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Acquired tracheo-oesophageal fistulas (TEFs) are rare and challenging complications in the course of oesophageal cancer. While surgery is the only curative treatment option for TEFs many patients are not eligible for surgery. Endoscopic treatment approaches such as tracheal- and/or oesophageal- stenting are available, but associated with complications like the development of new fistulas and mucus retention. Off- label-use of cardiac amplatzer occluder devices to close TEFs has been reported in few case-reports with inconsistent short-term outcomes. We report a case of successful closure of two adjacent TEFs with two partially overlapping cardiac amplatzer occluder devices. The insertion of a 12 mm and a 9 mm device was successful and without complications. The patient tolerated the cardiac amplatzer-devices well and could resume oral food uptake after 2 months. Two years after closure, the patient remained free of symptoms suggesting complete sealing of the fistulas., Competing Interests: None declared., (© 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Background and Objective: Idiopathic pulmonary fibrosis (IPF) is a devastating progressive lung disease affecting the parenchyma. Nitrogen multiple-breath washout (N 2 -MBW) is a lung function test that measures ventilation inhomogeneity, a biomarker of small airway disease. We assessed clinical properties of N 2 -MBW in IPF., Methods: In this prospective cohort pilot study, 25 IPF patients and 25 healthy controls were assessed at baseline and 10 patients at median 6.2 months later. Outcomes included the lung clearance index (LCI) from N 2 -MBW, forced vital capacity (FVC) from spirometry, diffusion capacity of the lungs for carbon monoxide (DL CO ), bronchiectasis score from computed tomography scans, the Gender-Age-Physiology (GAP score for IPF) stage and death or lung transplantation (LTx). Study end points were feasibility, repeatability, discriminative capacity and correlation with disease severity and structural lung damage., Results: All patients were able to perform N 2 -MBW. LCI was repeatable and reproducible. Median (interquartile range (IQR)) LCI in IPF was 11.6 (10.1-13.8) in IPF versus 7.3 (6.9-8.4) in controls (P < 0.0001). LCI correlated with DL CO corrected for haemoglobin (corrDL CO ; r = -0.49, P = 0.016), bronchiectasis score (r = 0.45, P = 0.024) and the GAP stage (r = 0.59, P = 0.002), but not with FVC. FVC was not related to bronchiectasis. During follow-up, six patients died and one received LTx. LCI correlated with the latter compound outcome: hazard ratio (95% CI) was 2.43 (1.26; 4.69) per one LCI SD from the patient population., Conclusion: N 2 -MBW is a feasible, reliable and valid lung function test in IPF. LCI correlates with diffusion impairment, structural airway damage and clinical disease severity. LCI is a promising surveillance tool in IPF that may predict mortality., (© 2018 Asian Pacific Society of Respirology.)

The hypothesis of this experiment was that humans in an anxious state compared with a nonanxious state are able to increase anxiety levels in other humans via their body odors. Specifically, we hypothesized that male chemosensory anxiety signals compared with neutral chemosignals increase state anxiety of female subjects. Thirteen male subjects participated in 2 different sweat donation sessions: chemosignals were collected during participation in a high rope course (anxiety condition) and in an ergometer workout (neutral condition). State and trait anxiety were evaluated in 20 female odor recipients using Spielberger's state-trait anxiety inventory in a double-blind design. Comparison of state anxiety of odor donors between control and anxiety condition differed significantly indicating that our model of anxiety induction successfully led to the expected change in emotion. Comparison of state anxiety of odor recipients showed a trend toward higher state anxiety in the anxiety condition compared with the neutral condition after 5 min of odor exposure. After 20 min of odor exposure, state anxiety of female subjects was significantly higher during the perception of sweat collected during the anxiety condition in comparison with the perception of sweat collected during the neutral condition. This experiment gives evidence that male anxiety chemosignals compared with neutral chemosignals are capable of inducing an increased state anxiety in female subjects.

End stage pulmonary emphysema is the most common indication for lung transplantation worldwide. The shortness of donor organs and the better natural prognosis compared to other diseases leading to transplantation such as pulmonary fibrosis and cystic fibrosis demands careful patient selection.Lung transplantation is considered in patients with declining lung function after receiving all conservative treatment options including smoking cessation and rehabilitation programmes. Preoperative evaluation using consensus criteria needs to be performed by a multidisciplinary team in specialized centres. Assessment of co-morbidities is crucial, as they may significantly increase transplant-related mortality. The largest survival advantage from lung transplantation has been shown for the subgroup of patients below 60 years of age presenting with end-stage obstructive lung disease (FEV1 < 20% predicted) and respiratory failure. Similarly, high risk patients with secondary pulmonary hypertension or cachexia (BMI < 20) will likely benefit from transplantation.The 5-year-survival rate averages 60 percent, with superior outcome following double versus single lung transplantation. A clear survival benefit can only be achieved in a subgroup of patients, whereas the impact on quality of life seems to be even more important in patients suffering from chronic obstructive pulmonary disease., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aims of the present study were to investigate the influence of laserneedle acupuncture on olfactory sensitivity and to examine whether the attitude towards laserneedle acupuncture affects the outcome. Olfaction was tested repeatedly on two days using the olfactory detection threshold subtest of the Sniffin' Sticks test battery in sixty-four healthy subjects of which 32 showed a positive attitude towards the effects of laserneedle acupuncture and 32 were sceptic about its effects. Testing was accomplished three times on day one (T1 = 0 min, T2 = 35 min, T3 = 105 min) without laserneedle acupuncture and on day two (T1* = 0 min, T2* = 35 min, T3* = 105 min) when the subjects were randomized in a non-stimulation (placebo) and a stimulation (laserneedle acupuncture) group. Stimulation or non-stimulation was conducted in a double-blinded design. Following laserneedle acupuncture a significant decrease in olfactory detection thresholds was observed at both, T2* and T3*, whereas no significant changes were found in the baseline or placebo group. Effects of laserneedle acupuncture on the olfactory detection threshold did not differ between sceptic and non-sceptic subjects. In conclusion, laserneedle acupuncture is an effective method to improve olfactory sensitivity after one session of stimulation for at least one hour, independently of the attitude of subjects towards the stimulation method.

The primary aim of this study was to investigate whether olfactory detection thresholds are dependent on different states of satiety. Using the threshold test of the Sniffin' Sticks test battery (single-staircase, three alternative forced choice procedure), sensitivity to a non-food odour (n-butanol) and a food-related odour (isoamyl acetate) was investigated. Twenty-four healthy, female subjects (mean age 24.2 years, SD 2.7 years) with normal olfactory function performed the tests when hungry and when satiated. Additionally, they rated their emotional condition, arousal, alertness as well as the intensity and pleasantness of both odorants. No significant change in the detection thresholds for the non-food odour n-butanol, but a significant change in detection threshold for the food-related odour isoamyl acetate was found. The detection threshold for isoamyl acetate was significantly lower in the state of satiety compared to the hungry condition. As expected, the perceived pleasantness of isoamyl acetate was significantly lower in satiety. In summary, the results indicate that in our experimental setting the actual state of satiety has effects on detection thresholds of a food-related odour, but not of a non-food odour. Interestingly, the higher sensitivity was found during the state of satiety challenging the current hypothesis that control of food intake is supported by a decrease in sensitivity to food odours. Instead our findings that satiety decreases the pleasantness of a food-related odour support the hypothesis that both odour threshold as well as pleasantness play an important role in the control of food intake.

Applied to the nasal mucosa in low concentrations, nicotine vapor evokes odorous sensations (mediated by the olfactory system) whereas at higher concentrations nicotine vapor additionally produces burning and stinging sensations in the nose (mediated by the trigeminal system). The objective of this study was to determine whether intranasal stimulation with suprathreshold concentrations of S(-)-nicotine vapor causes brain activation in olfactory cortical areas or if trigeminal cortical areas are also activated. Individual olfactory detection thresholds for S(-)-nicotine were determined in 19 healthy occasional smokers using a computer-controlled air-dilution olfactometer. Functional magnetic resonance images were acquired using a 1.5T MR scanner with applications of nicotine in concentrations at or just above the individual's olfactory detection threshold. Subjects reliably perceived the stimuli as being odorous. Accordingly, activation of brain areas known to be involved in processing of olfactory stimuli was identified. Although most of the subjects never or only rarely observed a burning or painful sensation in the nose, brain areas associated with the processing of painful stimuli were activated in all subjects. This indicates that the olfactory and trigeminal systems are activated during perception of nicotine and it is not possible to completely separate olfactory from trigeminal effects by lowering the concentration of the applied nicotine. In conclusion, even at low concentrations that do not consistently lead to painful sensations, intranasally applied nicotine activates both the olfactory and the trigeminal system.

Objective: Interoceptive awareness is known to be impaired in eating disorders. To date, it has remained unclear whether this variable is related to the construct of interoceptive sensitivity. Interoceptive sensitivity is considered to be an essential variable in emotional processes. The objective of the study was to elucidate this potential relationship and to clarify whether general interoceptive sensitivity is reduced in anorexia nervosa., Methods: Using a heartbeat perception task, interoceptive sensitivity was assessed in 28 female patients with anorexia nervosa and 28 matched healthy controls. Questionnaires assessing interoceptive awareness (EDI) and several other variables were also administered., Results: Patients with anorexia nervosa displayed significantly decreased interoceptive sensitivity. They also had more difficulties in interoceptive awareness., Conclusions: In addition to a decreased ability to recognize certain visceral sensations related to hunger, there is a generally reduced capacity to accurately perceive bodily signals in anorexia nervosa. This highlights the potential importance of interoceptive sensitivity in the pathogenesis of eating disorders.

The aim of this study was to compare the olfactory performance of anorectic patients and healthy controls with regard to the state of satiety. Using the Sniffin' Sticks, sensitivity to a nonfood odor (n-butanol) and to a food-related odor (isoamyl acetate) was assessed in 12 anorectic females and compared with 24 healthy controls. Threshold tests were performed in a hungry as well as in a satiated state, odor discrimination and odor identification only when satiated. Pleasantness of the odors was recorded. In terms of the non-food odor n-butanol, the olfactory sensitivity of anorectic patients and controls did not differ. Patients with anorexia nervosa had a significantly lower detection threshold for the food-related odor, but only in the hungry condition. Anorectic patients showed significant deficits in odor discrimination and identification, and under-evaluated the pleasantness of isoamyl acetate. Our results suggest an impaired projection from secondary to tertiary olfactory structures in anorexia nervosa, based upon the dichotomy of performance between detection threshold and odor discrimination/dentification. The reduced pleasantness of isoamyl acetate indicates a decreased olfactory responsiveness to food stimuli in anorexia nervosa.

Background: Clinical studies suggest that olfactory sensitivity is reduced in major depression. Nevertheless, only little is known about the relationship between depressive symptoms and olfactory functions in healthy subjects., Methods: The present study investigated the association between depressive symptoms and olfactory performance in 48 healthy subjects (14 male). First depressive symptoms were assessed using the Beck Depression Inventory, following by olfactory testing. Olfactory threshold and discrimination performance was assessed as well as emotional arousal and pleasantness during the testing procedure., Results: We observed a significant negative correlation between olfactory sensitivity and depressive symptoms while olfactory discrimination was not related to depressive symptoms., Limitations: The degree of depressive symptoms was assessed by questionnaire. A clinical interview might assess depressive symptoms more accurate., Conclusion: We conclude that depressive symptoms are related to a reduced olfactory sensitivity. The observed relation between reduced olfactory sensitivity and depressive symptoms could be mediated by functional deviations within brain structures subserving primary olfactory processing such as amygdala and piriform cortex which is in line with results showing abnormal activity pattern in the amygdala and other brain regions in depression.