recommended in the travel health brochure.

Conclusion:

Only half of travel clinic visitors read information on sexual risk in the health brochure received in the clinic and none of them visited the related websites mentioned in the brochure. Further research to identify the most effective way to inform travellers about sexual risk is needed.
How the size of governing coalitions shape legislative behavior: A subnational analysis of Argentine legislative chambers, 1992–2009
Authors: Barnes Tiffany D , Jang Jinhyeok
Published: September 2016

In presidential democracies, minority governments are widespread and the size of the governing coalition varies dramatically across legislatures. Despite substantial variation across legislatures, no significant research has been conducted to explore how the size of the governing coalition shapes legislative behavior. We argue that executives supported by a legislative majority have the necessary resources to promote the party; consequently, members of the governing coalition are subject to less partisan pressure. However, as the size of the governing coalition decreases, so does the executive’s political capital; thus, party leaders are required to exert party discipline to convalesce the party’s image. Using a unique comparative research design from Argentine provincial legislatures over an 18-year period, we provide strong empirical support for our theory of the conditional effect of inter-branch relations on legislative behavior.
Cost and Predictors of Hospitalizations for Ambulatory Care - Sensitive Conditions Among Medicaid Enrollees in Comprehensive Managed Care Plans
Authors: Mkanta William N. , Chumbler Neale R. , Yang Kai , Saigal Romesh , Abdollahi Mohammad
Published: September 2016

Introduction:

Preventable hospitalizations are responsible for increasing the cost of health care and reflect ineffectiveness of the health services in the primary care setting. The objective of this study was to assess expenditure for hospitalizations and utilize expenditure differentials to determine factors associated with ambulatory care - sensitive conditions (ACSCs) hospitalizations.

Methods:

A cross-sectional study of hospitalizations among Medicaid enrollees in comprehensive managed care plans in 2009 was conducted. A total of 25 581 patients were included in the analysis. Expenditures on hospitalizations were examined at the 50th, 75th, 90th, and 95th expenditure percentiles both at the bivariate level and in the logistic regression model to determine the impact of differing expenditure on ACSC hospitalizations.

Results:

Compared with patients without ACSC admissions, a larger proportion of patients with ACSC hospitalizations required advanced treatment or died on admission. Overall mean expenditures were higher for the ACSC group than for non-ACSC group (US$18 070 vs US$14 452). Whites and blacks had higher expenditures for ACSC hospitalization than Hispanics at all expenditure percentiles. Patient’s age remained a consistent predictor of ACSC hospitalization across all expenditure percentiles. Patients with ACSC were less likely to have a procedure on admission; however, the likelihood decreased as expenditure percentiles increased. At the median expenditure, blacks and Hispanics were more likely than other race/ethnic groups to have ACSC hospitalizations (odds ratio [OR]: 1.307, 95% confidence interval [CI]: 1.013-1.686 and OR 1.252, 95% CI: 1.060-1.479, respectively).

Conclusion:

Future review of delivery and monitoring of services at the primary care setting should include managed care plans in order to enhance access and overall quality of care for optimal utilization of the resources.
Integrating Liberal Arts Learning Outcomes in the Development and Implementation of a Multisection Undergraduate Public Health Capstone Course
Authors: Bass Sarah Bauerle , Scarpulla Michelle C. , Patterson Freda , Watts Sheldon O. , Twersky Sylvia
Published: September 2016

As demand increases for well-trained public health professionals, academic leaders of universities and colleges must tailor their curricula to prepare students to be ready for the public health workplace, while also providing critical thinking and awareness skills through a liberal arts course context. Temple University’s undergraduate public health program has created a capstone experience that bridges these two priorities. Using public health community-based program planning and evaluation as its content, this two-semester (32 weeks) writing-intensive course provides training for students in writing a grant proposal, including conducting a needs assessment, devising evaluable program goals and objectives, creating an intervention and planning its implementation and evaluation, and developing budgeting and marketing plans. Students also complete related assignments that help develop the critical thinking skills they need to understand the context of public health within the larger society. Utilizing the LEAP Essential Learning Outcomes, we infuse integrative, interdisciplinary, and applied knowledge with the concept of civic responsibility as pathways for ensuring learning, while still providing concrete skills related to public health practice. We discuss how the course is implemented and how public health practice and liberal arts learning objectives are emphasized to ensure an “educated citizenry.” Universities and colleges that offer an undergraduate degree in public health can use this framework to implement a capstone experience that bridges both public health and liberal arts skills.
Metacarpal Cortical Bone Area Predicts Tooth Loss in Men
Authors: Kaye E.K. , Vokonas P. , Garcia R.I.
Published: September 2016

The relationship between bone mineral density and tooth loss in men is unclear. The aim of this retrospective cohort study was to determine if relative metacarpal bone area (MCA) predicts tooth loss in a cohort of 273 male participants in the Dental Longitudinal Study and Normative Aging Study of the Department of Veterans Affairs. Outer and inner cortical bone widths of the middle metacarpal of the nondominant hand were measured on anteroposterior hand radiographs approximately 11 y apart. Baseline MCA was computed and categorized into quartiles. The men were followed from 1971 to 2015. Incident tooth loss during 2 intervals was examined: concurrent with the MCA measurements and long term over the total follow-up (17 ± 7 y). Radiographic alveolar bone loss (ABL) was measured on periapical radiographs as a percentage of the distance from the cementoenamel junction to root apex, and the number of teeth with ABL >40% was computed. Negative binomial generalized linear regression models estimated the mean number of teeth with ABL >40% and the number lost (concurrent and total), controlling for age, smoking, number of teeth at baseline, percentage teeth with ≥1 decayed/filled surface, and years of follow-up. At baseline, MCA was inversely related to number of teeth with >40% ABL. Men in the lowest MCA quartile (Q1) lost the most teeth, both concurrent with MCA measurements and long term, but the association differed by caries level (≤55% or >55% decayed/filled teeth). At the low caries level, the numbers lost in Q1 were 29% greater than in the highest MCA quartile (Q4). At the high caries level, the numbers lost in Q1 were more than twice those in Q4. Associations were attenuated when further controlled for number of teeth with ABL>40%. These findings suggest that systemic bone status plays a role in tooth loss and that the association may be mediated by alveolar bone loss.

Knowledge Transfer Statement: Low relative metacarpal bone area was related to loss of alveolar bone and incident tooth loss in men. This information extends previous research, primarily studies of women, showing that osteoporosis adversely affects oral health. Knowledge of a patient’s systemic bone status may be important for managing his or her periodontal disease. Tooth loss in the absence of periodontal inflammation may signify systemic bone loss. Interprofessional communication is central to maintaining optimal oral and bone health.
Infant lung function testing: available and useful methods
Authors: Ljungberg H. , Gustafsson P.M.
Published: September 2016

Educational aims

To provide an overview of which aspects of lung function can be measured in infants using currently commercially available equipment.

To describe the particular measurement conditions required for infant lung function testing.

To provide information concerning some of the, as yet, commercially unavailable methods.

Lung and airway function can now be measured in infants using standardised methods, allowing for an almost as complete picture of lung function as routinely obtained in adults. Recording systems are now available from several manufacturers. The tests are done during sleep, commonly after sedation with choral hydrate, and in a strictly standardised manner under standardised conditions. Despite the high frequency of chronic chest problems in infants and young children, facilities for assessment of lung function are lacking in many large paediatric centres worldwide. While infant lung function testing is now emerging as a clinical tool, the precise role and the value of the various tests in different clinical situations remain to be established.
Occupational asthma for the clinician
Authors: Nemery B.
Published: September 2016

Key points

Occupational asthma is an important disease.

Its prevention is necessary, but difficult.

Its diagnosis is not always easy, but within reach of most respiratory or occupational physicians.

Its correct management is complex because of the socio-economic consequences.

Educational aims

Occupational asthma is a “special” form of asthma that often causes diagnostic and therapeutic problems for busy clinicians. This article aims to help practising pulmonologists to:

avoid common pitfalls that lead to the role of occupation being missed in adult patients with asthma;

confirm the diagnosis of occupational asthma in patients with suspected occupational asthma;

manage patients with occupational asthma.

The issues of prevention and surveillance of workers at risk of occupational asthma, however important, will not be addressed here.
Pathological approach to idiopathic interstitial pneumonias: useful points for clinicians
Authors: Colby T.V.
Published: September 2016

Key points

IPF has been narrowed down to a more homogeneous group of patients with a very poor prognosis (median survival <3 yrs) and (by definition) the histological pattern of UIP.

Histological evaluation of IIPs in general (and cases formerly interpreted clinically as IPF in particular) has resulted in subclassification into prognostically significant histopathological groupings.

Histopathological classification of interstitial pneumonias generally requires a surgical lung biopsy (exceptions: some cases of COP and AIP); clinical diagnosis may not always require a biopsy (see below).

Histological classification of interstitial pneumonias requires (by definition) histopathology. HRCT is a surrogate for surgical lung biopsy in some settings, especially UIP. The other histological patterns have less distinctive HRCT features. In all the categories, there remain cases that are hard to classify.

Educational aims

To highlight the pathological features of the IIPs.

To show the correlation of histology and radiology in the IIPs.

To improve understanding of when to get a biopsy and what type of biopsy to get in the setting of an IIP.

Most of the IIPs are diagnosed histologically on the basis of patterns of inflammation and fibrosis. Most require open lung biopsy for definitive histological diagnosis. There is good histological/radiological (HRCT) correlation among the IIPs, but both have their limitations. Radiology gives the overview of gross pathology, but the resolution is limited, whereas biopsy shows the histological features but is limited by sampling; the two modalities are complementary. Histology is not always the gold standard. Histology is a relative gold standard that is modified by other findings (particularly those of HRCT). The new ATS/ERS classification of IIPs is based on clinical-radiological-pathological correlations. Coordinating clinicalradiological-pathological data in the diagnosis of IIP is significantly better than the sum of the individual data. NSIP is still evolving.
Prognosis of wheezing and asthma presenting in early childhood
Authors: Helms P.J. , Amin S.S.
Published: September 2016

Key points

Childhood asthma and wheezing illness encompass a wide clinical spectrum.

Most children with asthma first present before the age of 3 years.

Coexistent atopy and initial disease severity carry a poor long-term prognosis.

A switch from male to female predominance occurs at puberty.

Good prognostic factors include presentation before 2 years of age and exclusively virally induced episodes.

CME article: educational aims

To identify the different types of wheezing illness in asthma that present in childhood.

To aid healthcare professionals in the discussion of medium- to long-term prognosis with parents of children presenting with wheezing illness.

To place prophylactic therapy in the context of the natural history of the disease.

Childhood asthma covers a wide spectrum, ranging from mild-intermittent to severe-persistent disease, with different natural histories. Female sex, age at presentation, atopic constitution, parental atopy, and severity and frequency of attacks can all be identified as risk factors for persistence into adult life, while others, including maternal smoking, prematurity and bronchiolitis of infancy, do not appear to be associated to such an extent. The use of prognostic features alongside assessment of disease severity should inform long-term clinical management and be useful in counselling the child and her/his family.
Postgraduate Course ERS Glasgow 2004: Antibiotics
Authors: Cazzola M. , Korppi M.
Published: September 2016

Educational aims

To explain the importance of pulmonary deposition of antimicrobials.

To show that drugs that penetrate well and remain at the pulmonary sites of infection for long periods often induce therapeutic responses greater than expected on the basis ofin vitrodata.

To illustrate why the interrelationship between pharmacokinetics and pharmacodynamics determines the dosing duration and total dose required for optimal antimicrobial activity.

To examine the real effect of the interrelationship between pulmonary pharmacokinetics and pharmacodynamics on clinical and microbiological outcomes.

An important determinant of clinical outcome of a LRTI may be sterilisation of the infected lung, which is dependent on sustained antibiotic concentrations achieved in the lung. For this reason, recently, there has been increased interest in measuring the concentration of antimicrobial agents at different potential sites of infection in the lung. In patients with acute bronchitis, acute exacerbation of chronic bronchitis, bronchiectasis or cystic fibrosis, the infection develops within the airway lumen on the surface of mucus cells and in the mucosa itself. In patients with bacterial pneumonia, the site of infection is in the alveolar spaces or in the pulmonary interstitium. This article, adapted from the European Respiratory Society (ERS) School Course on “New perspectives in pneumonia treatment and prophylaxis”, held at the 2005 ERS conference in Glasgow, discusses the pharmacokinetics and pharmacodynamics of antibiotics with respect to clinical and microbiological outcomes.
Spirometry: then and now
Authors: Gibson G.J.
Published: September 2016

Key points

The spirometric measurements of most clinical value are FEV1and VC.

FEV1and VC are used for diagnosis, assessment of severity, and monitoring progress and response to treatment.

FEV1and VC are a valuable guide in the prognosis of many diseases, not only respiratory.

The greatest clinical value of maximum flow–volume curves is the recognition of central (upper) airway narrowing.

Educational aims

To outline the historical development and rationale of the measurements commonly made during forced expiration.

To review the diagnostic specificity of these measurements and their continuing value in clinical respiratory medicine.

To review the prognostic information conveyed by measurements of FEV1and VC in various respiratory and non-respiratory diseases.

Measurements of VC were first made in the 18th Century, and they had been reported in large numbers of healthy subjects and patients with respiratory disease (tuberculosis) by the middle of the 19th Century. However, little use was made of the VC in clinical medicine until the second half of the 20th Century. The FEV1was first described about 50 years ago. Although used widely by respiratory physicians, the value of both these simple measurements remains under-appreciated by non-specialists. Their main roles are in aiding diagnosis by pattern recognition, assessing severity of disease, and monitoring progress and/or the effects of treatment. The valuable prognostic information conveyed by FEV1and VC has been demonstrated in several conditions, both respiratory and nonrespiratory.
Sleep apnoea syndrome
Authors: McNicholas W.T.
Published: September 2016

Key points

OSAS, with a prevalence of 4% in adults, represents the most common chronic respiratory disorder after asthma.

The condition is fundamentally caused by an inability of the UA-dilating muscles to withstand the collapsing forces generated during inspiration.

Patients typically present with a triad of symptoms: snoring, witnessed apnoea and daytime sleepiness, in addition to other clinical features.

The most common physical morbidity of OSAS is cardiovascular disease, and successful therapy improves these outcomes.

While the gold-standard diagnosis is sleep laboratory-based polysomnography, increasing attention is being focused on limited cardiorespiratory studies, particularly in the home.

Most patients with OSAS are best managed by nasal CPAP, particularly in moderate to severe cases, and the improvements achieved can be dramatic, particularly in daytime alertness.

Educational aims

To provide a broad overview of OSAS, particularly from a clinical perspective.

To review the basic mechanisms of the disorder and provide a brief introduction to some of the emerging concepts concerning molecular mechanisms of cardiac dysfunction in OSAS patients.

To provide practical information for the clinician on the optimum approach to diagnosis and treatment of the disorder.

OSAS is characterised by recurring episodes of UA obstruction during sleep. Apnoeas are usually terminated by brief arousals, which result in marked sleep fragmentation, and contribute significantly to the symptoms of EDS and cognitive dysfunction. OSAS is also an independent risk factor for cardiovascular disease. The prevalence of OSAS is in the region of 2–4% of the adult population, and this high prevalence creates logistical difficulties in diagnosis.

This review aims to a give a broad overview of OSAS for the clinician, whilst providing practical information concerning the diagnosis and treatment of the disease, including nasal CPAP for the management of moderate to mild OSAS, and weight loss, alcohol avoidance, relief of nasal congestion and keeping the patient off their back in milder cases. The possibility of using a mandibular-advancement device is also discussed.
Postgraduate Course ERS Glasgow 2004: Surgical approach to multiresistant cavitary mycobacteriosis
Authors: Halezeroglu S.
Published: September 2016

Educational aims

To explain the present importance of surgery in TB management.

To describe the indications for surgery.

To discuss the different stages of surgery, along with important points to consider.

To present examples of data from one institution to help demonstrate the issues to be considered in surgical management.

Surgery remains an important adjunctive method in the treatment of MDR-TB. In this article, adapted from the European Respiratory Society (ERS) School Course on “Multi-resistant tuberculosis and atypical mycobacterial disease”, held at the 2004 ERS congress in Glasgow, the indications for surgical management in patients with MDR-TB are discussed, together with data from 75 patients with MDR-TB operated on in the Sureyyapasa Thoracic and Cardiovascular Diseases Teaching Hospital, Turkey, between 1993 and 2003.
Two patients presenting with mediastinal mass
Authors: Erdogan A. , Arife A. , Demircan A.
Published: September 2016

A 32-year-old female from a suburb of Antalya (Turkey) was admitted with a mediastinal mass. She was a housewife and had no history of pet or other animal contact. She had no symptoms and her physical examination was normal, with no other remote pathological findings. She was subsequently referred to the Department of Cardiothoracic Surgery due to hilar and mediastinal enlargement incidentally found on her chest radiograph (figure 1) and a well-shaped mediastinal mass (diameter of 4x5x6 cm) in the left side of the middle mediastinum identified from her chest computed tomography (CT) (figure 2). Routine blood and liver ultrasound tests were normal. The preliminary diagnosis was mediastinal unknown mass.
Complementary and alternative treatment of asthma
Authors: Bjermer L.
Published: September 2016

Key points

Currently, there are no reliable data documenting the effects of CAM treatment on asthma, although this does not automatically mean that CAM is worthless.

In most studies, it is difficult to sift out exactly what it is in the treatment that is effective, as most therapists tend to treat each subject in a unique manner.

Scientifically well-controlled, randomised CAM trials are possible and should be performed.

Educational aims

To review the range of complementary and alternative (CAM) treatments currently available.

To provide information about the systematic overviews in the Cochrane database concerning CAM and asthma.

Asthma and allergies are chronic conditions that cause considerable distress. In most cases, the use of modern medical therapy can control these conditions; however, there is still no cure for asthma. Therefore, many patients and, in the case of children, many parents seek CAM. This is often, but not always, concealed from the doctor treating the patient. Traditionally, there has been an antagonistic relationship between CAM and orthodox medicine, and this is why many patients do not inform their doctors that they are seeking CAM. This study aims to assess the current clinical medical value of CAM.
Non-invasive ventilation: a year in review
Authors: Nava S.
Published: September 2016

Educational aims

To present four innovative papers from the field on non-invasive ventilation published in 2004 and to discuss the important points and conclusions from each.

This paper summarises the findings of four important papers that have been published over the last year.

The first paper reports data on the success rate of NIV in patients with early onset of ARF due to SARS. Furthermore, the paper discusses how NIV may be used in patients affected by highly contagious diseases in a way which is safe for healthcare workers.

The second paper concentrates on dying at end-stage disease and the limits of medical care. It studies the use of NIV treatment in patients with CHF and COPD affected by ARF who have signed a DNI order.

The next article investigates the use of both CPAP and NIV delivered by face mask in patients with CPE, when compared with the use of oxygen alone, and their effect on physiological parameters and avoiding intubation.

Finally, the last paper reviewed reports on the use of NIV to treat an episode of post-extubation respiratory failure in “unselected” patients.

This review article aims to keep the reader updated on the most recent and some of the important advancements in this field over the last year.
Chest physical therapy in surgery: a theoretical model about who to treat
Authors: Fagevik Olsén M.
Published: September 2016

Key point

The major high-risk factors for developing PPC include: Advanced age Smoking Obesity Obstructive pulmonary disease

Educational aims

To highlight high- and low-risk factors for PPC.

To present overview data showing how the respiratory system is affected by different surgical interventions.

To present a model to determine which treatment is most suitable for each individual patient.

Chest physiotherapy is common for patients undergoing different types of surgery in order to avoid PPC. However, do all patients require treatment, is it possible to predict those patients at risk and is it possible to select the optimal treatment for each patient? This paper aims to address these questions and to propose a model that can be utilised for determining how much physical therapy is needed.
Postgraduate Course ERS Glasgow 2004 Large cell carcinoma
Authors: Brambilla E.
Published: September 2016

Educational aims

To explain the importance of discriminating between different histological types of NSCLC.

To explain the differences between large cell carcinoma (NOS) and their variants.

To link precise histopathological class with prognosis

The histopathological classification of lung cancer was revised in 1999, and, in addition, descriptions of their phenotypic and genetic abnormalities were reported in 2004. Several changes have occurred that increased the clinical significance of lung cancer histopathological classification. These include the subclassification of large cell carcinoma, which was defined on a negative basis (on exclusion criteria), into variants which are defined on objective histopathological positive criteria that endowed them with a strong clinical significance.
ERS School Course Cystic Fibrosis
Authors: Bush A. , Elborn S. , Götz I.
Published: September 2016

Educational aims

To identify patients with advanced and rapidly progressive lung disease.

To discuss how to best optimise standard therapies.

To understand the different approaches appropriate to patients who have and have not decided that lung transplantation is an option.

To detail innovative strategies which may be worth attempting if conventional means failure.

More than 90% of CF patients will eventually die of advanced lung disease, despite everything that has been attempted. This article will discuss strategies that can be adopted when a patient is doing badly.
Paediatric interstitial lung disease
Authors: Bush A.
Published: September 2016

Key points

Presentation of ILD is very non-specific.

Imaging, especially HRCT, confirms the presence of ILD, but is rarely diagnostic.

Invasive diagnosis is almost always needed.

Bronchoscopy rarely gives diagnostic information in paediatric ILD.

For most paediatric ILD, transbronchial or percutaneous lung biopsy gives insufficient tissue for diagnosis and carries increased risk.

Open lung biopsy or VATS is the diagnostic investigation of choice.

Educational aims

To allow the reader to correctly identify infants and children with interstitial lung disease (ILD).

To help the reader to appreciate the wide differential diagnosis, including that of disorders specific to infancy, comprising the surfactant protein disorders.

To explain the strengths and weaknesses of the different investigative modalities used in establishing a firm diagnosis.

To discuss the limited evidence for the different treatment options currently in use.

Paediatric interstitial disease is rare, and comprises many disparate diseases. This article aims to provide the reader with an update on how to recognise infants and children who should be considered as possibly having ILD. The diagnostic process, including the roles of HRCT and bronchoscopy, and the different methods of lung biopsy, will be set out. The newly recognised entities, such as neuroendocrine cell hyperplasia of infancy, pulmonary interstitial glycogenosis and the disorders of surfactant protein metabolism, are also described. Finally, the article reviews the evidence that exists to guide treatment of these conditions.
Vocal cord dysfunction
Authors: Stanton A.E. , Bucknall C.E.
Published: September 2016

Key points

VCD is an increasingly recognised co-existing feature in asthmatics.

VCD may arise from an alteration in the autonomic balance between the glottis and central control areas, with potential aggravation from direct laryngeal insult, laryngeal hyperresponsiveness and psychological factors.

There is significant psychiatric co-morbidity in VCD patients.

The classical appearances at laryngoscopy are adduction of the anterior two thirds of the vocal cords with the creation of a posterior glottic chink during inspiration.

The current gold standard for diagnosis rests with laryngoscopy at the time of an attack of symptoms, with the role of challenge testing as a diagnostic strategy not clear at present.

Treatment involves directing attention away from the inspiratory phase of breathing and oropharyngeal muscle use towards active expiration using anterior abdominal muscles along with psychiatric input if necessary.

Educational aims

To be aware of the possible co-existence of VCD in patients with poorly controlled asthma.

To recognise the various clinical presentations of VCD.

To be aware of the unanswered questions regarding the pathophysiology of VCD.

To be aware of treatment strategies for VCD.

Recently, there has been increasing recognition and understanding of vocal cord dysfunction (VCD), a condition characterised by abnormal adduction of the vocal cords, most often during inspiration, leading to airway obstruction and associated symptoms. VCD is recognised as a co-existing factor or an alternative diagnosis in patients with asthma, but the true prevalence and incidence are not entirely clear. VCD may arise from interrelationships between laryngeal hyperresponsiveness and autonomic imbalance. Diagnosis can be difficult and, although challenge testing may be helpful, there is no non-invasive alternative to direct visualisation of the larynx during an attack as a current gold standard. This review aims to summarise current understanding of the epidemiology, proposed underlying pathophysiological mechanisms, diagnosis and treatment of this disorder.
Inspiratory muscle training in obstructive lung disease
Authors: McConnell A.K. , Romer L.M. , Weiner P.
Published: September 2016

Key points

Dyspnoea is influenced by inspiratory muscle strength and the load placed upon the inspiratory muscles.

Dynamic hyperinflation is a major cause of dyspnoea and exercise intolerance in patients with expiratory flow limitation due to its detrimental effect upon inspiratory muscle loading.

Specific IMT improves inspiratory muscle strength, reduces dyspnoea and improves exercise tolerance, even in individuals without inspiratory muscle weakness or hyperinflation.

Pressure threshold IMT is the most reliable, convenient and commonly used method of IMT, eliciting improvements in a wide range of muscle functional characteristics, including strength, shortening velocity, power and endurance.

Inspiratory muscles adhere to the same training principles as other skeletal muscles, with respect to overload, specificity and reversibility.

Training loads must exceed 30% of inspiratory muscle strength, with at least once daily training and weekly increases in training load. Programmes should be least 6 weeks in duration, after which frequency can be reduced to two sessions, three times per week.

IMT can be implemented as a stand-alone intervention or as part of a comprehensive programme of rehabilitation.

Monitored outcomes should include inspiratory muscle strength, an index of dyspnoea (e.g. BDI/TDI and/or Borg CR-10) and exercise tolerance (e.g. 6MWD).

Educational aims

To provide an overview of the role of respiratory muscle function in the genesis of dyspnoea.

To describe the response of inspiratory muscles to different types of training stimuli.

To offer guidance on the implementation and monitoring of IMT.

Dyspnoea is strongly influenced by respiratory muscle function. Patients with obstructive lung disease become hyperinflated and experience an associated functional deficit in inspiratory muscle function, as well as a concomitant increase in the work of breathing. These changes result in a heightened sense of respiratory effort and a propensity for inspiratory muscle fatigue. There is now convincing evidence that specific inspiratory muscle training (IMT) improves respiratory muscle function, reduces dyspnoea and improves exercise tolerance. This review will describe the two most commonly implemented methods of IMT, and the specific functional adaptations that are elicited by each. It will also describe successful, evidence-based implementation and monitoring of the most commonly used method of IMT.
Induced sputum in occupational lung diseases
Authors: Fireman E. , Lerman Y.
Published: September 2016

Key points

BAL, an important tool in assessing occupational lung diseases, is an invasive technique and thus unsuitable for screening programmes, the evaluation of exposure and the monitoring of hazardous dust.

Examination of induced sputum is a noninvasive method to directly study particulate burden and inflammatory processes in the lung.

The correlation between cells retrieved by BAL and induced sputum shows different proportions of leukocytes, but similar eosinophil cell counts and qualitative/quantitative analyses of particles.

Many accumulating lines of evidence have shown that the eosinophil count is a useful marker for monitoring OA.

Educational aims

To introduce induced sputum methodology in the field of occupational lung diseases.

To describe the eosinophil count as a method of monitoring occupational asthma.

To explain how to use quantitative and qualitative analysis of inhaled particles in hazardous dust exposure.

Induced sputum is a particularly promising procedure, since it provides specific information on both the cellular and molecular constituents in inflammation. In the period 1950–1970, sputum cells were examined on stained smears in both research and clinical settings. After their recovery by spontaneous coughing, the cells were used to study lung cancer and respiratory infections, and, later on, to diagnosePneumocystis cariniipneumonia in patients infected with HIV. The method was widely improved upon by the induction of sputum with aerosol of hypertonic saline, and then extended to become part of the assessment of airway inflammation in bronchial asthma and COPD. However, less attention was given to the use of induced sputum in occupational exposures. This review analyses the value of induced sputum and presents its applications in pulmonary occupational and environmental medicine.
Postgraduate Course ERS Copenhagen 2005 - The side-effects of TB therapy
Authors: Zaleskis R.
Published: September 2016

Educational aims

To provide up-to-date insights on:

the side-effects of anti-TB chemotherapy

the symptom-based approach to the management of side-effects

the influence of side-effects on the outcomes of anti-TB treatment.

There is still much debate concerning the frequency and severity of symptoms of TB when undergoing chemotherapy. In addition, the frequency of complications is hard to quantify as many patients are treated with a range of different drugs. However, this article aims to give a brief overview of the side-effects associated with anti-TB drugs and the most appropriate management approaches to take.
Pulmonary arterial hypertension
Authors: Humbert M. , Jaïs X. , Sitbon O. , Parent F. , Hervé P. , Simonneau G.
Published: September 2016

Key points

PAH is defined by RHC showing a pre-capillary PH.

Clinical suspicion of PH should arise in the case of symptoms such as dyspnoea without overt signs of specific heart or lung disease.

RHC is required to confirm the diagnosis of PAH, to assess the severity of the haemodynamic impairment and to test the vasoreactivity of the pulmonary circulation.

Variables that have been shown to predict prognosis in IPAH include baseline NYHA functional classification, history of right heart failure, baseline 6-minute walk distance, and baseline haemodynamics.

FPAH segregates as an autosomal dominant trait, but with markedly reduced penetrance. Germline BMPR2 mutations have been detected in at least 60% of the families studied to date, as well as in cases of so-called IPAH.

Basic PAH therapy includes oxygen, diuretics and warfarin.

Chronic treatment with oral CCBs should be considered for PAH patients who respond to acute vasodilator challenge.

Cohort analysis of IPAH patients receiving continuous intravenous epoprostenol, as compared to historical control groups, clearly demonstrated clinical benefits in NYHA functional class III and IV patients.

Two double-blind, randomised, placebocontrolled trials have supported the efficacy of oral bosentan in patients with PAH class III.

One double-blind, randomised placebocontrolled trial has supported the efficacy of oral sildenafil in patients with symptomatic PAH.

Lung transplantation is the ultimate alternative for severe PAH cases who cannot be managed medically.

Educational aims

To improve awareness of PAH.

To describe the novel classification of PH.

To provide information regarding the therapeutic approach of PAH.

Pulmonary arterial hypertension (PAH) is a rare condition characterised by elevated pulmonary arterial resistance, leading to right heart failure. PAH can be sporadic (idiopathic PAH), familial or related to other conditions. Echocardiography is the investigation of choice for non-invasive screening. Measurement of haemodynamic parameters during right heart catheterisation (RHC) is mandatory to establish the diagnosis. Recent advances in the management of PAH include prostaglandins, endothelin receptor antagonists and PDE5 inhibitors. Lung transplantation is the last option for patients who deteriorate despite medical treatment. This review aims to update the reader on all these aspects of PAH.
Postgraduate Course ERS Copenhagen 2005 - Diet in respiratory disease
Authors: Romieu I. , McKeever T.
Published: September 2016

Educational aims

To introduce dietary factors and nutrients linked to lung function and diseases.

To describe host and environmental factors affecting pulmonary and systemic nutritional status.

To present epidemiological evidence of the association between nutrition and respiratory health.

To discuss nutritional counselling and vitamin supplementation.

Several lung diseases have been associated with oxidative stress. Consequently, dietary factors and nutrients with a potentially protective role in the oxidative process and inflammatory response have been implicated in the genesis or evolution of these diseases. Antioxidant vitamins and other nutrients have also been related to several components of the immune response. This paper briefly reviews the epidemiological evidence of an association between diet and lung health, focusing on the nutrients most frequently studied.
ERS School Course Basics in Asthma - Exercise testing, exercise induced asthma and sports
Authors: Carlsen K-H.
Published: September 2016

Educational aims

To inform about the occurrence of EIA, particularly in top athletes.

To describe how EIA can be diagnosed.

To describe the pathogenesis of the condition.

To familiarise the reader with treatment modalities available to athletes.

To make the reader aware of doping regulations in relation to EIA.

Exercise-induced asthma (EIA) is a general concern for growing children and adolescents, although it now occurs more commonly in top athletes. It specifically affects athletes competing in endurance sports in cold climates. EIA can be diagnosedviaexercise testing and can be easily treated both prophylactically and before exercise. However, with tight regulations now in force in the sporting world, athletes with EIA have to be sure that they adhere to doping rules. This review aims to briefly review these issues.
Lung transplantation: who, when?
Authors: Irani S. , Boehler A.
Published: September 2016

Key points

Lung transplantation is an established therapeutic option for selected patients suffering from end-stage lung diseases, providing survival and quality of life benefits.

Shortage of donor organs and chronic graft rejection in the form of bronchiolitis obliterans are the two major drawbacks in lung transplantation.

When to refer to the lung transplant centre is at least as crucial as whom to refer,e.g. patients with idiopathic pulmonary fibrosis have a high mortality on the waiting list and, therefore, this group of patients should be referred early.

The period of time on the waiting list should be used for active risk management: continuous optimisation of nutrition, comorbidities (e.g. osteoporosis), psychosocial issues and general health behaviour is important, and can be achieved through close collaboration with the lung transplant programme.

Educational aims

To provide information about the selection of appropriate patients for lung transplantation.

To outline recommendations for chest physicians concerning who to refer and when.

To better understand short- and long-term results after the procedure, considering underlying disease, quality of life and survival.

To present future trends in lung transplant medicine.

Since the first successful lung transplantation was performed in the early 1980s, this procedure has emerged as a mainstay of therapy for patients suffering from end-stage lung diseases. Due to a shortage of donor organs, time on the waiting list is increasing in most transplant programmes and, hence, the timing of referral and listing is crucial. This review discusses the different aspects that should be considered when advising potential lung transplant recipients. Particular focus is given to the appropriate time of referral, matters of medical care whilst on the waiting list, post-transplant prognosis and quality of life issues.
ERS School Course Sleep Medicine: Non-respiratory causes of excessive daytime sleepiness
Authors: Viot-Blanc V.
Published: September 2016

Educational aims

To present the symptoms, methods of assessment and the different causes of excessive daytime sleepiness when nocturnal respiratory disturbances have been excluded.

To enable physicians to confirm a diagnosis of sleepiness and recognise the pathology.

Excessive daytime sleepiness (EDS) is defined as an inability to stay awake and alert during the major waking episodes of the day, resulting in unintended drowsiness or sleep episodes almost daily for at least 3 months. This review will examine the assessment of sleepiness and different causes of EDS.
Croup: diagnosis and treatment
Authors: Canciani M. , Morittu A. , Del Pin B.
Published: September 2016

Key points

The term “croup” refers to a clinical syndrome characterised by barking cough, inspiratory stridor and hoarseness of voice.

The standard work-up for clinical diagnosis includes the assessment of skin colour, hydration, breath sounds and air movement.

The most important aspect in the treatment of patients with croup is airway maintenance.

The standard management of croup includes corticosteroids andL-adrenalin.

L-adrenalin is used because it is safe, cheap and available across the world.

Educational aims

To provide information on how to diagnose, treat and hospitalise patients with croup.

To enable clinicians to determine the appropriate treatment for every situation, according to score.

To explain the rationale of treatment.

“croup” (laryngotracheobronchitis) is a common illness during the first 6 years of childhood, which is characterised by barking cough, inspiratory stridor and hoarseness of voice. Patients with atypical features in whom the diagnosis is questionable or unclear should have a work-up to exclude other less common entities.

The most important aspect of the treatment is airway maintenance, and standard management includes corticosteroids andL-adrenalin.

Inhaled L-adrenalin has a transient beneficial effect on airway obstruction in children; even if it is not a definitive treatment, it may allow time for the basic pathology to resolve.