bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Metabolic Syndrome and Number of Teeth in Japan
Authors: Kawashita Y. , Kitamura M. , Ando Y. , Saito T.
Published: September 2016

The 2004 Japanese National Health and Nutrition Survey collected data on several measures, including self-reported dental health. In addition, this was the first nationwide survey to focus on metabolic syndrome (MetS) in Japan. Therefore, the authors used this nationwide data set to assess the relationship between number of teeth present and MetS. Anonymized data were available with permission from the Ministry of Health, Labour and Welfare of Japan. Data from 3,195 men and women aged 35 to 99 y were examined, and logistic regression analyses were used to evaluate the association between number of teeth and MetS. Moreover, the authors performed an analysis of covariance to compare the mean number of teeth between those with and those without MetS, after adjusting for confounders. In comparison with those having ≥28 teeth, those with fewer remaining teeth demonstrated significantly higher odds of having MetS. Specifically, those having 1 to 9 teeth had higher odds of having MetS than those with more teeth and were more than twice as likely to be affected than those with ≥28 teeth. Furthermore, individuals with MetS in the age groups of 45 to 54, 55 to 64, and 65 to 74 y had significantly fewer teeth than those without MetS in the same age groups. These results suggest that the number of teeth present is associated with the prevalence of MetS in the Japanese population.

Knowledge Transfer Statement: The results of this study can be used by clinicians when they examine patients with periodontal disease or extensive tooth loss to refer for a general medical examination.
Ipsilateral Recurrent Tubal Ectopic Pregnancy Following a Salpingectomy
Authors: Boykin Tabitha
Published: September 2016

Sonographers are acquainted with the signs, symptoms, and findings of ectopic pregnancies as well as their recurrence; however, a recurrent ipsilateral ectopic pregnancy after a salpingectomy is also possible. While recurrent ipsilateral ectopic pregnancies are rare, they are a significant diagnostic discovery. It is important to highlight this rare manifestation and be aware of the potential for recurrent ipsilateral findings to avoid a misdiagnosis or prolonged treatment. The goal of this case study is to review a patient’s presentation and raise awareness of recurrent ipsilateral tubal ectopic pregnancy.
Pulmonary rehabilitation
Authors: Wouters E.F.M.
Published: September 2016

Educational aims

To provide insights into management goals of pulmonary rehabilitation.

To provide information about the structure and setting-up of pulmonary rehabilitation programmes.

To provide information to health providers about the outcome of non-pharmacological treatment programmes.

Pulmonary rehabilitation programmes in chronic respiratory diseases have clear effects on improvements in exercise tolerance, reduction of symptoms such as dyspnoea and of health-related quality of life. Further studies are needed in order to define the long-term benefits as well as the optimal programme structure to get the greatest effects. Cost-effectiveness studies are needed, as well as data on more optimal selection procedures, in order to select the best possible candidates for rehabilitation. Exercise training programmes have to integrate present knowledge of muscular adaptations in patients with chronic respiratory diseases as COPD. The shift from empiricism to science in performing pulmonary rehabilitation may result not only in a further improvement in quality of life, but perhaps also in life expectancy for patients with usually incurable and sometimes inexorably progressive pulmonary disease.
Dyspnoea and its measurement
Authors: Ambrosino N. , Scano G.
Published: September 2016

Key points

Dyspnoea is the sensation of breathing discomfort that can be described with different terms according to different pathophysiological mechanisms that vary in intensity.

The mechanisms of dyspnoea are complex.

In COPD, whilst the intensity and quality of dyspnoea during activity correlates with the magnitude of lung hyperinflation and inspiratory events, it correlates poorly with FEV1.

Valid, reliable and responsive instruments are available to measure the severity of dyspnoea in patients with respiratory disease.

CME article: educational aims

To introduce dyspnoea and explain its mechanisms.

To present dyspnoea descriptors, which may help in the understanding of the language of dyspnoea, and to relate these to specific diseases.

To describe some of the methods available for the measurement of dyspnoea.

Dyspnoea, a term used to characterise a subjective experience of breathing discomfort, is perhaps the most important symptom in cardiorespiratory disease. Receptors in the airways, lung parenchyma, respiratory muscles and chemoreceptors provide sensory feedbackviavagal, phrenic and intercostal nerves to the spinal cord, medulla and higher centres. Knowledge of dyspnoea descriptors can help in understanding the language of dyspnoea and these are presented here. It is important to appreciate that differences in language, race, culture, sex and previous experience can all change the perception of and the manner in which the feeling of being dyspnoeic is expressed to others. Therefore, standard tools to measure dyspnoea are available. In addition, there are tools that can help to relate the severity of symptoms with observed levels of cardiac and pulmonary responses while performing supervised tasks. A range of methods are described here. Inventories that involve aspects of dyspnoea related to quality of life are not yet a routine part of the history and physical examination, although they have proved useful in the clinic. Measurement instruments may involve a cost for use, may be self-administered or require an interviewer, and can vary in the time required for completion and scoring.
Air pollution: from sources of emissions to health effects
Authors: Pénard-Morand C. , Annesi-Maesano I.
Published: September 2016

Key points

Immissions (=concentration of air pollutants in the ambient atmosphere) result from the intensity and the type of emissions of air pollutants, the dispersion of air pollutants and their transportation.

The main air pollution indicators are SO2, NOx, PM, CO, VOC and O3.

Road traffic has become the first source of air pollution in urban areas.

Health effects caused by air pollutants depend on the absorbed dose, the type of pollutants and the individual susceptibility.

Educational aims

To provide a thorough presentation of sources, dispersion and transformation of major air pollutants.

To describe the health effects of these air pollutants.

To explain the differences between emissions, immissions, exposure and absorbed dose.

To help readers to understand what is at stake in the topical scientific and political debate on air pollution.

Air pollution, particularly in urban areas, constitutes a public health concern, as it has a harmful effect on the health, survival and activities of humans and other living organisms.

Here, the main types of air pollution commonly found in urban environments are presented, along with their sources, levels of emissions, mechanisms of dispersion, transformation, concentrations in ambient air (=immissions), and effects on the environment and health. In particular, the concepts of exposure, absorbed dose and individual susceptibility are explained. The recent evolution in air pollutant emissions and immissions due to the growing weight of road traffic is also described. Finally, European air quality criteria are highlighted.
Exercise testing: why, which and how to interpret
Authors: Gosselink R. , Troosters T. , Decramer M.
Published: September 2016

Key points

An exercise test should be performed: if there is impaired exercise tolerance; to find out which system is limiting exercise; to establish which organ systems have an abnormal response during or after exercise; to investigate how much exercise is appropriate/safe in a patient; and to determine the response to treatment.

Prediction of exercise performance based solely on resting pulmonary function tests is inaccurate.

The gold standard in exercise testing is the incremental exercise test.

Two types of ergometers can be selected for incremental exercise testing: a treadmill or a cycle ergometer. More muscle mass is put to work using a treadmill when compared with cycling.

Incremental exercise testing and field testing have complementary value in, for example, pulmonary rehabilitation.

Exercise laboratories should be encouraged to test some healthy control subjects in the age span of interest to evaluate which normal values best suit their laboratory setting.

Educational aims

To address some questions that often arise when exercise testing is performed in the clinical routine:

What are the indications to perform an exercise test?

Which test should be used for which situation?

How should the test be carried out in practice?

How should the results of the test be interpreted?

Exercise testing is widely applied in clinical practice. The aim of this article is to address some questions that often arise when exercise testing is performed in clinical routine. Two complementary tests will be discussed in more detail: the maximal incremental ergometer test and the timed walk test.

First, the indication to perform exercise testing is discussed. The second question is which test to apply and how to carry out the test in practice. Finally, the interpretation of the results of the tests are discussed.
Assessing asthma quality of life: its role in clinical practice
Authors: Juniper E.F.
Published: September 2016

Key points

Asthma patients want help to improve their ability to function in their daily lives (physical, social, occupational and emotional).

Awareness of patients’ problems and a willingness to treat them may improve both asthma control and quality of life.

The clinician and the patient should negotiate a treatment plan that addresses both asthma control and the patient's needs, and that the patient is willing to follow.

Valid, easy-to-use, self-administered asthma quality-of-life questionnaires can be used in the clinic to identify quickly the patient's specific problems and treatment goals.

Educational aims

To define HRQL and emphasise its importance in patients with asthma.

To describe the HRQL impairments experienced by adults and children with asthma.

To discuss the role of HRQL in clinical practice and the concept of shared decision making.

To provide information on the selection, methods of administration, analysis, interpretation and cultural adaptation of HRQL questionnaires

An important contributor to poor patient compliance with treatment instructions may be a discrepancy between the goals of the clinician and those of the patient. Improved clinician awareness of patients’ asthma-related quality-of-life goals and a readiness to address them may enhance patients’ willingness to take medications and, thus, improve both their asthma control and their quality of life. The aim of this article is to explain how quick, valid, easy-to-use, self-administered and clinic-friendly HRQL can be used to identify patients’ greatest needs, ascertain how troublesome they are and ensure that they are included in the treatment plan. HRQL questionnaires can also be used to monitor patient progress over time.
ERS School Course - Smoking Cessation
Authors: Gratziou C. , Fagerstrüm K.
Published: September 2016

Educational aims

To provide healthcare professionals and respiratory physicians with a practical set of information based on the recommendations made by recent relevant guidelines to facilitate the treatment of tobacco dependence.

The potential health benefits of smoking cessation are substantial; however, many people find it very difficult to quit. The main physiological obstacle is addiction to nicotine. This article aims to describe the “5 As” for effective intervention for smoking cessation that should be followed in current smokers. In addition, some baseline and follow-up assessments to be performed during a smoking cessation programme are proposed.
Imaging: ultrasound in lung disease
Authors: Herth F.J.F. , Eberhardt R.
Published: September 2016

Key points

Transthoracic US is an inexpensive, lightweight and portable technique to evaluate the lungs and the pleural space.

US-guided punctures are safe procedures in the case of pathological findings in the pleural space.

With the help of EBUS, the diagnosis and staging of lung cancer can be improved.

US will become a practical and essential tool for the pulmonologist in the near future.

Educational aims

To outline the situations where US is indicated.

To discuss the importance of EBUS in the diagnosis and staging of lung cancer.

To encourage the pulmonologist to learn ultrasonic techniques, particularly transthoracic US, and emphasise the importance of formal training programmes.

Ultrasound (US) has received increased interest from chest physicians in recent years. Modern US devices are user friendly, inexpensive, lightweight and portable, which makes them suitable for outpatient settings, as well as for bedside investigations of the severely ill.

However, the view during bronchoscopy is limited to the inner surface in the case of parabronchial lesions. Therefore, endobronchial ultrasound (EBUS) systems were developed. In trials, it has been shown that, with the help of EBUS, the diagnosis and staging of lung cancer and other pathologies can be improved. EBUS is a safe technique and, so far, has proved extremely useful during diagnostic and interventional procedures. US is set to become a practical and essential tool for the pulmonologist in the near future. This review aims to assess the most important and interesting articles in the field and to encourage the pulmonologist to learn ultrasonic techniques, particularly with regard to transthoracic US.
Rare and orphan lung diseases
Authors: Cordier J-F.
Published: September 2016

Key points

Patients suffering from rare and orphan lung diseases often feel frustrated and angry because of a delayed diagnosis and the insufficient experience of their nearest physician.

As many diseases can be classed as rare or orphan, pulmonologists need to cooperate through networks and form connections with specialised reference centres to ensure optimal diagnosis and care.

Participation in registries and clinical studies helps to increase the collective and individual knowledge of respiratory specialists.

Providing information to patients both directly and through patients' associations is a necessity, as orphan diseases are not a regular subject covered in medical reports in the lay press.

Action is being taken by the ERS to include rare and orphan lung diseases in scientific and educational programmes and to develop task forces for specific diseases.

Educational aims

To motivate the interest of chest physicians in rare orphan lung diseases.

To define rare and/or orphan lung diseases.

To provide information on orphan drugs.

To give examples of orphan lung diseases.

To provide details about patient associations, networks and reference centres.

Patients with rare lung diseases often feel isolated, especially if their physician has limited experience and knowledge of their disease. They can feel like an “orphan” in the field of healthcare. A respiratory professional who does not work in a large hospital in a big town may not feel concerned by rare and so-called orphan lung diseases, since it is often supposed that these diseases are reserved for university specialists. However, this should not be the case, as patients live in different locations throughout every country and have proximity healthcare needs. Therefore, every respiratory professional should meet several patients with a rare disease in the course of their career. This review examines how to deal with such patients and where information can be obtained in order to offer the best current care.
Postgraduate Course ERS Copenhagen 2005: Biological and therapeutic implications of the united airways concept
Authors: Braunstahl G-J.
Published: September 2016

Key points

Rhinitis is an important risk factor for the development of asthma.

The nose interacts with the bronchi through the systemic circulation.

Treatment of allergic rhinitis in patients with concomitant asthma provides better asthma control.

Novel therapies are aimed at the systemic elements of allergic airway disease.

Educational aims

To introduce the factors involved in the expression of allergic phenotypes.

To define the mechanisms that may play a role in nasobronchial cross-talk.

To identify current and future therapies for combined asthma and rhinitis.

The condition of the nose affects the bronchi andvice versa. Local allergen exposure leads to a generalised airway response in atopic individuals, involving the systemic circulation. Therefore, upper and lower airways need to be regarded as one functional entity. This also has implications for rhinitis and asthma therapy, providing a rationale for combined treatment of both upper and lower airways. The systemic link between the upper and lower airways may provide new opportunities for systemic treatment.
Pulmonary rehabilitation: a year in review
Authors: Ambrosino N. , Serradori M.
Published: September 2016

Educational aims

To present innovative papers from the field of pulmonary rehabilitation published in 2005 and to discuss the important points and conclusions from each.

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

Two recently published studies have addressed the effects of different durations of pulmonary rehabilitation programme (PRP), indicating the greater benefits obtained by longer programmes.

Three other papers have described the effects of pulmonary rehabilitation on pulmonary mechanics and oxidative stress, indicating that exercise is able to reduce the mechanical disadvantage of the respiratory system and some aspects of oxidative stress associated with chronic obstructive pulmonary disease (COPD).

Other papers have discussed the effects of a number of breathing strategies, such as pursed-lip breathing (PLB), or training techniques, such as arm or inspiratory muscle training.

Finally, the addition of drug therapy to pulmonary rehabilitation and the role of outcome measures in providing rehabilitation programmes were examined in two other studies.
The mesh nebuliser: a recent technical innovation for aerosol delivery
Authors: Vecellio L.
Published: September 2016

Key points

Mesh nebulisers can be used to nebulise aqueous drugs and suspensions; however, with suspensions, there can be a reduction in performance in terms of aerosol output rate and inhaled mass.

Based only onin vitrostudies, marketed mesh nebulisers for ambulatory patients might reduce the nebulisation time without reducing drug efficiency or overdose risk.

The effect of disinfection and cleaning on marketed mesh nebulisers’ performances remains to be assessed.

Educational aims

To define the differences between the new mesh nebulisers and conventional jet and ultrasonic nebulisers.

To give recommendations regarding the choice of a mesh nebuliser in order to administer a therapeutic aerosol.

A nebuliser is a device that converts a liquid into aerosol droplets and must be loaded with the medication before each treatment. There are three types of nebulisers: jet nebulisers, which can nebulise all drugs and can be disposable; ultrasonic nebulisers, which are silent but can only nebulise aqueous solutions and may heat the drug; and mesh nebulisers, which can be used to nebulise aqueous solutions, but can be less efficient in nebulising suspensions. The latter are silent, portable and small. They can reduce the nebulisation time without reducing drug efficiency, but disinfecting and cleaning can be difficult.
Care of end-stage lung disease
Authors: Simonds A.K.
Published: September 2016

Key points

Most patients with COPD die during acute exacerbations; in those who have been treated with acute NIV, almost 80% will require admission in the following year.

A comprehensive management plan for endstage lung disease patients needs to address symptom burden, provide information, support carers and assist with end-of-life planning.

Management should include optimisation of treatment of airflow obstruction and pulmonary rehabilitation. In some patients, pharmacotherapy for dyspnoea, panic attacks, depression and insomnia have a key role, but the importance of practical measures, including stairlifts, bath aids and social support, should not be underestimated.

Advance directives enable patients to give direction to the medical team about treatment preferences and should be part of routine care, especially in individuals who have already experienced an acute hypercapnic exacerbation.

Educational aims

To raise awareness of the symptom load of end-stage lung disease.

To examine trajectories of end-stage disease.

To discuss treatment strategies.

Individuals with end-stage lung disease have a substantial symptom burden, which is often poorly addressed compared to patients with malignant disease. Recognition of the disease trajectory in the last few years of life enables a symptom-based approach that combines palliative care with active treatment of exacerbations where appropriate. Discussion of advance directives is helpful for both the patient and the physician.
Pulmonary carcinoid tumours
Authors: André S. , Correia J.M. , Raposo M. , Matos C. , Nogueira F. , Abreu M.C.
Published: September 2016

Key points

Pulmonary carcinoid tumours account for 2% of all lung tumours, with an increase in incidence due to more accurate diagnostic techniques.

Carcinoid tumours are relatively slow growing, although prognosis depends on histological subtype; atypical carcinoids have worse prognosis

Local pulmonary symptoms occur frequently

Paraneoplastic syndromes are dependent on the release of hormones or vasoactive peptides into the systemic circulation.

Carcinoid syndrome manifests with diarrhoea and flushing, which can lead to dehydration, hypotension and arrhythmias.

Carcinoid heart disease is a severe late complication of carcinoid syndrome, manifesting as valvular right-side heart disease, and is a frequent cause of death.

Urinary 5-HIAA and CgA are good biochemical markers of carcinoid tumours.

Nuclear scintigraphy techniques with111Indium-pentetreotide and131I-MIBG are very sensitive in the diagnosis of metastatic carcinoid tumour and are predictive of response to octreotide therapy.

Somatostatin analogues are first-line treatment for carcinoid metastatic tumours.

Systemic chemotherapy has limited success and is more effective in aggressive variants of carcinoid tumour; IFN-α therapy can also be used with good biochemical and symptomatic responses, but small effects on tumour reduction.

Educational aims

To describe the epidemiology and prognosis of pulmonary carcinoid tumours.

To discuss the pathophysiology and clinical presentation of pulmonary carcinoid tumours.

To outline the diagnostic procedures and treatment strategies in carcinoid metastatic disease.

To highlight the importance of carcinoid-related heart disease and carcinoid syndrome in the prognosis of carcinoid tumours.

Carcinoid tumours are neuroendocrine tumours derived from enterochromaffin cells, which are widely distributed in the body. Pulmonary carcinoids account for 25% of all carcinoid tumours and they comprise 1–2% of all lung tumours. The incidence of carcinoid tumours seems to be sharply increasing.

Carcinoid tumours can be classified as typical or atypical, ranging from low-grade malignant to high-grade malignant, according to histological characteristics and differentiation level. Carcinoids can be placed in a spectrum of neuroendocrine tumours, ranging from low-grade malignant typical carcinoid to intermediate atypical carcinoid, to highgrade large cell neuroendocrine carcinoma and small cell lung carcinoma.

Carcinoid pulmonary tumours can present with lymph node or distant metastases, most frequently at the liver. Carcinoid tumours have the ability to secrete many vasoactive peptides, most frequently serotonin. The hormonal secretion is related to systemic manifestations of carcinoid syndrome and carcinoid heart disease. Combining new diagnostic and treatment modalities in metastatic carcinoid patients may result in better prognosis.

The review aims to elucidate the reader on the many aspects of carcinoid pulmonary tumours.
ERS School Course Early-stage lung cancer - What's new in the epidemiology of lung cancer: the female aspect
Authors: Quoix E. , Mennecier B.
Published: September 2016

Key points

Lung cancer is more frequent in non-smoking females than in non-smoking males.

Although the main reason for the tremendous increase in lung cancer incidence in females is tobacco, there are several other potential risk factors.

There are genetic factors that could explain different susceptibility to lung cancer development in both sexes.

Educational aims

To describe the incidence of lung cancer in the USA and Europe.

To identify the epidemiological specificities of lung cancer in females.

To correlate some of these specificities with genetic and hormonal factors.

There has been a tremendous increase in lung cancer incidence in females, which is mainly due to the increase in tobacco consumption by females after the Second World War in the USA and from the end of the 1960s in Europe.

However, there are more non-smoking females developing lung cancers than non-smoking males, and lung cancer can be attributed to active tobacco smoking only in ~70% of female lung cancer cases in Europe. Even if the female patients who develop lung cancer are smokers, the amount smoked is consistently less than that of males, thus suggesting an increased susceptibility to carcinogens of smoke. This increased susceptibility is still controversial, but there are several genetic differences that may account for such an increased susceptibility.
The global burden of chronic respiratory diseases
Authors: Maio S. , Baldacci S. , Carrozzi L. , Pistelli F. , Viegi G.
Published: September 2016

Key points

Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community.

In the period of 1990–2020, COPD deaths are expected to increase from 2.2 to 4.7 million worldwide.

Reducing chronic disease death rates by an additional 2% annually would avert 36 million deaths by 2015.

The abatement of the main risk factors for respiratory diseases, in particular tobacco smoking, environmental tobacco smoke, indoor biomass fuels, outdoor air pollution and unhealthy diet, can achieve huge health benefits.

Educational aims

To define the burden of chronic respiratory diseases all over the world.

To underline the importance of chronic diseases recognition by the international health community.

To provide details about the burden of chronic obstructive pulmonary disease (COPD): the predicted third cause of death by 2020.

Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. Moreover, chronic diseases are not only a problem of the ageing population in developed countries. In fact, it has been estimated that 80% of mortality for chronic diseases occurred in low-income and middleincome countries in 2005. Thus, the World Health Organization (WHO) Dept of Chronic Diseases and Health Promotion has suggested a new Millennium Development Goal for the next few years: to reduce chronic disease death rates by an additional 2% annually, in order to avert 36 million deaths by 2015.
Chronic disease in the elderly: back to the future of internal medicine
Authors: Fabbri L.M. , Ferrari R.
Published: September 2016

Key points

The ageing of the population has increased the prevalence of chronic diseases, which represent a huge proportion of human illness.

The two most important risk factors underlying the most frequent chronic diseases of the elderly are tobacco use and obesity.

The most important comorbidities are cardiovascular diseases and chronic respiratory diseases, particularly COPD.

Comorbidities may not only contribute to the severity of a patient's clinical manifestations, but they may also complicate its treatment, and they are therefore important to recognise and treat effectively.

Educational aims

To increase the interest of chest physicians in multiple chronic comorbidities in the elderly.

To define the most important and frequent comorbidities in elderly patients, particularly those with COPD.

To provide updated information on the most common chronic diseases present in the elderly.

To emphasise the limitations of single disease-oriented clinical practice guidelines, and the need for a more comprehensive “internistic” approach to patients with multiple chronic comorbidities.

To suggest that chronic inflammation might represent the common pathogenetic link between the different chronic diseases present in the elderly.

Elderly people are often affected by two or more chronic diseases, more frequently cardiovascular diseases, chronic respiratory diseases, metabolic syndrome and cancer. These most frequent chronic diseases share largely preventable risk factors, the most important being smoking and obesity, and may be linked to chronic systemic inflammation. Coexisting chronic diseases affect the course of the primary disease and alter the efficacy and safety of its management. Current clinical practice is dominated by the "singledisease" approach, which has major limitations, and there is increasing evidence that a patient-oriented approach that takes into account the several co-existing components of chronic disease is required. This "change of concept" implies the need for medical specialists to extend their expertise to broader diagnostic and treatment approaches that are traditionally the purview of internal medicine. This new approach also requires a different approach to clinical research and teaching, followed by extensive rewriting of medical textbooks and remodelling of teaching curricula to reflect the complexity of the patient affected by chronic diseases.
Problems of air travel for patients with lung disease: clinical criteria and regulations
Authors: Robson A.G. , Innes J.A.
Published: September 2016

Key points

Commercial aircraft have a hypoxic environment, equivalent to an altitude of 2,438 m (8,000 ft) above sea level.

Normal subjects and the majority of respiratory patients can tolerate this without symptoms. In practice, medical diversions for respiratory problems are very rare.

The tendency of individual patients to become hypoxic in these conditions cannot be predicted with accuracy from sea-level oxygen saturation or spirometry.

Hypoxic challenge may be used to simulate the inflight environment, to predict hypoxaemia and to assess the effectiveness of inflight oxygen.

Most airlines, with adequate warning, can provide oxygen at 2 or 4 litres per minute for respiratory patients.

While it may be possible to predict hypoxia during flight, there are no means of predicting symptoms or actual risk of harm during air travel.

Educational aims

To identify the potential problems that patients with chronic respiratory conditions may encounter during air travel.

To recognise that guidelines have been developed from a number of sources to assist doctors involved in assessing a patient who is considering air travel.

To make clinicians aware of the different methods of hypoxic challenge that have been developed to help with the clinical assessment of patients.

To highlight that many patients with chronic lung disease are capable of air travel without developing significant hypoxia, but to raise awareness about which patients are likely to be at risk.

To discuss the potential difficulties that may arise for the patient when they are arranging inflight oxygen.

Doctors are frequently asked by patients with chronic lung disease if they are fit to fly. As commercial flights are not pressurised to sea level, there is a reduction in partial pressure of oxygen (PO2), which may result in significant hypoxia in otherwise asymptomatic patients.

A number of different assessment methods have been developed to assess flight fitness and several professional organisations have developed guidelines to help doctors give informed advice.

Patients who become significantly hypoxic during a flight assessment may still be able to travel with supplemental oxygen. However, the provision of supplemental oxygen is dependent on individual airline policy and considerable variations in policy have been recorded.

This review aims to give a brief overview of air travel for patients with lung disease, including physiology, guidelines, assessing fitness to fly and oxygen supplementation.
ERS School Course Basic principles of clinical exercise testing - Clinical exercise testing
Authors: Palange P. , Ward S.A. , Whipp B.J.
Published: September 2016

Educational aims

To provide a comprehensive introduction to the physiological basis of integrative exercise testing.

To identify the indications and the protocols used in clinical settings.

To discuss the clinical applications of exercise testing with special reference to lung and heart diseases.

To understand the utility of exercise testing in the prescription and evaluation of therapeutic interventions and in rehabilitation.

Exercise intolerance is the hallmark of pulmonary and cardiac diseases. However, measurements of lung and cardiac function obtained at rest (e.g.forced expiratory volume in one second (FEV1), pulmonary diffusing capacity of the lung for carbon monoxide (DL,CO), left ventricular ejection fraction (EF)) are poorly predictive of the degree of exercise intolerance. Therefore, it is necessary to directly assess an individual's exercise intolerance and, where possible, establish its cause(s). The “gold standard” approach for this is cardiopulmonary exercise testing (CPET). CPET has also proven to be very useful in the following applications: prognostic evaluation of patients with chronic lung and heart diseases, such as chronic obstructive pulmonary diseases (COPD), interstitial lung diseases (ILD), cystic fibrosis (CF) and chronic heart failure (CHF); and evaluating the effects of interventions such as drug therapy, oxygen and heliox supplementation during exercise, and pulmonary rehabilitation based on exercise training.
Chronic cough: diagnosis, treatment and psychological consequences
Authors: Morice A.H.
Published: September 2016

Educational aims

To motivate the clinician to see chronic cough as a serious condition with extensive morbidity.

To arm the clinician with the knowledge of the pathophysiology of chronic cough giving rise to the typical clinical history, enabling a firm diagnosis to be made.

To suggest successful treatment strategies in patients with chronic cough.

Chronic cough is a common and disabling symptom leading to a marked decrement in a patient's quality of life. The vast majority of patients with chronic cough can be helped by making an accurate diagnosis, usually of either reflux disease or asthma.

Reflux cough presents in a fashion markedly different from the classic symptoms of gastro-oesophageal reflux, such as heartburn. Indeed, <50% of patients with reflux cough suffer from heartburn. The correct diagnosis and correct treatment modality leads to amelioration of cough in the majority of cases.

Where no diagnosis is obtained or there is a failure of therapy, non-specific cough suppression can dramatically improve the patient's quality of life.

This overview provides information on the pathophysiology of the causes of chronic cough, hence enabling the reader to make an accurate clinical diagnosis and suggest therapy to improve even those with apparently intractable symptoms.
Causes and management of exacerbations of COPD
Authors: Vijayasaratha K. , Stockley R.A.
Published: September 2016

Key points

Diagnosis of exacerbations of COPD is based largely on key symptoms (increasing sputum purulence and volume, and breathlessness) and the severity depends on the level of healthcare resource utilisation.

Aetiology is varied, although infection is the major causative factor. Neutrophilic inflammation is a major pathological event, but eosinophils are also implicated, suggesting an "asthmatic" aetiology.

Airflow limitation and dynamic hyperinflation are the physiological changes, which can result in deterioration in gas exchange and respiratory failure.

Antibiotics are reserved for purulent exacerbations, with the exception of the presence of pneumonia and prophylaxis during ventilation.

Steroids are recommended for all hospitalised patients and outpatients with a significant increase in breathlessness.

Controlled oxygen therapy is central to management and is guided by arterial blood gas measurements.

Noninvasive ventilation is the preferred management for patients with acidotic respiratory failure when the arterial pH is 7.25–7.35 despite the standard initial therapy.

Prevention of exacerbations is aided by influenza vaccination and the institution of regular inhaled long-acting bronchodilators and inhaled corticosteroids.

Educational aims

To understand the definition and burden of exacerbations.

To understand the aetiology and varied pathophysiology.

To understand the treatment and prevention of exacerbations.

Exacerbation of COPD is a common problem, which causes a considerable burden to the patient and the healthcare system. This article aims to give a structured overview of the different aspects of COPD exacerbations, including their classification, aetiology, pathophysiology, differential diagnosis, management and prevention.
Postgraduate Course ERS Munich 2006 - Paediatric respiratory medicine: allergy for paediatric pulmonologists; Management of paediatric anaphylaxis
Authors: Dubois A.E.J.
Published: September 2016

Educational aims

To understand how to identify those patients at substantial risk of anaphylaxis who are likely to be encountered in everyday practice.

To explain how to undertake initial preventive strategies to reduce risk and facilitate specialist care aimed at further risk reduction and treatment.

To detail the prescription of an adrenaline self-administration device and provide instructions on its proper use.

Anaphylaxis is a severe, systemic allergic reaction. It is also potentially life-threatening. Acute treatment depends on the administration of adrenaline. It is possible to identify those at greatest risk of anaphylaxis and to reduce the danger, by helping them to modify their behaviour and by prescribing them an adrenaline self-administration device. Education and prevention are vital.
Tuberculosis in children
Authors: Corrigan D.L. , Paton J.Y.
Published: September 2016

Key points

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Children with TB are markers of recent disease transmission, usually from infectious adults. The 1 million cases of TB in children registered each year is likely to be a gross underestimate.

The diagnosis is challenging and often presumed rather than confirmed. Symptoms, if present, are nonspecific.

TB infection occurs when a previously uninfected child inhales an infected aerosol droplet. At this stage, the child usually shows no symptoms, the infection passes undetected and the primary focus heals. In most cases the infection is controlled by the body's immune system and the organisms remain dormant. This is called latent TB. TB disease can develop either then or at a later stage when the organism multiplies, overpowering the host defences. At this stage, symptoms develop and there may be radiological or microbiological evidence of disease.

"More bugs require more drugs". In TB infection, the organism load is small and therefore drug-resistant mutations are rare: hence simpler drug regimes are effective. In TB disease, the number of organisms is greater, so a combination of ≥3 drugs is required. Increasing resistance worldwide has led to four drugs being recommended as standard in many areas.

Poor adherence to drug therapy is the main barrier to cure. Although directly observed therapy (DOTS) and intermittent therapy may improve the outcome, neither is a panacea. Co-operation and other strategies are required.

Bacille Calmette-Guérin (BCG) vaccination remains the most widely used preventative strategy. Its efficacy is uncertain and its use needs to be targeted to neonates in high-risk areas who are most likely to benefit. The development of new vaccines against pulmonary TB is an important global challenge.

Educational aims

To describe the epidemiology and natural history of TB in children, focusing on pulmonary TB.

To explore the challenges of diagnosis and provide an up-to-date overview of the methods available.

To outline the management and prevention of pulmonary TB in children.

Despite advances in diagnosis, treatment and prevention, tuberculosis (TB) remains a major cause of mortality and morbidity worldwide. Diagnosis and treatment in children present a challenge, particularly in the face of growing drug resistance and coexistent disease such as HIV. New diagnostic methods have not yet been fully validated for use in children. No new drugs have become available in the past 30 years and many of the commercially available preparations are unsuitable for children. In 2006, a number of major documents and strategies were launched aimed at improving the care of children with TB, a previously neglected area.
General continuous-time Markov model of sequence evolution via insertions/deletions: local alignment probability computation
Authors: Ezawa Kiyoshi
Published: September 2016

Background

Insertions and deletions (indels) account for more nucleotide differences between two related DNA sequences than substitutions do, and thus it is imperative to develop a method to reliably calculate the occurrence probabilities of sequence alignments via evolutionary processes on an entire sequence. Previously, we presented a perturbative formulation that facilitates the ab initio calculation of alignment probabilities under a continuous-time Markov model, which describes the stochastic evolution of an entire sequence via indels with quite general rate parameters. And we demonstrated that, under some conditions, the ab initio probability of an alignment can be factorized into the product of an overall factor and contributions from regions (or local alignments) delimited by gapless columns.

Results

Here, using our formulation, we attempt to approximately calculate the probabilities of local alignments under space-homogeneous cases. First, for each of all types of local pairwise alignments (PWAs) and some typical types of local multiple sequence alignments (MSAs), we numerically computed the total contribution from all parsimonious indel histories and that from all next-parsimonious histories, and compared them. Second, for some common types of local PWAs, we derived two integral equation systems that can be numerically solved to give practically exact solutions. We compared the total parsimonious contribution with the practically exact solution for each such local PWA. Third, we developed an algorithm that calculates the first-approximate MSA probability by multiplying total parsimonious contributions from all local MSAs. Then we compared the first-approximate probability of each local MSA with its absolute frequency in the MSAs created via a genuine sequence evolution simulator, Dawg. In all these analyses, the total parsimonious contributions approximated the multiplication factors fairly well, as long as gap sizes and branch lengths are at most moderate. Examination of the accuracy of another indel probabilistic model in the light of our formulation indicated some modifications necessary for the model’s accuracy improvement.

Conclusions

At least under moderate conditions, the approximate methods can quite accurately calculate ab initio alignment probabilities under biologically more realistic models than before. Thus, our formulation will provide other indel probabilistic models with a sound reference point.
On multiplicative metric spaces: survey
Authors: Došenović Tatjana , Postolache Mihai , Radenović Stojan
Published: September 2016

The purpose of this survey is to prove that the fixed point results for various multiplicative contractions are in fact equivalent to the corresponding fixed point results in (standard) metric spaces. For example, such are recent results established by He et al. (Fixed Point Theory Appl. 2014:48, 2014), Mongkolkeha and Sintunavarat (J. Nonlinear Sci. Appl. 8:1134-1140, 2015) and Abdou (J. Nonlinear Sci. Appl. 9:2347-2363, 2016) and all others from the list of references. Our results here generalize, complement, and improve recent ones from existing literature.
RETRACTED ARTICLE: An algebra of reversible computation
Authors: Wang Yong
Published: September 2016

We design an axiomatization for reversible computation called reversible ACP (RACP). It has four extendible modules: basic reversible processes algebra, algebra of reversible communicating processes, recursion and abstraction. Just like process algebra ACP in classical computing, RACP can be treated as an axiomatization foundation for reversible computation.
Complete genome sequence of Pseudomonas citronellolis P3B5, a candidate for microbial phyllo-remediation of hydrocarbon-contaminated sites
Authors: Remus-Emsermann Mitja N.P. , Schmid Michael , Gekenidis Maria-Theresia , Pelludat Cosima , Frey Jürg E. , Ahrens Christian H. , Drissner David
Published: September 2016

Pseudomonas citronellolis is a Gram negative, motile gammaproteobacterium belonging to the order Pseudomonadales and the family Pseudomonadaceae. We isolated strain P3B5 from the phyllosphere of basil plants (Ocimum basilicum L.). Here we describe the physiology of this microorganism, its full genome sequence, and detailed annotation. The 6.95 Mbp genome contains 6071 predicted protein coding sequences and 96 RNA coding sequences. P. citronellolis has been the subject of many studies including the investigation of long-chain aliphatic compounds and terpene degradation. Plant leaves are covered by long-chain aliphates making up a waxy layer that is associated with the leaf cuticle. In addition, basil leaves are known to contain high amounts of terpenoid substances, hinting to a potential nutrient niche that might be exploited by P. citronellolis. Furthermore, the isolated strain exhibited resistance to several antibiotics. To evaluate the potential of this strain as source of transferable antibiotic resistance genes on raw consumed herbs we therefore investigated if those resistances are encoded on mobile genetic elements. The availability of the genome will be helpful for comparative genomics of the phylogenetically broad pseudomonads, in particular with the sequence of the P. citronellolis type strain PRJDB205 not yet publicly available. The genome is discussed with respect to a phyllosphere related lifestyle, aliphate and terpenoid degradation, and antibiotic resistance.