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Background: Heart rhythm disturbances are cardiac side effects in patients with sleep-disordered breathing (SDB), which in itself is considered to be a risk factor for bradycardic rhythm disturbances. Objective: We analyzed the prevalence and degree of SDB in patients who received a cardiac pacemaker due to bradycardic rhythm disturbances and investigated the relationship between the severity of an underlying SDB and the type of heart rhythm disturbance. Methods and Results: 192 patients (100 males, 92 females, mean age 62.2 ± 12.2 years) were studied using the portable screening device MESAM IV. The respiratory disturbance index (RDI) was calculated visually. The mean RDI in all patients was 9.13 ± 11.09/h, 11.7 ± 13.15/h in males and 6.33 ± 7.42/h in females. The prevalence ratio of SDB between men and women was 1.7:1, with significant differences in the respective severity (p < 0.05). The screening showed a prevalence of SDB (RDI > 10/h) of 32.3%. The highest prevalence was found in the group of patients with atrial fibrillation and bradycardia. However, there were no significant differences compared to other types of rhythm disturbances. The RDI in the population studied depended on age and body mass index, but not on the existence or type of rhythm disturbance and not on concomitant diseases. Conclusion: The prevalence of SDB in cardiac pacemaker patients is similar to that in patients of comparable age without a pacemaker. A heart rhythm disturbance does not seem to be an independent risk factor for development of SDB. Nevertheless, the differential diagnosis of bradycardic rhythm disturbances in this age group should include a screening for sleep apnea.

OBJECTIVE The clinical course of fibrosing alveolitis (FA) in patients with systemic sclerosis (SSc) may vary considerably from stable condition for years to continuous fatal progression. This prospective study aimed at identifying the prognostic value of bronchoalveolar lavage fluid (BALF) analysis in FASSc. METHODS Seventy three consecutive patients with SSc and clinical signs of pulmonary involvement were enrolled. Every patient underwent clinical examination, lung function tests, computed tomography (CT), gallium scan, echocardiography, and bronchoalveolar lavage (BAL). Forty nine patients, 26 with pathological and 23 with normal BALF findings were prospectively followed up for two years and re-evaluated annually. RESULTS At baseline, 51 subjects (70%) showed radiological signs of lung fibrosis and/or alveolitis by CT and diffusion capacity for carbon monoxide (DLco) was decreased in 47 patients (64%). Thirty five patients (48%) had pathological BALF findings. BALF differential counts included BALF granulocytosis in 18, BALF lymphocytosis in 12, and a mixed increase of both granulocytes and lymphocytes in five patients. On follow up, a progression of FA with a significant decrease of DLco was only observed in patients with BALF granulocytosis. In contrast, patients with BALF lymphocytosis or normal BALF cell count had stable lung funtion parameters during the study period. In none of our patients echocardiography showed evidence of pulmonary hypertension. CONCLUSION BALF granulocytosis predicts progression of FA with deterioration of lung function, which is most sensitively monitored by DLco. Immunosuppressive treatment is recommended in patients with granulocytic FASSc.

This study estimates the nitrogen (N), phosphorus (P) and potassium (K) requirements of irrigated rice (Oryza sativa L.) in South- and Southeast Asia. Grain yield and plant nutrient accumulation in above-ground plant dry matter (DM) were measured at physiological maturity of rice ( n ∼ 2000) in on-station and on-farm experiments in six Asian countries between 1995 and 1997. These data were used to model the nutrient requirements for yields up to 11 t ha −1 using the QUEFTS (Quantitative Evaluation of the Fertility of Tropical Soils) approach. The model required the estimation of two borderlines describing the minimum and maximum internal efficiencies (IE, kg grain per kg nutrient in plant DM), which were estimated at 42 and 96 kg grain kg −1 N, 206 and 622 kg grain kg −1 P and 36 and 115 kg grain kg −1 K, respectively. The model predicted a linear increase in grain yield if nutrients are taken up in balanced amounts of 14.7 kg N, 2.6 kg P and 14.5 kg K per 1000 kg of grain until yield targets reached ca. 70–80% of the climate-adjusted potential yield ( Y max ). The corresponding IEs were 68 kg grain kg −1 N, 385 kg grain kg −1 P and 69 kg grain kg −1 K for a balanced nutrition. The model predicted a decrease in IEs when yield targets approached Y max . The derived borderlines are valid for current modern, high-yielding indica cultivars with a harvest index of 0.50 kg kg −1 and can be used for all methods of crop establishment. Only Y max is required as site- or season-specific information when estimating nutrient requirements for a yield target making the model applicable for all irrigated lowlands in South- and Southeast Asia. Predicted IEs were greater than actual IEs measured in more than 200 farmers' fields ( n ∼ 700), the latter averaging 59 kg grain kg −1 N (27–100 kg kg −1 ), 354 kg grain kg −1 P (158–1069 kg kg −1 ), and 64 kg grain kg −1 K (27–179 kg kg −1 ) with grain yields ranging from 1.5 to 9.9 t ha −1 (mean 5.2 t ha −1 ). Low and varying IEs in the farmers' practice were caused by nutritional imbalances, inadequate irrigation, or problems with pests and weeds.

In cardiac muscle, the giant protein titin exists in different length isoforms expressed in the molecule's I-band region. Both isoforms, termed N2-A and N2-B, comprise stretches of Ig-like modules separated by the PEVK domain. Central I-band titin also contains isoform-specific Ig-motifs and nonmodular sequences, notably a longer insertion in N2-B. We investigated the elastic behavior of the I-band isoforms by using single-myofibril mechanics, immunofluorescence microscopy, and immunoelectron microscopy of rabbit cardiac sarcomeres stained with sequence-assigned antibodies. Moreover, we overexpressed constructs from the N2-B region in chick cardiac cells to search for possible structural properties of this cardiac-specific segment.We found that cardiac titin contains three distinct elastic elements: poly-Ig regions, the PEVK domain, and the N2-B sequence insertion, which extends ∼60 nm at high physiological stretch. Recruitment of all three elements allows cardiac titin to extend fully reversibly at physiological sarcomere lengths, without the need to unfold Ig domains. Overexpressing the entire N2-B region or its NH2 terminus in cardiac myocytes greatly disrupted thin filament, but not thick filament structure. Our results strongly suggest that the NH2-terminal N2-B domains are necessary to stabilize thin filament integrity. N2-B–titin emerges as a unique region critical for both reversible extensibility and structural maintenance of cardiac myofibrils.

Reaction parameters were optimized for the synthesis of high molecular weight ω-phenylalkyl-substituted derivatives of poly(p-xylylene) (PPX) by base-induced 1,6-dehydrohalogenation of corresponding 4-halogenomethyltoluenes. Glass transition temperatures decreased systematically with increasing alkyl spacer of the lateral substituent. The highest elongation at break was observed for the 4-phenylbutyl-substituted PPX. Level I tests on the biocompatibility of 4-phenylbutyl-substituted PPX indicated low toxicity.

The aim of the present study was to investigate the influence of the chemical insertion of poly(ethylene oxide), PEO, into a poly(lactide-co-glycolide), PLG, backbone on the mechanisms of in vitro degradation and erosion of the polymer. For this purpose microspheres prepared by a modified W/O/W double emulsion technique using ABA triblock copolymers, consisting of PLG A-blocks attached to central PEO B-blocks were compared with microspheres prepared from PLG. Due to their molecular architecture the ABA triblock copolymers differed in their erosion and degradation behavior from PLG. Degradation occurred faster in the ABA polymers by cleavage of ester bonds inside the polymer backbone. Even erosion was shown to start immediately after incubation in different buffer media. By varying pH and ionic strength of the buffer it was found that both mass loss and molecular weight decay were accelerated in alkaline and acidic pH in the case of the ABA triblock copolymers. Although the pH of the medium had a moderate influence on the degradation of PLG, the molecular weight decay was not accompanied by a mass loss during the observation time. In a second set of experiments we prepared bovine serum albumin, BSA, loaded microspheres from both polymers. The release of BSA from ABA microspheres under in vitro conditions parallels the faster swelling and erosion rates. This could be confirmed by electron paramagnetic resonance, EPR, measurements with spin labeled albumin where an influx of buffer medium into the ABA microspheres was already observed within a few minutes. In contrast, PLG microspheres revealed a burst release without any erosion. The current study shows that the environmental conditions affected the degradation and erosion of the pure polymer microspheres in the same way as the release of the model protein. This leads to the conclusion that the more favorable degradation profile of the ABA triblock copolymers was responsible for the improvement of the release profile.

Pulmonary arterial hypertension (PAH) is a progressive disease, with right-heart failure being the main cause of death. In patients refractory to conventional drug therapy, atrial septostomy can serve as palliative treatment or as a bridge to transplantation. A 41-year-old woman with a 15-year history of PAH associated with a corrected atrial septal defect presented with severe deterioration of symptoms. Echocardiography confirmed reocclusion of an atrial septal stoma that had been created several months before. After performing a repeat atrial septostomy, we implanted a custom-made atrial septostomy device, an Amplatzer septal occluder that had been fenestrated to serve as a custom-made atrial septostomy device. This resulted in an improvement in cardiac output and a marked symptomatic relief. During the 6-year follow-up, the patient was clinically stable with limited but constant exercise tolerance, under specific medical therapy. Repeated echocardiography confirmed long-term patency of the device.

Mutations in the human cardiac troponin T gene (TNNT2) are associated with familial hypertrophic cardiomyopathy (FHC) linked to chromosome 1q3 (CMH2). Mutation analyses of TNNT2 have been restricted to RNA-based screening methods because only the TNNT2 cDNA sequence was known. We characterized the genomic structure of 15 TNNT2 exons spliced into the adult isoform. A protocol for rapid mutation detection based on direct sequencing of large PCR-amplified genomic DNA fragments revealed a known TNNT2 mutation (Phe110Ile) in one of 30 FHC probands. Three polymorphic short tandem repeat elements (D1S477, D1S2622, and D1S1723), useful for FHC pedigree analyses at CMH2, were shown to be physically tightly linked to TNNT2.

Background In dilative cardiomyopathy several factors influence dyspnoea. Patients with chronic heart failure may demonstrate impairment of breathing pattern, ventilatory drive and respiratory muscle strength, as well as reduction of ventilatory efficiency. The purpose of this study was to evaluate whether dilative cardiomyopathy is accompanied by changes in breathing pattern, respiratory muscle weakness and ventilatory neural drive. Methods We investigated 47 patients (36 men, mean age=47-8 ± 11-2 years) with chronic heart failure due to dilative cardiomyopathy, and 30 healthy subjects (10 men, mean age = 35-4± 11-7 years) served as controls. Patients and controls underwent evaluation of left ventricular ejection fraction by 2D echocardiography, spirometry, body plethysmography, mouth occlusion pressure and respiratory muscle strength, as well as by submaximal treadmill exercise testing with gas exchange measurements. The patients' results were compared to controls and predicted standard normal values, and evaluated for differences according to the degree of severity of functional impairment. Results Patients with dilative cardiomyopathy demonstrated a slight reduction in lung volumes (15% of the patients with obstructive and 15% with restrictive lung function pattern) and diffusion capacity (20-4 ± 6-8 vs 15-4 ±6-7 ml. min" 1 . kPa" '; P

Purpose: This retrospective study was done to determine the frequency and radiographic pattern multiple myeloma in the mandible. Patients and Methods: Seventy-seven patients with multiple myeloma were studied using skull and panoramic radiographs of the jaws made at the time of initial diagnosis. Results: Skull manifestations were present in 46.7% and jaw manifestations in 15.6% of the cases studied. The pattern of jaw involvement was characterized by osteolytic lesions without other radiographic manifestations of bone involvement. There was no relationship between the pattern of jaw and extragnathic involvement and increased M-component of secreted immune globulin. Jaw involvement was largely unaccompanied by oral symptoms. Conclusion: The results suggest that mandibular lesions are a common finding in multiple myeloma.

As much as one-third of patients develop fever and flu-like symptoms after fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) for yet unknown reasons. The aim of the present study was to investigate factors mediating these side effects. Fifty consecutive patients with various pulmonary diseases who underwent FOB without further interventions (n = 30) or combined with BAL (n = 20) were enrolled. Serum levels of the proinflammatory cytokines IL-1beta, IL-6, and TNF-alpha were determined directly prior to (t0), directly after (t1), and 6 h after (t2) the procedures by ELISA. In parallel, blood cultures were drawn at t2. At to and t1, generally only low cytokine concentrations could be detected. At t2, however, significant increases of cytokine levels were found. IL-6 and TNF-alpha were significantly higher in patients after BAL than in patients after FOB. Comparing patients who developed fever (n = 12) with those who did not (n = 38), irrespective of the endoscopic procedures performed, dramatic increases of all three cytokines were detected in febrile patients that were significantly higher than in patients without fever. In the FOB group only patients who received local anesthesia by prilocaine bolus injection into the airways via the working channel of the bronchoscope developed fever and increases of IL-6 and IL-beta, whereas patients anaesthetized by inhalation of a prilocaine aerosol remained afebrile and had slight IL-6 increases only. There was a highly significant correlation between IL-6 values at t2 and the number of BAL alveolar macrophages (r = 0.98). All blood cultures remained sterile. These results indicate that fever after FOB and BAL is induced by proinflammatory cytokines derived from alveolar macrophages activated by instillation of fluid into the airways.

Interventional pneumology includes both bronchological and vascular methods of diagnosis and therapy, especially in emergency situations such as pulmonary hemorrhage. In massive pulmonary hemorrhage bronchological diagnosis is required to determine the site and extent of bleeding, as well as angiography of bronchial arteries, and of pulmonary arteries. Bronchus occlusion by aid of balloon catheter or double lumen tube are holding measures until definitive surgery or embolization of bronchial or pulmonary arteries can be performed. The paper suggests a close relationship between bronchoscopic and angiographic diagnosis and therapy in case of severe pulmonary bleeding.

Study Design/Materials and Methods: The aim of this experimental study was to investigate the effect of Nd:YAG laser on metallic trachebronchial stents, because Nd:YAG laser could be used for resection of tumourous tissue growing through stent meshes (Strecker-, Palmaz-, Wallstent). Study Design/Materials and Methods: An in vitro worst-case-model was used to investigate the effects of different types of laser application on metallic stents: non-contact application, and contact application with bare fibres and with hemispherical sapphires. Results: In the non-contact method and with bare fibres stent destruction occurred at power settings exceeding 10 W, whereas in the contact method with hemispherical sapphires power settings of 20 W were possible without stent damage.

This paper addresses the diagnosis and management of superior vena cava syndrome (SVCS) due to malignant intrathoracic tumours. Diagnosis of SVCS is usually established by bedside examination. Chest X-ray and computed tomography may be helpful, but the cavography remains the “gold-standard”. Other imaging techniques (MRI, nuclear flow studies) are more of scientific interest. Bronchoscopy helps to evaluate the risk of pulmonary complications and endoscopic procedures often lead to histological findings. In the treatment of malignant SVCS surgery, radiotherapy, and chemotherapy have been successfully used. The placement of a vascular stent might be an additional or alternative possibility. There are no conclusive indication criteria and no conclusive regimen concerning post-stenting anticoagulation. From all reported results and published papers we draw the conclusion that the immediate effects of stent implantation and the long-term results of tumour-specific therapy are complementary to one another. The stent dilates the local venous stenosis while tumour-specific therapy has a general effect on the vascular and respiratory situation in a multi-therapy concept.

After Mandel and Metais (1) had originally described the existence of free circulating nucleic acids in plasma/serum in humans, Stroun et al. (2)(3) demonstrated that part of the free circulating DNA in cancer patients is of tumor origin (4)(5)(6). The quantity of DNA that can be isolated from human plasma/serum is very low and is frequently the limiting factor when a larger marker panel is to be used for genetic characterization of the DNA. In most of the recently published studies, commercially available columns were used for isolation of cell-free plasma/serum DNA, which made DNA isolation fast and allowed it to be standardized. Mandel and Metais (1) found ∼5.4 μg/mL total nucleic acids in the plasma in 10 healthy controls, and Stroun et al. (3) isolated between 150 ng/mL and 12 μg/mL DNA from the plasma of cancer patients. Much less DNA can be isolated with the aforementioned columns, however; we therefore wondered whether there are ways …

Circulating cell-free nucleic acids have been detected in serum. In cancer patients levels of free DNA seem to be higher than in non-tumor controls and the detectable nucleic acids are partly of tumor origin. We asked whether free RNA can be detected as well in cell-free bronchial lavage fluid (BLF) supernatant, and whether quantification of free RNA allows to discriminate between tumor and non-tumor patients. 73 patients with lung cancer (NSCLC n=62, SCLC n=11) and 56 patients with non-malignant lung diseases were included. The RNA was isolated from 1 mL serum and lavage, respectively with the Quiamp MinElute Virus Vacuum Kit (Qiagen, Germany). A real-time quantitative RT-PCR assay was used for transcript quantification of the glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene. Intact RNA was detectable in cell-free supernatants of BLF from 126/129 patients and was investigated in all 64 serum samples. RNA levels were higher in the cell-free supernatant of BLF than in serum. RNA concentration in the BLF from tumor patients was higher than in patients with a benign lung disease (p=0.009). In conclusion, quantification of intact RNA isolated from BLF supernatant and from serum might become a valuable tool for differentiation between tumor and non-tumor patients.

Purpose Data from previous studies show that everolimus can facilitate CNI minimization with comparable efficacy and safety, while simultaneously reducing CNI-induced chronic nephropathy in transplant recipients. The 4EVERLUNG study (NCT01404325) aims to evaluate the impact of a “quadruple low” immunosuppressive regimen on renal function, safety and efficacy in lung transplant recipients (LTxR). Methods and Materials 4EVERLUNG is a multi-center, randomized, controlled, open-label trial. Overall, 232 LTxR will be randomized to receive either Everolimus (C 0-h 4±1ng/mL) + reduced CNI (Tac C 0h 3-5ng/mL or CsA C 0h 50±25ng/mL) + MPA + steroids or standard CNI (Tac C 0h >5ng/mL or CsA C 0h >100ng/mL) + MPA + steroids. Everolimus introduction and CNI reduction in the “quadruple low” arm should be achieved latest within two weeks post randomization. One primary objective is to demonstrate superior renal function after partial substitution of CNIs by Everolimus 12 months post randomization. Moreover, significant inhibition of the progression of bronchiolitis obliterans syndrom (BOS) could be an effect by using Everolimus. Key secondary objectives at the end of study include non-inferior efficacy (BPAR, graft loss, death), safety (infections, hypertension, hyperlipidemia) and evaluation of the patient’s quality of life (QoL, SF36). Results Recruitment started in Feb 2012, whereas 21 patients at seven transplantation centers have been randomized in 4EVERLUNG until Nov 2012. Conclusions Reducing CNI-dependent side effects such as chronic allograft nephropathy, which contribute to fatal long-term outcomes after Tx, represent one of the most pressing issues in transplantation. The results of 4EVERLUNG might therefore contribute to evaluate the benefit of an innovative “quadruple low” immunosuppressive regimen in LTxR by preserving renal function and/or limiting progression of BOS.

Nemaline myopathy is the most common congenital skeletal muscle disease, and mutations in the nebulin gene account for 50% of all cases. Recent studies suggest that the disease severity might be related to the nebulin expression levels. Considering that mutations in the nebulin gene are typically recessive, one would expect that a single functional nebulin allele would maintain nebulin protein expression which would result in preserved skeletal muscle function. We investigated skeletal muscle function of heterozygous nebulin knock-out (i.e., nebulin(+/-)) mice using a multidisciplinary approach including protein and gene expression analysis and combined in vivo and in vitro force measurements. Skeletal muscle anatomy and energy metabolism were studied strictly non-invasively using magnetic resonance imaging and 31P-magnetic resonance spectroscopy. Maximal force production was reduced by around 16% in isolated muscle of nebulin(+/-) mice while in vivo force generating capacity was preserved. Muscle weakness was associated with a shift toward a slower proteomic phenotype, but was not related to nebulin protein deficiency or to an impaired energy metabolism. Further studies would be warranted in order to determine the mechanisms leading to a mild skeletal muscle phenotype resulting from the expression of a single nebulin allele.

Background: The prevalence of cardiovascular mortality is high in Chronic Obstructive Pulmonary Disease (COPD) and the identification of clinical parameters to improve risk stratification is of great interest. Objectives: This study aims to assess the predictive strength of daily walking activity on expression of cardiac biomarkers in patients with COPD. Methods: One hundred and five patients with COPD (66.1 ± 8.7 years of age) were prospectively analyzed. Daily walking activity was measured by means of accelerometry. Stepwise multivariate regression analyses were employed with either midregional proatrial natriuretic peptide (MRproANP) or plasma proadrenomedullin (MRproADM) as dependent variables, and age, age-adjusted Charlson score, Modified Medical Research Council Dyspnea Scale (MMRC), Saint Georges Respiratory Questionnaire total score and either total walk, steps per day or fast walk as covariates. Results: Independent predictors of MRproANP included age (p = 0.015) and either total walk or steps per day (both p < 0.0001). Total walk or steps per day were the only independent predictors of MRproADM (p < 0.0001). There was a significant negative correlation between fast walk and MMRC (R = -0.70; p < 0.001) and fast walk was only independently predictive of MRproANP but not MRproADM once MMRC was excluded from the list of covariates (p = 0.023 and p = 0.057, respectively). Conclusions: Daily walking activity independently predicts levels of circulating MRproANP and MRproADM in stable COPD patients, two prognostic biomarkers of cardiac distress associated with long-term survival upon exacerbation of COPD. Employing activity monitors in the stable state might simplify risk stratification in daily living.

Die idiopathische pulmonale Fibrose (IPF) ist eine schwerwiegende und in der Regel zum Tod fuhrende Erkrankung, die bisher nur unzureichend behandelt werden kann. Empfehlungen zur Diagnostik und Therapie wurden erstmals im ATS-ERS-Statement im Jahr 2000 publiziert 1 . Seither haben sich die diagnostischen Standards geandert und es liegen zahlreiche Therapiestudien zu diesem Krankheitsbild vor, die es erforderlich machten, die bestehenden Empfehlungen zu uberarbeiten und eine wissenschaftlich begrundete Leitlinie zu erstellen. Diese wurde von einer internationalen Expertengruppe in den Jahren 2006 – 2010 erarbeitet und publiziert 2 . Die folgenden Ausfuhrungen beinhalten eine Ubersetzung wesentlicher Inhalte der Originalleitlinie sowie die Interpretation und Adaptation der Empfehlungen an die speziellen Belange des deutschen Gesundheitssystems, wobei auch neue wissenschaftliche Erkenntnisse Berucksichtigung fanden. Die Deutsche Leitlinie zur Diagnostik und Therapie der IPF beruht auf einer Initiative deutscher Experten unter der Schirmherrschaft der Deutschen Gesellschaft fur Pneumologie und Beatmungsmedizin (DGP) und auf den Ergebnissen einer Konsensuskonferenz, die am 3. 12. 2011 in Bochum unter Supervision der „Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)“ abgehalten wurde. Die Mehrzahl der Empfehlungen der internationalen Leitlinie konnten dabei ubernommen werden. Basierend auf aktuellen Studienergebnissen, die zum Zeitpunkt der Verabschiedung der internationalen Leitlinie noch nicht bzw. nicht vollstandig vorlagen wurden die schwach negativen Empfehlungen fur die Antikoagulantientherapie und die Kombinationstherapie mit Prednison, Azathioprin und N-Acteylcystein in stark negative Empfehlungen umgewandelt, wahrend fur Pirfenidon, welches inzwischen in der Europaischen Union zugelassen ist, eine schwach positive Therapieempfehlung ausgesprochen wurde.

Purpose The Lung Allocation Score (LAS), first introduced in the United States in 2005, was developed with the aim of allocating organs based on predicted transplant benefit. Analysis of its impact in the US revealed reduced waiting times, increased numbers of procedures and decreased mortality amongst listed patients. Transplant survival appeared unchanged. On December 10th 2011, Germany became the first European country to adopt LAS for organ allocation, abandoning the previous urgency system. The current study compares the effects of LAS on transplant activity, wait list mortality and outcomes directly before and after its introduction. Methods and Materials Retrospective analysis of all 506 patients undergoing lung transplantation between 14.03.2011 and 05.09.2012 was performed comparing a 9 month period before and after the introduction of LAS. Results Of these patients, 252 were transplanted prior to the introduction of LAS and 254 thereafter (p=0.68). Despite an increase in waiting list registrations, a net reduction in the number of active patients on the waiting list of 20% was observed. A significant reduction in median time to transplantation amongst transplant recipients was observed under LAS (108 vs. 208 days, p=0.001). Age of transplant recipients and the composition of underlying diagnoses did not change significantly since LAS introduction. No change in waiting list mortality were observed, remaining at 19% in both periods. A trend towards increased prevalence of ventilatory or ECMO support prior to transplantation post-LAS introduction were noted (15 vs. 26 pts. p=0.077). Conclusions Early experience with LAS in Germany corroborates previous reports from the United States. Increased numbers of procedures and improved waiting times, without any detrimental effects on early survival are apparent. Regular and objective reassessment of patients after listing acts as an early warning system, leading to earlier transplantation in unstable patients.

The diagnostic relevance of bronchoalveolar lavage (BAL) and associated non-invasive findings in connective tissue diseases (CTD) has not been established regarding alveolitis so far. The goal of the study was to determine the relations between BAL cell differential count and findings of non-invasive diagnostic procedures for alveolitis to predict the clinical value of BAL in CTD.One hundred-five patients (92 non-smokers; 13 smokers) with CTD (73 patients with systemic sclerosis, 19 with systemic lupus erythematosus, 13 with primary Sjögren's syndrome) had symptoms or signs of lung involvement and were further examined (lung function test, chest radiography, thoracic computed tomography, 67 gallium scintigraphy and BAL). The relations between BAL in middle lobe and cell count differentiation to non-invasive investigations were analyzed by logistic regression.In all CTD patients investigated a pulmonal involvement occurred based on non-invasive methods. Regarding non-invasive methods, alveolitis determined by BAL cell differential count was significantly associated with an increased 67-gallium uptake and late inspiratory crackles (P < 0.01), and to a lesser extent with an abnormal interstitial pattern in CT (P < 0.055). Parameters of lung function and laboratory parameters were related to alveolitis using multivariate testing. Considering the alveolities subtype (granulo- or lymphocytosis), only a reduced FEV1showed a relationship to granulocytic alveolitis (P < 0.01).Late inspiratory crackles and increased 67 gallium uptake as non-invasive diagnostic findings point out alveolitis in CTD remarkably. Therapeutic and prognostic aspects necessitate BAL to specify the type of alveolitis (lymphocytosis or granulocytosis or mixed forms) in CTD patients with lung manifestation. Non-invasive diagnostic procedures cannot predict the type of alveolitis sufficiently.

We report here on two cases of double airway and esophageal stenting in patients with multiple esophagotracheal fistulas and stenoses of the airways and esophagus due to squamous-cell carcinoma. Dumon stents and a Strecker device were used for tracheobronchial stenting. Covered Gianturco Z-stents were implanted into the esophagus. In one case, extrinsic compression of the trachea and tumor progression required recanalization by Nd :YAG laser. Clinical improvement led to discharge of the patients within two weeks after the procedure. The results show that simultaneous implantation of stents in the central airways and covered Gianturco Z-stents in the esophagus is an effective therapeutic strategy in patients with tracheal and esophageal obstructions and esophagorespiratory fistulas. Further systematic studies evaluating double stenting are warranted.

Background. Two-dimensional transesophageal echocardiography is the most widely used diagnostic approach in the rare entity of heart tumors. The aim of this study was to assess the diagnostic usefulness of three-dimensional echocardiography in comparison with the two-dimensional technique in a rare clinical setting. Methods. Twenty-seven patients (18 women; mean age, 49.7 ± 14 years) with a histologically proven diagnosis of a cardiac tumor were studied. The primary diagnosis was done by two-dimensional transthoracic echocardiography (n = 9) and transesophageal echocardiography (n = 18). In addition, we performed three-dimensional trans-esophageal assessment in 5 patients with left atrial myxomas. The echocardiographic findings were compared with the intraoperative appearance and pathologic diagnosis. Results. The echocardiographically suspected diagnosis of a heart tumor in 29 cases was histologically correct in 27 patients (myxomas, 20; epicardial lipoma, 1; malignant epicardial mesothelioma, 1; metastatic processes of hypernephromas, 2; and undifferentiated tumors of the pericardium, 3). Only the combination of multiplane transesophageal and three-dimensional echocardiography was able to demonstrate the shape, dimensions, location, origin, surface, three-dimensional movement, and involvement of valves and was most useful in the preoperative diagnosis and planning. Conclusions. Three-dimensional transesophageal echocardiography yields important additional clinical information and improves the operative planning. Three-dimensional echocardiography may become the best approach to study the anatomy and pathology of the heart as it provides an objective display of cardiac size and shape in heart tumors.

Ziel der vorliegenden prospektiven Untersuchung war es, die Effizienz, Komplikationsrate sowie den Verlaufnach endotrachealer Stentimplantation bei benignen oder malignen Stenosierungen zu prUfen. Im Zeitraum 1992–1995 wurden bei 31 Patienten mit Trachealstenosen (16 benigne, 15 maligne) Stentimplantationen (22 Dumon-, 2 Dynamic- und 7 Strecker-Stents) vorgenommen. Die Stentimplantationen verliefen in 29 Fallen komplikationslos und fUhrten zu deutlicher klinischer und lungenfunktioneller Besserung. Die Entscheidung zur Dauer der Stentbehandlung leitet sich aus der Grunderkrankung (benigne oder maligne Stenose), den geplanten weiteren Massnahmen und dem prospektiven Verlauf im Sinne einer Konsolidierung der Stenoseursache ab. Unsere Ergebnisse lassen die Schlussfolgerung zu, dass bei Trachealstenosen die Stentimplantation in das Therapiekonzept mit einzubeziehen ist.

Introduction: The Lung Volume Reduction Coil (LVRC) is a bronchoscopic device made of self-expandable nitinol wire for the treatment of emphysema. A previous single center pilot study showed safety and efficacy in severe upper-lobe emphysema. Aim: In this study we investigated the feasibility, safety and efficacy of LVRC treatment in a multicenter cohort trial design in patients with severe upper or lower lobe heterogeneous emphysema. Methods: 44 patients (23F/21M, 60yrs (±11), FEV1 29.9%pred (±6.9%), RV 249%pred (±52%), TLC 135%pred (±16%)) were bronchoscopically treated under general anesthesia using fluoroscopy with LVRCs (PneumRx, USA) in either one or two lungs (in two sequential procedures) in 10 European centers. Safety was evaluated by recording of all adverse events (AEs). Efficacy as measured by questionnaires, pulmonary function- and exercise testing will be measured at 3, 6 and 12 months post treatment. Results: 83 LVRC procedures were performed (39 bilateral, 5 unilateral). 33 patients were treated in the upper lobes and 11 in the lower lobes. The mean procedure time was 50 mins (±24), using a median of 10 coils (range 8-14) per lobe. The coil lengths used were 70mm (2x), 85mm (19x), 100mm (352x), 125mm (347x), 150mm (81x) and 175mm (25x). AEs

Electron–phonon coupling processes determine electronic transport properties of materials and are responsible for the transfer of electronic excess energy to the lattice. With decreasing device dimensions an understanding of these processes in nanoscale materials is becoming increasingly important. Here we use time-resolved electron diffraction to directly study energy relaxation in thin bismuth films after optical excitation. Precise measurements of the transient Debye–Waller-effect for various film thicknesses and over an extended range of excitation fluences allow to separate different contributions to the incoherent lattice response. While phonon softening in the electronically excited state is responsible for an immediate increase of the r.m.s. atomic displacement within a few hundred fs, ‘ordinary’ electron–phonon coupling leads to subsequent heating of the material on a few ps timescale. The data reveal distinct changes in the energy transfer dynamics which becomes faster for stronger excitation and smaller film thickness, respectively. The latter effect is attributed to a crossinterfacial coupling of excited electrons to phonons in the substrate. OA gold

The need for a less invasive procedure than surgical lung volume reduction that can produce consistent improvements with reduced morbidity remains a medical goal in patients with emphysema. We sought to determine the effect of bronchoscopic thermal vapour ablation (BTVA) on lung volumes and outcomes in patients with emphysema. 44 patients with upper lobe-predominant emphysema were treated unilaterally with BTVA. Entry criteria included: age 40-75 yrs, forced expiratory volume in 1 s (FEV(1)) 15-45% predicted, previous pulmonary rehabilitation and a heterogeneity index (tissue/air ratio of lower lobe/upper lobe) from high-resolution computed tomography (HRCT) ≥ 1.2. Changes in FEV(1), St George's Respiratory Questionnaire (SGRQ), 6-min walk distance (6 MWD), modified Medical Research Council (mMRC) dyspnoea score, and hyperinflation were measured at baseline, and 3 and 6 months post-BTVA. At 6 months, mean ± SE FEV(1) improved by 141 ± 26 mL (p

Background: Bronchoscopic thermal vapor ablation (BTVA) ablates emphysematous tissue through a localized inflammatory response followed by contractive fibrosis and tissue shrinkage leading to lung volume reduction that should not be influenced by collateral ventilation. Objectives: To determine the correlation of clinical data from a trial of BTVA with fissure integrity visually assessed by computed tomography (CT). Methods: We conducted a single-arm study of patients with upper lobe-predominant emphysema (n = 44). Patients received BTVA either to the right upper lobe or left upper lobe, excluding the lingula. Primary efficacy outcomes were forced expiratory volume in 1 s (FEV1) and St. George’s Respiratory Questionnaire (SGRQ) at 6 months. Lobar volume reduction from CT was another efficacy outcome measurement. The fissure of the treated lobe was analyzed visually on preinterventional CT. Incompleteness of the small fissure, the upper half of the right large fissure and the whole left large fissure were estimated visually in 5% increments, and the relative amount of fissure incompleteness was calculated. Pearson correlation coefficients were calculated for the association between fissure incompleteness and change in efficacy outcomes (baseline to 6 months) of BTVA. Results: A total of 38 out of 44 patients (86%) had incompleteness in the relevant fissure. Calculated relevant fissure incompleteness was a mean of 13% of fissure integrity (range 0–63). Correlation coefficients for the association of incompleteness with outcomes were as follows: FEV1 = 0.17; lung volume reduction = –0.27; SGRQ score = –0.10; 6-min walk distance = 0.0; residual volume (RV) = –0.18, and RV/total lung capacity = –0.14. Conclusions: Lobar fissure integrity has no or minimal influence on BTVA-induced lung volume reduction and improvements in clinical outcomes.

Item does not contain fulltext RATIONALE: Postoperative pulmonary complications are significant contributors to morbidity in patients who have undergone upper abdominal, thoracic, or cardiac surgery. The pathophysiology of these complications might involve postoperative inspiratory muscle weakness. The nature of postoperative inspiratory muscle weakness is unknown. OBJECTIVE: To investigate the effect of surgery on the functioning of the diaphragm, the main muscle of inspiration. METHODS: Serial biopsies from the diaphragm and the latissimus dorsi muscle were obtained from 6 patients during thoracotomy for resection of a tumor in the right lung. Biopsies were taken as soon as the diaphragm had been exposed (t(0)) and again after 2 hours (t(2)). The contractile performance of demembranated muscle fibers, as well as fiber morphology and markers for proteolysis, was determined. RESULTS: In all patients, the force-generating capacity of diaphragm muscle fibers at t(2) was significantly reduced (~35%) compared with that at t(0), with a more pronounced force loss in type 2 fibers compared with type 1 fibers. Diaphragm weakness was not part of a generalized muscle weakness as contractile performance of latissimus dorsi fibers was preserved at t(2). Diaphragm fiber size and myofibrillar structure were not different at t(2) compared with t0, but myosin heavy chain type 2 was significantly reduced at t(2) and MuRF-1 mRNA and protein levels were elevated at t(2). CONCLUSIONS: Only 2 hours of thoracic surgery causes marked, and selective, diaphragm muscle fiber weakness. 01 december 2011

Test structures for electromigration with defined grain boundary configurations can be fabricated using focused ion beam (FIB). We present a novel approach of combining epitaxial growth of Ag islands with FIB milling. Depending on the growth parameters, bi-crystalline Ag islands can be grown on Si(111) surfaces and can be structured into wires by FIB. To avoid doping effects of the used Ga FIB, silicon on insulator (SOI) substrates are used. By cutting through the device layer of the SOI substrate with deep trenches, the Ag wire can be electrically separated from the rest of the substrate. In this way, Ag wires with one isolated grain boundary of arbitrary direction can be assembled. Using scanning electron microscopy we demonstrate the feasibility of our approach.