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Noriane A Sievi,1 Daniel Franzen,1 Malcolm Kohler,1,2 Christian F Clarenbach1 1Division of Pulmonology, University Hospital of Zurich, 2Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland Background: Arterial stiffness is an important predictor of cardiovascular risk besides classic cardiovascular risk factors. Previous studies showed that arterial stiffness is increased in patients with COPD compared to healthy controls and exercise training may reduce arterial stiffness. Since physical inactivity is frequently observed in patients with COPD and exercise training may improve arterial stiffness, we hypothesized that low daily physical activity may be associated with increased arterial stiffness. Methods: In 123 patients with COPD (72% men; mean [standard deviation] age: 62 [7.5] years; median [quartile] forced expiratory volume in 1 second 35 [27/65] %predicted), arterial stiffness was assessed by augmentation index (AI). Daily physical activity level (PAL) was measured by an activity monitor (SenseWear Pro™) >1 week. The association between AI and PAL was investigated by univariate and multivariate regression analysis, taking into account disease-specific characteristics and comorbidities. Results: Patients suffered from moderate (35%), severe (32%), and very severe (33%) COPD, and 22% were active smokers. Median (quartile) PAL was 1.4 (1.3/1.5) and mean (standard deviation) AI 26% (9.2%). PAL showed a negative association with AI (B=-9.32, P=0.017) independent of age, sex, blood pressure, and airflow limitation. Conclusion: In COPD patients, a higher PAL seems to favorably influence arterial stiffness and therefore may reduce cardiovascular risk. Clinical Trial Registration: www.ClinicalTrials.gov, NCT01527773 Keywords: activity monitor, airflow limitation, COPD, physical activity level

Allison A Vanderbilt,1 Julie Mayglothling,1 Nicholas J Pastis,2 Douglas Franzen31School of Medicine, Virginia Commonwealth University, Richmond, VA, 2Division of Pulmonary and Critical Care, Medical University of South Carolina, SC, 3School of Medicine, University of Washington, WA, USAIntroduction: A review of the literature was conducted to analyze the impact of simulation-based training for direct and video laryngoscopy (VL) skills for health care professionals and health care students.Methods: This review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop airway management skills and identify pertinent literature by searching PubMed from inception of the database up to July 2013. This current review addresses the question of whether airway management simulation-based training improves the acquisition of resuscitation skills for health care profession learners.Results: A total of eleven articles qualified for this systematic review based on the inclusion and exclusion criteria. These studies were analyzed and the specific simulators, participants, assessments, and details related to: time of intubation; Cormack and Lehane classification; success and failure rate; and number of attempts.Conclusion: This review suggests that simulation-based training is one effective way to teach VL skills. VL allows for a higher success rate, faster response time, and a decrease in the number of attempts by health care students and health care professionals under the conditions based on the eleven studies reviewed.Keywords: laryngoscopy, video laryngoscopy, simulation, systematic review, health care professionals, health care students

Kristine Jensen,1 Thomas Egenod,2 Daniel P Franzen,3,4 Michael Perch1,5 1Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Rigshospitalet Heart Center, Copenhagen, Denmark; 2Department of Interventional Pulmonology, Dupuytren University Hospital, Limoges, France; 3Department of Internal Medicine, Uster Hospital, Uster, Switzerland; 4Department of Pulmonology, University of Zurich, Zurich, Switzerland; 5Department of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Michael Perch, Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Rigshospitalet, Heart Center, Inge Lehmanns Vej 7, Copenhagen, 2100, Denmark, Email Michael.perch@regionH.dkAbstract: Endoscopic lung volume reduction (ELVR) is an established treatment option for patients with severe emphysema. Not all patients are candidates for this type of intervention, and in the context of significant airway secretions, they may be excluded from treatment. Bronchial Rheoplasty (BR) was developed to treat mucus hypersecretion by delivering nonthermal pulsed electric fields to the airway epithelium and submucosa. The literature to date demonstrates that patients treated with BR in clinical studies have a reduction in airway goblet cell hyperplasia as well as substantive clinical improvement in the setting of chronic bronchitis (CB). In this case series, we present four patients treated at three different institutions who had previously undergone ELVR with beneficial outcome. However, over time, these patients subsequently developed worsening clinical issues, including complaints of increased and thickened mucus, along with exacerbations in the setting of a loss of some ELVR-associated benefits. These patients then underwent exploratory treatment with BR with the intent of reducing their secretion burden and potentially restoring the efficacy associated with the initial placement of the airway valves. All BR procedures were well tolerated, and three of the four patients showed substantial improvement in their symptom burden. Airway examinations during the second of the two BR procedures also revealed what appeared to be less airway mucosal inflammation and a decrease in the quantity of airway secretions. Therefore, treatment with BR may have the potential to improve and restore the initial benefits associated with ELVR, thus enhancing long-term outcomes. Further clinical studies with sufficient follow-up are warranted to assess this in a larger cohort of patients, and to determine whether treatment with BR prior to ELVR may make more patients eligible for this treatment through reduction in their secretions and/or symptoms.Keywords: bronchial rheoplasty, endobronchial valves, emphysema