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Introduction: Lung cancer patients (LCP) require invasive evaluation of left adrenal glands (LAG) if distant metastases (M1b/1c) are suspected in CT or PET-CT. Only few studies showed utility of endosonography and particularly EUS-b-FNA as minimally invasive endoscopic method of LAG analysis. Material and Methods: A retrospective study of consecutive LCP was conducted in two pulmonology centers between January 2010 and December 2019. Records of complete endosonographic staging with use of single ultrasound bronchoscope or two scopes were overviewed. The analysis included cases of enlarged LAG (body size or limbs > 10 mm) examined and sampled by EUS-b-FNA or EUS-FNA. Results: 142 of 2596 LCP staged by complete endosonography (M: 88, F: 54 mean age 64.7) had enlarged LAG, which were biopsied by conventional EUS-FNA (52) and/or by EUS-b-FNA (90). Strong correlation with gland diameter (p < 0.001) was observed. The incidence of LAG metastases in analyzed group was 52.1% (74/142) and regarding histology: SCLC 76.9% (10/13), adenocarcinoma 66.7% (44/66), NSCLC 56.3% (9/16) and SCC 17.5% (7/40). A specificity and PPV for both methods were 100%. A sensitivity, accuracy and NPV for EUS-FNA were 91.7%, 96.2%, 93.3% and for EUS-b-FNA 88%, 93.3% and 87%, respectively and no significant differences for both methods were noted (p = 0.62, 0.44, 0.35). No severe complications afterall biopsies were observed. A six months clinical follow up included all negative LCP with enlarged LAG. Conclusions: After our study EUS-b-FNA seems to be a reasonable method of choice for LAG assesssment in LCP.

Background To date, there has been no reliable in vitro test to either diagnose or differentiate nonsteroidal anti‐inflammatory drug (NSAID)–exacerbated respiratory disease (N‐ERD). The aim of the present study was to develop and validate an artificial neural network (ANN) for the prediction of N‐ERD in patients with asthma. Methods This study used a prospective database of patients with N‐ERD (n = 121) and aspirin‐tolerant (n = 82) who underwent aspirin challenge from May 2014 to May 2018. Eighteen parameters, including clinical characteristics, inflammatory phenotypes based on sputum cells, as well as eicosanoid levels in induced sputum supernatant (ISS) and urine were extracted for the ANN. Results The validation sensitivity of ANN was 94.12% (80.32%‐99.28%), specificity was 73.08% (52.21%‐88.43%), and accuracy was 85.00% (77.43%‐92.90%) for the prediction of N‐ERD. The area under the receiver operating curve was 0.83 (0.71‐0.90). Conclusions The designed ANN model seems to have powerful prediction capabilities to provide diagnosis of N‐ERD. Although it cannot replace the gold‐standard aspirin challenge test, the implementation of the ANN might provide an added value for identification of patients with N‐ERD. External validation in a large cohort is needed to confirm our results., Artificial neural network based on a set of clinical and biochemical parameters is able to stratify N‐ERD patients among asthmatic population. The sensitivity of the present artificial neural network is 94.12% and specificity is 73.08% for the prediction of N‐ERD. Artificial neural network could become a screening tool and allow to quickly identify patients with a high suspicion of N‐ERD

Patients with resectable lung cancer require invasive evaluation of the enlarged left adrenal gland (LAG). Few studies showed the utility of endoscopic ultrasound using ultrasound bronchoscope (EUS‑B) in LAG assessment. Moreover, little is known on the combination of computed tomography (CT), positron emission tomography-computed tomography (PET‑CT), and EUS‑B for predicting left adrenal metastasis.In this retrospective cohort study performed from 2012 to 2019, patients with left adrenal enlargement were evaluated by CT, PET‑CT, and EUS‑B, followed by complete endoscopic mediastinal staging. The adrenal glands were sampled by EUS‑B-guided fine‑needle aspiration. Patients were followed for 6 months.During the staging of lung cancer in 2176 patients, 113 enlarged LAGs (5.19%) were biopsied. Malignancy was reported in 51 LAGs (45.13%). Endoscopic ultrasound upstaged 7 patients (6.2%) and downstaged 11 patients (9.37%) after false CT or PET‑CT findings. There were no biopsy‑related complications. Radiologic predictors of left adrenal metastases had the highest yield at the following cutoff points: Hounsfield units23, standardized uptake value4.2, and LAG size25 mm. Hypoechogenic LAGs with loss of sea‑gull shape on EUS‑B were associated with a 28.67‑fold higher likelihood of metastases. The sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for all ultrasound predictors were 86.21%, 85.45%, 85.84%, 85.45%, and 86.21%, respectively. When combined with radiologic features, the respective values were 93.10%, 94.55%, 93.81%, 92.86%, and 94.74%.Hypoechogenicity and loss of sea‑gull shape on EUS‑B are the most reliable predictors of left adrenal metastasis. The combination of CT, PET‑CT, and EUS‑B improves the noninvasive diagnosis of left adrenal metastases in lung cancer patients.

Introduction Patients with resectable lung cancer require invasive evaluation of enlarged left adrenal gland (LAG). There are only few studies showing utility of endosonography with single ultrasound bronchoscope (EUS-b) in LAG assessment. Combination of CT, PET-CT and EUS-b and ultrasonographic predictors of malignancy (M1b/c) in LAG are not well known. Patients and methods A two center cohort retrospective study was performed from 2012 to 2019. Enlarged LAGs were evaluated by CT, PET-CT and EUS-b. Then, a complete endoscopic mediastinal staging was performed, enlarged LAGs were sampled by EUS-b-FNA. Patients were followed up for 6-months. Results During the diagnosis of 2176 staged LCP, 113 (5.19%) enlarged LAGs were biopsied. 51 (45.13%) were positive for malignancy, predominantly adenocarcinoma (46.9%). Endosonography up-staged 7 (6.2%) patients, and down-staged 11 (9.37%) after false CT or PET-CT findings. No complications were noted after any biopsies. Radiological predictors of LAG metastases had the highest yield if cut offs were set as follows: HU>23, SUV>4.2 and LAG size >25mm. Hypoechogenic LAGs with loss of sea-gull shape in EUS-b indicated 28.67 times bigger likelihood of metastases. The sensitivity, specificity, accuracy, NPV and PPV for all measured ultrasound predictors were: 86.21%, 85.45%, 85.84%, 85.45%, 86.21%, combined with radiological measurements: 93.10%, 94.55%, 93.81%, 92.86% and 94.74%, respectively. Conclusions Hypoechogenicity and loss of sea-gull shape in EUS-b are the most reliable predictors of malignancy in enlarged LAG. A combination of radiological assessment based on CT/PET-CT and EUS-b findings improves noninvasive diagnostics for LAG metastases in LCP.

Background Aspirin desensitization followed by daily aspirin use is an effective treatment for aspirin-exacerbated respiratory disease (AERD). Objective To assess clinical features as well as genetic, immune, cytological, and biochemical biomarkers that might predict a positive response to high-dose aspirin therapy in AERD. Methods We enrolled 34 AERD patients with severe asthma who underwent aspirin desensitization followed by 52-week aspirin treatment (650 mg/d). At baseline and at 52 weeks, clinical assessment was performed; phenotypes based on induced sputum cells were identified; eicosanoid, cytokine, and chemokine levels in induced sputum supernatant were determined; and induced sputum expression of 94 genes was assessed. Responders to high-dose aspirin were defined as patients with improvement in 5-item Asthma Control Questionnaire score, 22-item Sino-Nasal Outcome Test (SNOT-22) score, and forced expiratory volume in 1 second at 52 weeks. Results There were 28 responders (82%). Positive baseline predictors of response included female sex (P=0.002), higher SNOT-22 score (P=0.03), higher blood eosinophil count (P=0.01), lower neutrophil percentage in induced sputum (P=0.003), higher expression of the hydroxyprostaglandin dehydrogenase gene, HPGD (P=0.004), and lower expression of the proteoglycan 2 gene, PRG2 (P=0.01). The best prediction model included Asthma Control Test and SNOT-22 scores, blood eosinophils, and total serum immunoglobulin E. Responders showed a marked decrease in sputum eosinophils but no changes in eicosanoid levels. Conclusions and clinical relevance Female sex, high blood eosinophil count, low sputum neutrophil percentage, severe nasal symptoms, high HPGD expression, and low PRG2 expression may predict a positive response to long-term high-dose aspirin therapy in patients with AERD.

This study aimed to analyze the effect of bilateral mediastinal lymphadenectomy (BML) on survival of non-small cell lung cancer (NSCLC) patients. The hypothesis was: BML offers survival benefit as compared with SLND.A randomized clinical trial including stage I-IIIA NSCLC patients was performed. All patients underwent anatomical lung resection. BML was performed during the same operation via additional cervical incision (BML group). In the control group, standard lymphadenectomy (systematic lymph node dissection, SLND) was performed.In total, 102 patients were randomized. No significant difference was found in the type of lung resection, blood loss, chest tube output, air leak, pain, and complications (p = 0.188-0.959). In the BML group, the operative time was longer (318 vs 223 min, p 0.001) with higher number of removed N2 nodes (24 vs 14, p 0.001). The 5-year survival rate was 72 % in the BML group vs 53 % in the SLND group (OR 2.33, 95 % CI 0.95-5.69, p = 0.062). Separate comparisons for different lobar locations of the tumor have shown no significant difference in survival for the right lung tumors and left upper lobe tumors. For the left lower lobe tumors, survival time was longer in the BML group (p = 0.021), and the 5-year survival rate was 90.9 % vs 37.5 %, (OR 16.66, 95 % CI 1.36-204.04, p = 0.0277).In patients with NSCLC located in the left lower lobe, bilateral lymph node dissection may be associated with better survival. The invasiveness of BML is comparable to that of SLND.

Introduction: Needle biopsy of enlarged lymph nodes is accepted method for the diagnosis of sarcoidosis, but there is still place for investigating the optimal endosonography guided approach. Objectives: The aim of this study was to assess the relative diagnostic yield of the combination (CUS-b-NA) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine-needle aspiration (EUS-b-FNA) but also a role of cell blocks (CB) and lymph node localization for the diagnosis of sarcoidosis. Methods: This was a prospective, multicenter study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. CUS-b-NA with smears and CB technique was performed within all group. If sarcoidosis was not confirmed invasive diagnostics was scheduled and 6 months follow-up was continued. Results: Since Nov 2017 to Sep 2019 fifty patients were enrolled for the final analysis. The overall sensitivity of EBUS-TBNA, EUS-b-FNA and CUS-b-NA was 76.6%, 70.2% and 91.7%, respectively. There were no significant differences between EBUS-TBNA and EUS-b-FNA (P=0.52) but CUS-b-NA had significantly higher yield (P=0.005 and P=0.001). No serious complications after all biopsies were observed. Adding CB to smear technique (P=0.008) and biopsy of the subcarinal lymph nodes (P=0.001) significantly increases the diagnostic yield. Conclusions: A diagnostic yield of CUS-b-NA is higher than endosonographic techniques alone in stage I and II of sarcoidosis. The preparation of cytological material including CB technique and the biopsy of subcarinal lymph node station increases diagnostic efficacy.

Introduction Needle biopsy of enlarged lymph nodes is an accepted method for the diagnostic workup of sarcoidosis, but the optimal endosonography‑guided approach is yet to be determined. Objectives The aim of our study was to assess the relative diagnostic yield of combined ultrasound‑guided needle aspiration (CUS‑b‑NA), which includes endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA) with endoscopic ultrasound fine‑needle aspiration (EUS‑b‑FNA), as well as the role of the cell block (CB) technique and lymph node localization in the diagnostic workup of sarcoidosis. Patients and methods This was a prospective multicenter study including consecutive patients with clinical suspicion of stage I or II sarcoidosis. CUS‑b‑NA with smears and CB technique were performed in the whole study group. If a biopsy result was not conclusive, an invasive diagnostic workup and a 6-month follow‑up were scheduled. Results Out of 77 screened patients, 54 signed written consent and 50 were enrolled for the final analysis. The overall sensitivity of EBUS‑TBNA, EUS‑b‑FNA, and CUS‑b‑NA was 76.6%, 70.2%, and 91.7%, respectively. There were no differences between EBUS‑TBNA and EUS‑b‑FNA (P = 0.52) but CUS‑b‑NA had a higher diagnostic yield (P = 0.005 and P = 0.001, respectively). Adding the CB method to smear technique (P = 0.008) and biopsy of the subcarinal lymph nodes increased the diagnostic yield (P = 0.001). Conclusions: The diagnostic yield of CUS‑b‑NA is higher than that of endosonographic techniques alone in the diagnostic workup of stage I and II sarcoidosis. The preparation of cytological material including CB and the choice of the subcarinal lymph node station for the biopsy increase the diagnostic efficacy.

Background Induced sputum (IS) allows to measure mediators of asthmatic inflammation in bronchial secretions. NSAID‐exacerbated respiratory disease (NERD) is recognized as a distinct asthma phenotype, usually with a severe course, eosinophilic airway inflammation, and increased production of pro‐inflammatory eicosanoids. A more insightful analysis of NERD patients has shown this phenotype to be nonhomogeneous. Objective We aimed to identify possible subphenotypes in a cohort of NERD patients with the means of latent class analysis (LCA). Methods A total of 95 asthma patients with aspirin hypersensitivity underwent sputum induction. High‐performance liquid chromatography or gas chromatography coupled with mass spectrometry was used to profile eicosanoids in induced sputum supernatant (ISS). Sixteen variables covering clinical characteristics, IS inflammatory cells, and eicosanoids were considered in the LCA. Results Three classes (subphenotypes) were distinguished within the NERD cohort. Class 1 subjects had mild‐to‐moderate asthma, an almost equal distribution of inflammatory cell patterns, the lowest concentrations of eicosanoids, and logLTE4/logPGE2 ratio. Class 2 represented severe asthma with impaired lung function despite high doses of steroids. High sputum eosinophilia was in line with higher pro‐inflammatory LTE4 in ISS and the highest logLTE4/logPGE2 ratio. Class 3 subjects had mild‐to‐moderate asthma and were also characterized by eosinophilic airway inflammation, yet increased production of pro‐ (LTE4, PGD2 and 11‐dehydro‐TBX2) was balanced by anti‐inflammatory PGE2. The value of logLTE4/logPGE2 was between values calculated for classes 1 and 3, similarly to disease control and severity. Conclusions LCA revealed three distinct NERD subphenotypes. Our results support a more complex pathobiology of aspirin hypersensitivity. Considering NERD heterogeneity, the relationship between inflammatory pathways and clinical manifestations of asthma may lead to more individualized treatment in difficult to treat patients in the future., Heterogeneity of NERD phenotype reflects differences in inflammatory response measured by airway cells and eicosanoids. Identifying subphenotypes provides a more insightful perception and suggests a need for more individualized approach. In aspect of logLTE4/logPGE2 ratio, latent class analysis assigned subject to different groups better than identification by disease severity or control emphasizing the heterogeneity in NERD subgroup. Abbreviations: LTE4, Leukotriene E4; NERD, NSAID‐exacerbated respiratory disease; PGE2, Prostaglandin E2

BACKGROUND: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. METHODS: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. RESULTS: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours ( P l 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group ( P l 0.05). CONCLUSIONS: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

Immunoglobulin E plays an important role in allergic diseases. In patients with allergic asthma, exposure to allergens releases a wide range of proinflamatory mediators, which are responsible for acute and chronic symptoms of the disease. IgE has become an attractive target in allergic asthma. In 2006, in Europe omalizumab became available. Objectives Our knowledge of who will derive the highest benefit from omalizumab therapy is still limited. The aim of this study was to evaluate the efficacy of omalizumab during one year of therapy carried out under real-life conditions in Polish patients with severe allergic asthma. We also attempted to identify predictors for very good responses to treatment. Methods We enrolled 15 patients due to inclusion criteria of the program for severe allergic asthma funded by the National Health Insurance. All the patients were assessed for asthma control, quality of life, daily dose of oral and inhaled corticosteroids, asthma exacerbation rate, and lung function. The effectiveness of the treatment was analyzed after 16 weeks and one year following the inclusion each patient to the therapy. The patients were divided into two groups according to their response to the treatment: very good and good, based on the GETE scale. Results Omalizumab decreased the severity of symptoms, improved asthma control and quality of life in patients. It helped to reduce episodes of asthma exacerbation and the use of systemic corticosteroids. At present, the overall assessment by physicians is still the best and most reliable method of identifying responders to the omalizumab therapy.

Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus there is an unmet need for phenotype identification especially among patients with granulomatosis with polyangiitis GPA, patients with microscopic polyangiitis MPA group seems to be more uniform. Recently, based on previous clustering analysis and clinical, histopathological, serological and prognostic aspects three subcategories of AAV have been proposed and named as: non-severe AAV, severe PR3-AAV and severe MPO-AAV [1].Objectives:In line with these attempts to subcategorize AAV we decided to use latent class analysis (LCA) on a large multicenter cohort of polish AAV patients from POLVAS [2] registry to identify potential new subphenotypes or confirm already proposed ones.Methods:Latent Class Analysis (LCA) approach was used as a model based clustering method of objects described by dichotomous (e.g., gender; ANCA status – cANCA, pANCA; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves) and polytomous (number of relapses) variables supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever).Results:Results of LCA on our AAV group returned four class model of AAV subphenotypes, confirming existence of the previously proposed by Mahr at al. [1] and revealed fourth – previously not described clinically relevant subphenotype. To this fourth class - belong patients only with GPA, diagnosed at young age, with multiorgan involvement, high relapse rate and relatively high risk of death.Table 1.AAV subcategorization – summary of clinical characteristics and ANCA specificityLCA Class 1LCA Class 2LCA Class 3LCA Class 4No of patients13019410297AAV typeMainly GPAMainly GPAmainly MPAOnly GPAAge at diagnosisMiddle ageMiddle ageOldYoungMale/female ratio1:22:11:11:1Main organ involvementENT, respiratory, eyeRenal, respiratory, ENTRenal, respiratory, skinMultiorgan involvementRelapse rateintermediateintermediatelowhighModified class description (based on ref. [1])Non severe AAVSevere PR3 AAVSevere MPO AAVSevere non-renalPR3 AAVConclusion:Based on multiple clinical and serological variables LCA methodology identified 4-class subphenotypes model of AAV. Fourth-class is a new clinically important subphenotype including exclusively PR3-positive young AAV patients with multiorgan involvement, high risk of relapse and distinct mortality.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9.https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, i in. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:Krzysztof Wójcik: None declared, Adam Ćmiel: None declared, Anna Masiak: None declared, Zbigniew Zdrojewski: None declared, Radoslaw Jeleniewicz: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Iwona Brzosko: None declared, Marek Brzosko: None declared, Piotr Głuszko: None declared, Małgorzata Stasiek: None declared, Małgorzata Wisłowska: None declared, Joanna Kur-Zalewska: None declared, Marta Madej: None declared, Anna Hawrot-Kawecka: None declared, Hanna Storoniak: None declared, Barbara Bułło-Piontecka: None declared, Alicja Dębska-Ślizień: None declared, Eugeniusz Kucharz: None declared, Katarzyna Jakuszko: None declared, Jacek Musiał: None declared

Background Aspirin desensitization (AD) is an effective and safe therapeutic option for patients with nonsteroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (N-ERD). The mechanisms driving its beneficial effects remain poorly understood. Objective To investigate the effect of long-term AD on clinical, biochemical and radiological changes in N-ERD patients. Methods The study group consisted of twenty-three individuals with N-ERD who underwent AD, followed by ingestion of 325 mg aspirin twice daily. Twenty patients completed the 52 weeks of AD. The following evaluations were conducted at baseline and in the 52nd week of AD: (i) clinical: asthma exacerbations, Asthma Control Test (ACT), Visual Analogue Scale (VAS) for the assessment of nasal symptoms; (ii) blood and induced sputum supernatant (ISS) periostin, (iii) phenotypes based on induced sputum (IS) cells, (iiii) ISS and nasal lavage (NL) concentration of prostaglandin D2 (PGD2), prostaglandin E2 (PGE2), tetranor-PGD-M, tetranor-PGE-M, 8-iso-PGE2, leukotriene B4 (LTB4), LTC4, LTD4 and LTE4, and urine LTE4. Results A significant improvement was observed in ACT (P = 0.02) and VAS score (P = 0.008) in the 52nd week of AD. ISS periostin and IS eosinophil count decreased significantly in the 52nd week of AD (P = 0.04 and P = 0.01, respectively). ISS and NL eicosanoid concentrations did not change following long-term AD. Conclusion and Clinical Relevance: AD is associated with a decrease in sputum periostin biosynthesis, which may prevent the recruitment of eosinophils into respiratory tissue and be one of explanation of the clinical benefits of AD. Long-term aspirin administration does not lead to an imbalance between pro- and anti-inflammatory ISS eicosanoids.

BACKGROUND A special regulatory role for prostaglandin E2 (PGE2 ) has been postulated in nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD). OBJECTIVE To investigate the effect of systemic aspirin (acetylsalicylic acid) administration on airway PGE2 biosynthesis in induced sputum supernatant (ISS) among subjects with NERD or aspirin-tolerant asthma with chronic rhinosinusitis with nasal polyposis (ATA-CRSwNP), as well as healthy controls (HC). METHODS Induced sputum (IS) was collected from patients with NERD (n = 26), ATA-CRSwNP (n = 17), and HC (n = 21) at baseline and after aspirin challenge. Sputum differential cell count and IS supernatant (ISS) levels of prostanoids, PGE2 , 8-iso-PGE2 , tetranor-PGE-M, 8-iso-PGF2 α, and leukotriene C4 , D4 , and E4 , were determined using mass spectrometry. Urinary excretion of LTE4 was measured by ELISA. RESULTS NERD subjects had elevated sputum eosinophilic count as compared to ATA-CRSwNP and HC (median NERD 9.1%, ATA-CRSwNP 2.1%, and HC 0.4%; P

Introduction Endoscopic biopsy techniques are useful in the diagnosis of sarcoidosis. There is a need for randomized trials to establish where these procedures fit in the diagnosis of sarcoidosis. Objectives The aim of the study was to compare the diagnostic yield of conventional transbronchial needle aspiration (TBNA) with endobronchial ultrasound-guided TBNA (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in stages I and II of pulmonary sarcoidosis. Patients and methods Patients suspected of sarcoidosis were randomized to undergo TBNA or EBUS-TBNA or EUS-FNA. Patients with negative TBNA and EBUS-TBNA results underwent EUS-FNA and those with negative EUS-FNA results—EBUS-TBNA. If both tests were negative, patients in stage I were scheduled for mediastinoscopy (MS) and those in stage II—for transbronchial lung biopsy (TBLB). Results In 100 patients, 34 TBNA, 30 EBUS-TBNA, and 36 EUS-FNA procedures were performed at baseline. TBNA was positive in 20 patients (58.8%); EBUS-TBNA, in 23 (76.7%); and EUS-FNA, in 31 patients (86.1%). In patients with negative biopsy results, the second procedure was performed. The results of EUS-FNA were positive in 9 patients and of EBUS-TBNA—in none. Of 17 patients with negative results of both procedures, MS was performed in 6 patients and was positive in 2. In the remaining 11 patients, sarcoidosis was confirmed by TBLB. Sensitivity and accuracy of TBNA compared with EBUS-TBNA and EUS-FNA were 62.5% and 64.7%, 79.3% and 80%, and 88.6% and 88.9%, respectively. Sensitivity and accuracy of EBUS-TBNA were higher (P = 0.139) and of EUS-FNA were significantly higher compared with TBNA (P = 0.012). Conclusions In stages I and II of pulmonary sarcoidosis, endoscopic ultrasound is a reasonable approach but EUS-FNA seems to be the method of choice.

A special regulatory role for prostaglandin ETo investigate the effect of systemic aspirin (acetylsalicylic acid) administration on airway PGEInduced sputum (IS) was collected from patients with NERD (n = 26), ATA-CRSwNP (n = 17), and HC (n = 21) at baseline and after aspirin challenge. Sputum differential cell count and IS supernatant (ISS) levels of prostanoids, PGENERD subjects had elevated sputum eosinophilic count as compared to ATA-CRSwNP and HC (median NERD 9.1%, ATA-CRSwNP 2.1%, and HC 0.4%; P 0.01). Baseline ISS levels of PGEAspirin-precipitated bronchoconstriction is associated with a decrease in airway PGE

Introduction: There is no data regarding the value of endosonography techniques with use of 25 gauge needles for non-small cell lung cancer (NSCLC) staging in small mediastinal lymph nodes (MLN). Objective: To assess the diagnostic yield of endobronchial (EBUS-TBNA) and endoscopic ultrasound-guided needle aspiration (EUS-B-FNA) for small MLN in NSCLC staging with use of 25 gauge needles. Methods: Prospective, multicenter national clinical trial in consecutive, suspected or confirmed NSCLC patients, with not enlarged ( Results: 53 patients underwent endosonography after PET-CT and 186 MLN were biopsied. Combined EBUS-TBNA and EUS-B-FNA revealed metastatic MLN involvement in 16 patients (30,2%) and was false negative in 3 (5,6%), confirmed either by TEMLA in two or by SLND in one. Only in 5 (2,6%) of all 186 MLN a biopsy performed by 25 gauge needle was undiagnostic. A diagnostic sensitivity, specificity, accuracy, PPV and NPV of PET-CT were 90%, 72.7%, 79.2%, 66.7% and 92.3% and of combined endosonography were 84%, 100%, 94.3%, 100% and 91.9%, respectively. No complications after biopses were observed. Conclsion: Combined endosonographic NSCLC staging with use of 25 gauge needles is effective and safe in small nodes.

INTRODUCTION There are no widely accepted standards for the diagnosis of sarcoidosis. OBJECTIVES The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS -FNA) and endoscopic ultrasound fine needle aspiration (EUS -FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. PATIENTS AND METHODS This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS -FNA) or group B (EUS -FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS -FNA and all patients with negative results in group B underwent EBUS -FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. RESULTS We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). CONCLUSIONS The sensitivity and accuracy of EBUS -FNA and EUS -FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS -FNA tend to be higher than those of EBUS -FNA.

INTRODUCTION There are no widely accepted standards for the diagnosis of sarcoidosis. OBJECTIVES The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS -FNA) and endoscopic ultrasound fine needle aspiration (EUS -FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. PATIENTS AND METHODS This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS -FNA) or group B (EUS -FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS -FNA and all patients with negative results in group B underwent EBUS -FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. RESULTS We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). CONCLUSIONS The sensitivity and accuracy of EBUS -FNA and EUS -FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS -FNA tend to be higher than those of EBUS -FNA.

Introduction: Antibodies reacting with various microbial epitopes have been described in inflammatory bowel disease (IBD) and are associated with a specific diagnosis and clinical presentation. Aim: To evaluate the profile of new anti-glycan antibodies, their potential association with disease phenotype and diagnostic accuracy in paediatric Crohn’s disease (CD). Material and methods: Blood samples from 134 paediatric IBD patients (109 CD, 25 ulcerative colitis (UC)) and 67 controls were blindly analysed for anti-Saccharomyces cerevisiae (ASCA), anti-chitobioside carbohydrate (ACCA), anti-laminaribioside carbohydrate (ALCA), and anti-mannobioside carbohydrate (AMCA) antibodies using commercially available assays. The serological response to glycans was correlated with clinical disease characteristics. Results: At least one of the tested anti-glycan antibodies was present in 75% of CD patients. Despite the high frequency of reactivity to glycan epitopes, a limited overlap of serological markers was observed. In total, 49% of ASCA-negative patients presented with one of the following: ACCA, ALCA, or AMCA. The occurrence of one antibody from the anti-glycan panel was independently associated with complicated disease phenotype and ileocolonic disease location. A higher level of immune response as assessed by the quartile sum scores for ACCA, ALCA, and AMCA was linked with older age at diagnosis (10-17 years) and ileocolonic disease location. The ASCA had the greatest accuracy for diagnosis and differentiation of CD. Conclusions: Qualitative and quantitative serologicalal response to glycan epitopes was associated with distinct clinical presentation in paediatric CD patients. This raises the possibility for the use of these markers to differentiate subgroups of CD patients with more sever clinical presentation. The ASCA was the most accurate serological marker for CD; however, testing for the new anti-glycan antibodies may constitute an adjunctive tool in a specific group of patients to aid in the differentiation of CD with absent ASCA from ulcerative colitis.

OBJECTIVES: Evaluation of the diagnostic efficiency of the intraoperative cytological examination of lymphatic nodes obtained during transcervical extended mediastinal lymphadenectomy (TEMLA). METHODS: All mediastinal nodes obtained during consecutive TEMLA operations in patients with confirmed lung cancer were examined. Cytological imprints from cross sections of nodes were performed, fixed in 96 proof alcohol and stained with Haematoxylin– Eosin. The cytological slides were evaluated by light microscopy intraoperatively, and a standard paraffin histological examination of the same nodes was done afterwards for confirmation of the final diagnosis. RESULTS: Intraoperative cytological studies were performed in 63 patients (17 women and 46 men; overall in 453 mediastinal nodal stations) from 1 April 2009 to 28 February 2011. The mean number of nodes/procedure was 27.8. The mean time of performance of the examination was 37 min, including 7 min for smears, 13 min for staining and 17 min for microscopic examination (overall 37 min). The cytological study discovered neoplasmatic cells in 12 of 63 patients, nodal stations in 22 of 453 and nodes in 44 of 1724. According to the analysis of the 63 patients, the imprint cytology technique had a sensitivity of 92.3%, specificity of 100%, accuracy of 98.4%, positive predictive value of 100% and negative predictive value of 98.0%, as was confirmed by the final histopathological examination. CONCLUSIONS: (i) Cytological imprints examination was characterized by a very high specificity and sensitivity, is technically simpler and faster and allows for the examination of several dozens of lymphatic nodes during a single TEMLA procedure within an acceptable time, and after the exclusion of N2 nodes enables the simultaneous performance of a radical lung resection. (ii) The presented technique was the alternative for the traditional histopathological examination of the material frozen in cryostat.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are minimally invasive techniques for the diagnosis of pulmonary sarcoidosis. Little is known about the utility of transesophageal biopsy performed by single ultrasound bronchoscope (EUS-b-FNA) for sarcoidosis. Aims and objectives: To compare directly EBUS-TBNA vs EUS-b-FNA in stage I/II of pulmonary sarcoidosis. Methods: In patients suspected of stage I/II sarcoidosis a prospective, single-center study was performed. Patients underwent EBUS-TBNA and EUS-b-FNA with 22gauge needles in one session, under conscious sedation. If negative, patients in stage I were scheduled for mediastinoscopy and in stage II for transbronchial lung biopsy. A 6 month clinical and radiological follow up was used as the reference standard. Results: From January 2011 to July 2015, 167 patients underwent EBUS-TBNA and EUS-b-FNA consequtively. Sensitivity, accuracy and negative predictive value (NPV) of EBUS-TBNA vs EUS-b-FNA were 0.58, 0.64 and 0.29 vs 0.84, 0.87 and 0.52, respectively. Sensitivity, accuracy and NPV of EUS-b-FNA were significantly higher over EBUS-TBNA (p Conclusions: After our study EUS-b-FNA seems to be the method of choice in stage I /II of pulmonary sarcoidosis, particularly in patients with predominance of mediastinal adenopathy.

Introduction: Routine videobronchofiberoscopy (VBF) using endobronchial biopsy (EBB) and conventional transbronchial needle aspiration (TBNA) is widely accepted method for diagnosis of lung cancer (LC). Endosonography including endobronchial ultrasound-guided TBNA (EBUS-TBNA), endoscopic ultrasound fine needle biopsyperformed by single ultrasound bronchoscope (EUS-b-FNA) and combined both techniques called CUS-b-NA are predominantly used for staging rather than for diagnosis of advanced LC. EBUS scope is not designed for a detailed assessment of the bronchial tree, so the examination is usually preceded by VBF. Aims and objectives: To establish the diagnostic yield of EBUS-TBNA and CUS-b-NA for advanced LC and to compare endosonography with routine VBF. Methods: In patients suspected of LC a prospective, single-center study was performed. Under conscious sedation patients underwent VBF with EBB and conventional TBNA, EBUS-TBNA or CUS-b-NA (if necessary), consecutively. Results: From January to December 2015, 212 patients (M:136, F:76, mean age 68) underwent VBF and EBUS-TBNA and 49 underwent CUS-b-NA. Sensitivity and accuracy of VBF vs EBUS-TBNA vs CUS-b-NA were 43% and 44.3% vs 93.7%and 93.8% vs 94.7% and 94.8%, respectively. Sensitivity and accuracy of EBUS-TBNA and CUS-b-FNA were significantly higher over routine VBF (p Conclusions: Results of our study confirm that diagnostic yield of routine bronchoscopy is unsatisfactory for diagnosis of advanced LC and EBUS-TBNA or in some cases CUS-b-FNA should be commonly added to VBF.

Background: Omalizumab(OMA) is the youngest medicine in asthma therapy. It is being evaluated in real-world clinical practice to provide complete understanding of the benefit of this otherwise expensive medicine. Objectives: To evaluate efficacy of OMA during one year of therapy in real-life conditions in Polish patients with severe allergic asthma. Methods: Due to the introduction of Program for Severe Allergic Asthma funded by the National Health Insurance OMA became more commonly available for Polish patients. Strict inclusion criteria should be met to enter the program. The study is one-year open-label observation lead in 15 patients qualified to the program in Pulmonary Department in Krakow. All patients have been assessed for asthma control (Asthma Control Questionnaire-ACQ), quality of life (Asthma Quality of Life Questionnaire-AQLQ), daily dose of oral corticosteroids (OCS) and asthma exacerbation rate. Results: All patients have shown good (47%,n=7,GR) or very good (53%,n=8) response (VGR) to OMA according to Global Evaluation of Treatment Effectiveness (GETE) scale after one-year therapy. OMA significantly reduced asthma exacerbation rate by 80% (by 91% in VGR and by 65% in GR group) and the dose of OCS by 62% (by 76% in VGR and by 46% in GR). ACQ declined by 34% in the group (p=0.005), by 52% in VGR (p=0,01) and by 10% in GR(p=0,2). AQLQ grew in the whole group by 34%(p=0,03) and in VGR by 40%(p=0.01). In GR group the increase by 25% was insignificant. Conclusions: Omalizumab has shown high effectiveness in real-world Polish patients in reduction of asthma exacerbations and the dose of oral corticosteroids, improvement in asthma control and quality of life indicators.

INTRODUCTION Airway remodeling plays an important role in the development of chronic obstructive pulmonary disease (COPD). Imaging methods, such as computed tomography (CT) and endobronchial ultrasound (EBUS), may be useful in the assessment of structural alterations in the lungs. OBJECTIVES The aim of this study was to evaluate a relationship between the severity of emphysema assessed by chest CT, the thickness of bronchial wall layers measured by EBUS, and the markers of remodeling in bronchoalveolar lavage fluid (BALF) in patients with COPD. PATIENTS AND METHODS The study included 33 patients with COPD who underwent pulmonary function tests, emphysema score assessment by chest CT, as well as bronchofiberoscopy with EBUS in order to measure the total bronchial wall thickness and, separately, layers L1, L2, and L3-5. Selected remodeling (matrix metalloproteinase 9 [MMP-9], tissue inhibitor of metalloproteinase 1, transforming growth factor β1 [TGF-β1]) and inflammatory markers (neutrophil elastase, eosinophil cationic protein) were measured in BALF samples using an enzyme-linked immunosorbent assay. RESULTS MMP-9 levels in BALF were significantly higher in patients with very severe bronchial obstruction than in those with moderate and mild bronchial obstruction (P = 0.02), and showed a negative correlation with forced expiratory volume in 1 second (r = -0.538, P = 0.002). The thickness of L1 and L2, which histologically correspond to the mucosa, submucosa, and smooth muscle, demonstrated a positive correlation with TGF-β1 levels in BALF (r = 0.366, P = 0.046 and r = 0.425, P = 0.02) and the thickness of L1 showed a negative association with neutrophil elastase levels (r = -0.508, P = 0.004). There was no significant correlation between the analyzed markers in BALF and the emphysema score. CONCLUSIONS Significant correlations of TGF-β1 and elastase with the thickness of bronchial wall layers, and of MMP-9 with the severity of obstruction, may suggest the involvement of these markers in airway remodeling in patients with COPD.

INTRODUCTION In the pathogenesis of diffuse parenchymal lung diseases (DPLDs), growth factors, including transforming growth factor beta1 (TGF-beta1), are responsible for cell proliferation, apoptosis, chemotaxis, and angiogenesis, and also for the production and secretion of some components of the extracellular matrix. OBJECTIVES The aim of the study was to evaluate correlations in DPLDs between TGF-beta1 levels in bronchoalveolar lavage (BAL) fluid and high-resolution computed tomography (HRCT) score. PATIENTS AND METHODS The study was performed in 31 DPLD patients in whom a selection of lung segments with high and low intensity of abnormalities was estimated by HRCT score. All patients underwent BAL with TGF-beta1 measured by an enzyme immunoassay in BAL fluid and video-assisted thoracic surgery lung biopsy from both selected segments. RESULTS All 31 patients were diagnosed, and based on histopathology, they were classified into 2 groups: idiopathic interstitial pneumonia (usual interstitial pneumonia - 12, nonspecific inter stitial pneumonia - 2, cryptogenic organizing pneumonia - 2, and desquamative interstitial pneumonia - 1) and granulomatous disease (sarcoidosis - 7, extrinsic allergic alveolitis - 5, and histiocytosis X - 2). The final analysis was performed in 28 patients who showed nonhomogenous distribution on HRCT. TGF-beta1 levels in BAL fluid were significantly higher in the areas with high intensity of abnormalities assessed by HRCT score (P = 0.018, analysis of variance). These levels were not different between the groups, but a trend towards higher levels in idiopathic inter stitial pneumonia was observed. CONCLUSIONS The results confirm that TGF-beta1 may be a good but not specific marker of fibrosis in DPLDs. A significant positive correlation between TGF-beta1 levels in BAL fluid and the HRCT score was observed.

INTRODUCTION Besides radio logical methods (especially positron emission tomography combined with computed tomography), endoscopic techniques including transbronchial needle aspiration (TBNA) of mediastinal lymph nodes play an important role in lung cancer staging, thus having a significant effect on further patient management. OBJECTIVES The aim of the study was to investigate the diagnostic value of blind TBNA in staging of lung cancer, using systematic mediastinal lymph node dissection (SLND) at thoracotomy as a confirmatory test. PATIENTS AND METHODS Patients with lung cancer and enlarged mediastinal lymph nodes on computed tomography scans underwent TBNA. Non-small cell lung cancer (NSCLC) patients with negative TBNA or with single-level N2 disease underwent thoracotomy with appropriate pulmonary resection and with SLND. RESULTS In 84 lung cancer patients, 166 TBNA were performed. Metastatic lymph node involvement was identified in 57 patients (67.9%). There were 10 patients (11.9%) with small cell lung cancer. Of the 74 NSCLC patients, TBNA revealed meta stases in 48 (64.9%). Twenty-four TBNA-negative patients (32.4%) and 4 patients (5.4%) with single-level N2 disease underwent pulmonary resection with SLND. In 8 of 28 operated patients (28.6%), N2 meta static nodes were identified. The per-patient analysis showed the sensitivity of TBNA to be 81.5%, specificity - 100%, accuracy - 86.5%, and negative predictive value (NPV) - 66.7%. CONCLUSIONS Our results suggest that TBNA may be a useful method for initial NSCLC staging in patients suspected of N2-3 disease. Positive TBNA in 1 station only should not be considered as a true single-level N2 disease, because of a relatively low NPV for TBNA.

Background Endobronchial ultrasound (EBUS) is a new technique that enables the assessment of bronchial wall layers. The aim of the study was to verify the utility of EBUS for the assessment of bronchial wall remodeling in patients with asthma. Methods In 35 patients with asthma and 23 control subjects, high-resolution CT (HRCT) scanning and EBUS were used to measure bronchial wall thickness in the 10th segment of the right lung. With a radial 20-MHz probe, EBUS identified the 5-laminar structure of the bronchial wall. Layer 1 (L 1 ) and layer 2 (L 2 ) were analyzed separately, and layers 3 through 5 (L 3–5 ), which corresponded to cartilage, were analyzed jointly. Digitalized EBUS images were used for the quantitative assessment of bronchial wall thickness and the wall area (WA) of the layers. Finally, bronchial biopsy specimens were taken for measuring the thickness of the reticular basement membrane (RBM). The thickness and WA of the bronchial wall layers, which were assessed using EBUS, were correlated with FEV 1 and RBM. Results There was no significant difference in the measurements of total bronchial wall thickness using EBUS and HRCT scanning. The thickness and WA of the bronchial wall and its layers were significantly greater in patients with asthma than in the control subjects. A negative correlation among the thicknesses of L 1 , L 2 , and L 3–5 and FEV 1 , and a positive correlation with RBM were observed only in the patients with asthma. Conclusions EBUS allows precise measurement of the thickness and WA of bronchial wall layers. The correlation of these parameters with asthma severity suggests implementation of EBUS in the assessment of bronchial wall remodeling in patients with asthma.

Background: A special regulatory role for prostaglandin E 2 has been postulated in aspirin-induced asthma. A study was undertaken to investigate the effects of aspirin on the systemic production of prostaglandin E 2 and cysteinyl leucotrienes in patients with asthma. Methods: The urinary concentrations were determined of two main prostaglandin E 2 metabolites (13,14-dihydro-15keto-PGE 2 using a commercial enzyme immunoassay and 9,15-dioxo-11α-hydroxy-2,3,4,5-tetranor-prostane-1,20-dioic acid by gas chromatography/mass spectrometry) and leucotriene E 4 using an immunoassay. Determinations were performed at baseline and following oral aspirin and celecoxib challenges in two well-defined asthma phenotypes: aspirin-sensitive and aspirin-tolerant patients. Results: Aspirin precipitated bronchial reactions in all aspirin-sensitive patients but in none of the aspirin-tolerant patients. Celecoxib 400 mg was well tolerated by all patients except for one with aspirin-induced asthma. At baseline, the mean levels of prostaglandin E 2 metabolites did not differ between the groups. Following different aspirin provocation doses, the mean levels of the two main prostaglandin E 2 metabolites were decreased in the aspirin-tolerant group but remained unchanged in the aspirin-sensitive group. The dose of aspirin had no effect on the magnitude of the response on the prostaglandin E 2 metabolites and its duration. In both groups, urinary prostaglandin E 2 metabolites decreased following celecoxib challenge. No correlation was found between prostaglandin E 2 metabolites and leucotriene E 4 . Conclusions: Aspirin-precipitated asthmatic attacks are not associated with changes in the systemic production of prostaglandin E 2 . In contrast, the systemic production of prostaglandin E 2 becomes depressed by aspirin in non-sensitive patients. This different response might indicate COX-1-dependent prostaglandin E 2 control of inflammatory cells in aspirin-induced asthma. Thus, PGE 2 is released during the clinical reactions to aspirin through an alternative COX-2 pathway. The clinical implications of this finding are in line with current observations of good tolerance of the selective COX-2 inhibitors in aspirin-sensitive patients.

Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy.Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed.Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (Plt; 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (Plt; 0.05).Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.

Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used—bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Materials and Methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and the differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.

Introduction While spirometry plays a key role in diagnosing chronic obstructive pulmonary disease (COPD), imaging methods including endobronchial ultrasound (EBUS) and chest computed tomography (CT) appear to be useful for investigating structural changes in the lungs. Objectives The aim of this study was to evaluate remodeling in COPD patients using EBUS and chest CT. Patients and methods The study included 33 patients with COPD, 15 patients with severe asthma, and 15 control subjects. All subjects underwent pulmonary function tests and bronchoscopy with EBUS to measure the total thickness of the bronchial wall and its layers. Additionally, in COPD patients, a chest CT was performed to measure total bronchial wall thickness. Results The total bronchial wall thickness measured by EBUS in patients with COPD (1.192 ±0.079 mm) was significantly smaller than that in asthmatic patients (1.433 ±0.230 mm, P = 0.001) and significantly greater than in control subjects (1.099 ±0.095 mm, P = 0.04), and was positively correlated with residual volume (RV) / total lung capacity (r = 0.5, P = 0.02), RV (r = 0.6, P = 0.007), and RV (%) (r = 0.5, P = 0.05). The thickness of the bronchial wall layers in patients with COPD were as follows: L1 = 0.135 ±0.018 mm, L2 = 0.151 ±0.026 mm, and L3-5 = 0.906 ±0.065 mm. There was no correlation between the thickness of the bronchial wall layers and forced expiratory volume in 1 second. Conclusions The results of this study show that EBUS is a useful method for evaluating bronchial wall layers not only in asthma but also in COPD, and suggest that the pattern of remodeling differs in each of these diseases.

Background Induced sputum (IS) allows to measure mediators of asthmatic inflammation in bronchial secretions. The specific role of induced sputum supernatant (ISS) endogenous bioactive lipid mediators in subtypes of asthma is not well understood. Objective To investigate the interactions between airway inflammation and clinical phenotypes of asthma, we integrated induced sputum supernatant (ISS) eicosanoids and quantitative assessment of infiltrating cells into new subtypes with the means of latent class analysis (LCA). Methods One hundred and thirty-nine asthmatics with and without aspirin hypersensitivity underwent sputum induction. High-performance liquid chromatography or gas chromatography coupled with mass spectrometry was used to profile eicosanoids. Nineteen variables covering clinical characteristics, IS inflammatory cells and eicosanoids were considered in the LCA. Results Four phenotypic asthma classes were distinguished. Class 1 with mild-to-moderate asthma, chronic rhinosinusitis (CRS), high PGA2 in ISS and almost equal distribution of inflammation cell patterns. Class 3 subjects also had mild-to-moderate asthma but without upper airway symptoms. Induced sputum was often paucigranulocytic with low levels of lipid mediators. Classes 2 and 4 represented severe asthma with CRS and impaired lung function despite high doses of steroids. High blood and sputum eosinophilia was in line with high cysteinyl leukotrienes and PGD2 in ISS only in class 2. Class 4 subjects tended to have increased sputum neutrophilia and PGE2 in ISS. Aspirin hypersensitivity was most frequent among class 2 subjects. Conclusions & clinical relevance The LCA revealed four distinct asthma classes differing in eicosanoid pathways.

Background Treatment with antileukotriene drugs results in clinical improvement in many, though not all, patients with asthma. It can be hypothesized that the subpopulation of asthmatic patients, characterized by aspirin intolerance and cysteinyl-leukotriene overproduction, might profit most from antileukotriene treatment. Materials and methods We compared the clinical response to montelukast in two well-matched groups of patients with mild asthma: 26 aspirin-intolerant asthmatics (AIAs) and 33 aspirin-tolerant asthmatics (ATAs). We also searched for possible predictors of the clinical response among the parameters reflecting the expression and production of cysteinyl-leukotrienes (cys-LTs). This was an 8-week, single-blind, placebo-controlled trial. Results Following a 3-week montelukast 10 mg day−1 treatment compared with placebo, there was a statistically significant reduction in the mean daytime and nocturnal asthma symptoms and β2-agonist use, as well as a significant improvement in the morning and evening peak expiratory flows and quality of life. Both groups showed a similar significant improvement in the parameters studied. Clinical response did not correlate with the baseline urinary LTE4 excretion level. Improvement of asthma was observed mostly in patients with a low baseline and non-IL-5 inducible expression of LTC4 synthase (LTC4S) mRNA in eosinophils. There was a trend toward a better response in carriers of LTC4S allele C, but no relationship to the CC10 genetic polymorphism. Conclusions No difference in the clinical response to the montelukast treatment was observed between the AIAs and the ATAs.

Summary Background Montelukast, a cysteinyl-leukotriene receptor antagonist, was reported to have a protective effect against exercise-induced bronchoconstriction (EIB). Aspirin-induced asthma (AIA) is characterized by overproduction of cysteinyl-leukotrienes. Objective The aim of the study was to compare the response to exercise and the effect of montelukast on EIB in AIA as compared to aspirin-tolerant asthma (ATA). Methods A placebo-controlled, double blind, cross-over randomized study was performed in 19 AIA and 21 ATA patients with stable asthma. A single dose of montelukast (10 mg) or placebo (PL), was given orally one hour prior to exercise challenge. FEV1 was measured before and 5, 10, 15 min after exercise and then at 15-minute intervals for 4 h. Urinary LTE4 excretion and blood eosinophil count were measured at baseline, 2 h and 4 h following exercise challenge. Results Positive bronchial response to exercise was observed in 47.5% of all patients studied. Exercise led to almost identical maximal fall in FEV1 in AIA and ATA patients (23.5% ± 6.8% vs. 21.8% ± 12.0%, respectively; P = 0.7). Montelukast, as compared to PL, significantly attenuated EIB in 63.2% of 19 patients with positive exercise test preceded by PL. The mean of maximum fall in FEV1 from the pre-exercise value was 10.2% ± 13.8 after montelukast as compared to 22.5% ± 10.2 after placebo (P

We determined the effect of a long acting beta2-agonist, salmeterol, on aspirin-induced asthma (AIA) attacks and urinary release of eicosanoids in a double-blind, placebo-controlled, crossover study in 10 asthmatics sensitive to aspirin. The patients inhaled 50 microgram of salmeterol or placebo 15 min prior to a cumulative challenge with increasing doses of lysine-aspirin (L-ASA) (Part I), and before a single, predetermined dose of L-ASA that caused a 20% fall in FEV1 (PD20) (Part II). Salmeterol significantly attenuated aspirin-precipitated bronchoconstriction and the increase in urinary LTE4. Salmeterol also prevented the decrease in blood eosinophils, and abolished the correlation between the urinary levels of LTE4 and provocative doses of aspirin. In addition, PGD-M, the major urinary metabolite of PGD2, increased after L-ASA inhalation in six of nine subjects; this increase was blocked in all six by salmeterol. The protective effect of salmeterol on aspirin-induced attacks and mediator release suggests that it may be efficacious in aspirin-sensitive asthma.

Background Numerous open trials have demonstrated the beneficial clinical effects of aspirin desensitization (AD) in patients with aspirin-induced asthma (AIA). These beneficial effects might be attributable to aspirin's potent anti-inflammatory properties, but that supposition requires further corroboration. Objective We sought to compare the clinical and biochemical responses to chronic oral AD in 20 patients with AIA and 14 patients with aspirin-tolerant asthma (ATA). All of the patients had chronic rhinosinusitis and nasal polyposis, and these responses were investigated in a pilot, double-blind, placebo-controlled study. Methods Twelve patients with AIA and 6 patients with ATA were randomly assigned to receive 624 mg of aspirin, and 8 patients with AIA and 8 patients with ATA received placebo. Both aspirin and placebo were administered once daily for 6 months. Nasal symptoms, Sino-Nasal Outcome Test (SNOT20) scores, peak nasal inspiratory flows, Asthma Control Questionnaire scores, spirometric parameters, peak expiratory flows, blood eosinophilia, and corticosteroid doses were assessed on a monthly basis. Levels of urinary leukotriene E 4 and the stable plasma prostaglandin (PG) D 2 metabolite 9α,11β-PGF2 were evaluated at baseline and after 1, 3, 5, and 6 months. Results Only the patients with AIA subjected to AD reported improvements in smell and reductions in sneezing and nasal blockade. The SNOT20 and Asthma Control Questionnaire scores of these patients decreased, and their peak nasal inspiratory flows increased. The dosages of inhaled corticosteroids were reduced. There were no changes in leukotriene E 4 or 9α,11β-PGF 2 levels after AD. Conclusion The clinically beneficial effects of AD on nasal and bronchial symptoms occurred only in the patients with AIA.

In this paper the random balanced solution to forward-lag-type and mixed-lag-type dynamic input-output models is given. The exact value of the essential time-lag parameter for both models cannot usually be found, especially in the case of economies in transition. The reason for this is the lack of pertinent statistical data. The problems with statistical data are caused by changes of the structure of the economy accompanied by a high rate of inflation. Some data are still computed using old methods typical for the centrally planned economy and the collection of the other data follows by means of market-oriented methods. For this reason different data are not compatible, especially those that concern investment outlays. Usually, experts can establish the most probable or expected value of time-lag. Thus, the growth factor and, consequently, the respective balanced growth paths of both models are random. In this paper the general formulas for stochastic characteristics of both kinds of models are derived

In this paper, the random balanced growth factor to forward-lag-type and mixed-lag-type input–output (IO) models is considered. The instability of IO and capital matrices is taken into account by stochastic methods. Exact and approximate characteris-tics of stochastic solutions are given.

OBJECTIVES: The aim of the study was to compare diagnostic utility of combined (i.e. transbronchial and transoesophageal) ultrasound imaging with needle biopsy of the mediastinum in lung cancer (LC) staging, (a) by use of a single ultrasound bronchoscope (CUSb) and (b) by using two scopes (CUS). METHODS: In consecutive LC patients, clinical stage IA-IIIB the CUS or CUSb was performed under mild sedation and, if negative, underwent lung resection with confirmatory systematic lymph node dissection. RESULTS: From 214 LC patients, 110 underwent CUS and 104 underwent CUSb (618 biopsies); both revealed metastases in 50% of cases. There was ‘minimal N2’ in 11 of 14 false negative patients. Diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CUS was 91.7%, 98%, 94.6%, 98.2% and 90.7% respectively and of CUSb was 85%, 93.2%, 88.5%, 94.4%, 82%, respectively with no significant difference in yield of CUS vs CUSb (P = 0.255 and P= 0.192). The mean time of CUS (25 ± 4.4 min) was significantly longer as compared to CUSb (14.9 ± 2.3 min) (P< 0.001). No severe complications of either method were observed. CONCLUSIONS: The combined ultrasound imaging of the mediastinum by use of CUSb is significantly less time-consuming and equally as effective and safe as the use of CUS for LC staging.