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ZusammenfassungEs wird der Fall einer 19-jährigen Schülerin vorgestellt, bei der seit ihrem 14. Lebensjahr eine Vocal Cord Dysfunction (VCD) bekannt ist. 3 Jahre nach der Diagnose kommt es nun auch in zunehmender Häufigkeit (1–3 ×/Woche) zu Anfällen mit Bluthusten. Es wird gemutmaßt, dass die Hämoptoe infolge der VCD auftritt. Durch das frustrane Anatmen gegen die obere Atemwegsobstruktion kann es zu hohen negativen intrathorakalen Drucken (Müller-Manöver) kommen, die eine Kapillarwandschädigung mit Einblutung in die Alveolen zur Folge haben. Nach Botulinumtoxininfiltration in den m. vocalis bds. ist es zu einem Sistieren der VCD-Anfälle und auch der Hämoptoen für 3 Monate gekommen.

OBJECTIVES: This prospective study aimed to evaluate the value of B-mode lung ultrasound (LUS) for the early diagnosis of coronavirus disease 2019 (COVID-19) infection in nonhospitalized COVID-19 suspected cases in a population with a low prevalence of disease. METHODS: From April 2020 to June 2020, in an ambulatory testing center for COVID-19-suspected cases, 297 subjects were examined by LUS before a nasopharyngeal swab was taken for a reverse transcription polymerase chain reaction (RT-PCR) test. The following LUS findings were defined as pathological ultrasound findings and were analyzed: the presence of 1) pleural effusion, 2) B-lines, 3) fragmented visceral pleura, 4) consolidation, and 5) air bronchogram in the consolidation. The LUS findings were compared with the RT-PCR test results. RESULTS: The result of the RT-PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive in 11 and negative in 286 subjects, and the prevalence of COVID-19 infection in the study participants was 3.7%. On LUS, a pathological finding could be detected in 56/297 (18.9%) study participants. The LUS revealed a sensitivity of 27.3%, a specificity of 81.5%, a positive predictive value of 5.4%, a negative predictive value of 96.7%, and a diagnostic accuracy of 79.9% for the identification of COVID-19 infection. CONCLUSIONS: For the identification of COVID-19 infection, LUS is highly sensitive to the patient spectrum and to the prevalence of the disease. Due to the low diagnostic performance in nonhospitalized COVID-19 cases in low-prevalence areas, LUS cannot be considered to be an adequate method for making a diagnosis in this group.

We present the case of an otherwise healthy 19-year-old student who has been affected by vocal cord dysfuntion (VCD) since she is fourteen. 3 years after that diagnosis she has also been coughing blood at an increasing rate (1-3 times per week). We postulate that the haemoptoe is the result of breathing against a closed airway which can lead to excessively high negative intrathoracic pressures. Which, in turn, rapture alveolar capillaries. After bilateral injection of Botulinum toxin injection into the muscles vocalis, VCD as well as haemoptoe episodes ceased for three months.Es wird der Fall einer 19-jährigen Schülerin vorgestellt, bei der seit ihrem 14. Lebensjahr eine Vocal Cord Dysfunction (VCD) bekannt ist. 3 Jahre nach der Diagnose kommt es nun auch in zunehmender Häufigkeit (1–3 ×/Woche) zu Anfällen mit Bluthusten. Es wird gemutmaßt, dass die Hämoptoe infolge der VCD auftritt. Durch das frustrane Anatmen gegen die obere Atemwegsobstruktion kann es zu hohen negativen intrathorakalen Drucken (Müller-Manöver) kommen, die eine Kapillarwandschädigung mit Einblutung in die Alveolen zur Folge haben. Nach Botulinumtoxininfiltration in den m. vocalis bds. ist es zu einem Sistieren der VCD-Anfälle und auch der Hämoptoen für 3 Monate gekommen.

Excessive daytime sleepiness is a common symptom in obese patients with obstructive sleep apnea. We investigated predisposing factors of excessive daytime sleepiness by comparing obese non-sleepy with sleepy patients with obstructive sleep apnea. Excessive daytime sleepiness was determined by the Epworth Sleepiness Scale in 43 patients (34 men and 9 women) with obstructive sleep apnea (apnea-hypopnea index ≥ 15 events per hr) and obesity (body mass index ≥ 30 kg m-2 ). Two subgroups were formed with (Epworth Sleepiness Scale ≥ 11) and without (Epworth Sleepiness Scale

Objectives This prospective study aimed to evaluate the value of B‐mode lung ultrasound (LUS) for the early diagnosis of coronavirus disease 2019 (COVID‐19) infection in nonhospitalized COVID‐19 suspected cases in a population with a low prevalence of disease. Methods From April 2020 to June 2020, in an ambulatory testing center for COVID‐19‐suspected cases, 297 subjects were examined by LUS before a nasopharyngeal swab was taken for a reverse transcription polymerase chain reaction (RT‐PCR) test. The following LUS findings were defined as pathological ultrasound findings and were analyzed: the presence of 1) pleural effusion, 2) B‐lines, 3) fragmented visceral pleura, 4) consolidation, and 5) air bronchogram in the consolidation. The LUS findings were compared with the RT‐PCR test results. Results The result of the RT‐PCR test for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was positive in 11 and negative in 286 subjects, and the prevalence of COVID‐19 infection in the study participants was 3.7%. On LUS, a pathological finding could be detected in 56/297 (18.9%) study participants. The LUS revealed a sensitivity of 27.3%, a specificity of 81.5%, a positive predictive value of 5.4%, a negative predictive value of 96.7%, and a diagnostic accuracy of 79.9% for the identification of COVID‐19 infection. Conclusions For the identification of COVID‐19 infection, LUS is highly sensitive to the patient spectrum and to the prevalence of the disease. Due to the low diagnostic performance in nonhospitalized COVID‐19 cases in low‐prevalence areas, LUS cannot be considered to be an adequate method for making a diagnosis in this group.

PURPOSE To describe the perfusion patterns of peripheral pulmonary granulomatous lesions (PPGLs) by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical (CD34) endothelial staining. PATIENTS AND METHODS From January 2007 until September 2020, 10 consecutive patients with histologically confirmed PPGLs were investigated by CEUS. The time to enhancement, classified as early pulmonary-arterial (PA) pattern of enhancement versus delayed bronchial-arterial (BA) pattern of enhancement, the extent of enhancement, classified as marked or reduced, the homogeneity of enhancement, classified as homogeneous or inhomogeneous, and the decrease of enhancement, classified as rapid washout (

PURPOSE: To describe perfusion patterns of peripheral pulmonary lesions (PPLs) in COVID-19 patients using contrast-enhanced ultrasound (CEUS). PATIENTS AND METHODS: From April 2020 until July 2020, 11 consecutive patients with RT-PCR-confirmed COVID-19 and PPLs sized over 5 mm were investigated by B-mode ultrasound (B-US) and CEUS. The homogeneity of enhancement (homogeneous and inhomogeneous) was examined retrospectively using CEUS. An inhomogeneous enhancement was defined as a perfused lesion with coexisting non-perfused areas (NPA). RESULTS: On B-US, all 11 patients showed an interstitial syndrome (B-lines) with PPLs between 0.5 and 6 cm. On CEUS, all cases showed peripheral NPA during the complete CEUS examination. One patient underwent a partial lung resection with subsequent histopathological examination. The histological examination showed vasculitis, microthrombus in the alveolar capillary, and small obliterated vessels. CONCLUSION: In our case series, PPLs in patients with RT-PCR-confirmed COVID-19 infection presented a CEUS pattern with NPA during the complete CEUS examination. Our findings suggest a peripheral pulmonary perfusion disturbance in patients with COVID-19 infection. In 1 case, the histopathological correlation with the perfusion disturbance in the PPL was proven.

The worldwide shortage of medical-grade ventilators is a well-known issue, that has become one of the central topics during the COVID-19 pandemic. Given that these machines are expensive and have long lead times, one approach is to vacate them for patients in critical conditions while patients with mild to moderate symptoms are treated with stripped-down ventilators. We propose a mass-producible solution that can create such ventilators with minimum effort. The central part is a module that can be attached to CPAP machines and repurpose them as low-pressure ventilators. Here, we describe the concept and first measurements which underline the potential of our solution. Our approach may serve as a starting point for open-access ventilator technologies.

As part of a plethora of global efforts to minimize the negative effects of the SARS-CoV2 (COVID-19) pandemic, we developed two different mechanisms that, after further development, could potentially be of use in the future in order to increase the capacity of ventilators with low-cost devices based on single-use-bag-valve mask systems. We describe the concept behind the devices and report a characterization of them. Finally, we make a description of the solved and unsolved challenges and propose a series of measures in order to better cope with future contingencies.

Die Osophagusperforation ist eine seltene Ursache eines Pleuraempyems und deshalb nicht unbedingt im Fokus der Diagnostik. Doch gerade bei unpassender Anamnese ist die ohnehin schon grose Gefahr einer verzogerten Diagnosestellung erhoht.

Background: Various exercise training programs are used for patients with chronic obstructive pulmonary disease (COPD) of different severity. Objectives: To investigate the impact of individualized high-intensity training on exercise capacity with COPD. Methods: A total of 49 patients agreed to participate. Of these, 31 were assigned to the training group and 18 served as controls. The training group exercised twice a week for 90 min with consecutively increasing loads. At the time of enrollment (T0), as well as after 3 (T1) and 6 (T2) months, a 6-min walk test (6-MWT) was performed and data on health-related quality of life, femoral muscle thickness, and various serum markers were obtained. Results: The training group improved in their 6-MWT results (T0 = 407 ± 152 m vs. T1 = 459 ± 127 m, p = 0.002, vs. T2 = 483.2 ± 130.1 m, p = 0.004), in their cross-sectional area of the musculus rectus femoris (T0 = 6.2 ± 1.2 cm2 vs. T1 = 6.9 ± 1.2 cm2, p = 0.003, vs. 7.5 ± 1.6 cm2, p = 0.002), and in their St. George's Respiratory Questionnaire (SGRQ) score (T0 = 43.3 ± 18.0 vs. T1 = 36.0 ± 18.4, p = 0.001, vs. T2 = 34.7 ± 18. 0, p = 0.004). Serum levels of myostatin, irisin, resistin, and α-Klotho did not change significantly within the training period. Of note, the exercise group showed an inverse relationship between serum levels of resistin and those of α-Klotho after 6 months (r = -0.608, p = 0.021). Conclusions: COPD patients undergoing an individualized, structured, high-intensity training program improved their exercise capacity, gained muscle mass, and improved their quality of life.

We report about a case of a compassionate off-label use of the anti-interleukin-5-agent mepolizumab in a ventilated patient with life-threatening asthma attack in eosinophilic asthma. The patient suffered from severe eosinophilic asthma and was transmitted to our hospital with an asthma attack and a life-threatening respiratory state under ventilation. Since high dose steroids had not yielded a sufficient respiratory improvement mepolizumab was administered subcutaneously. After administration of mepolizumab respiratory state and ventilation parameter improved significantly. Two days after administration the patient was weaned could be extubated 8 days later and recovered completely from the asthma attack.The presented clinical case is suggestive of future clinical trials or registry studies to evaluate potential clinical benefits of anti-interleukin-5 treatment in patients with severe exacerbations of eosinophilic asthma. Keywords: Anti-IL-5-therapy, Asthma, Eosinophilia, Exacerbation, Intensive care medicine

Seit Ende letzten Jahres ist durch das GOLD-Kommitee die Klassifizierung der COPD modifiziert worden. Die ehemals rein spirometrische Einteilung ist um die Erfassung der Symptomatik (z. B. COPD Assessment Test, CAT) und der Exazerbationsrate erganzt worden. Der Serummarker Adiponectin ist mit einem erniedrigten Risiko fur kardiovaskulare Ereignisse assoziiert, zeigt aber umgekehrt ein deutliches Risiko fur respiratorisch bedingte Mortalitat an. Mit einer elektronischen Nase konnten Patienten mit COPD von einer Kontrollgruppe ohne COPD unterschieden werden. Ferner ist damit eine Differenzierung von COPD-Patienten mit und ohne Alpha-1-Antitrypsinmangel moglich. In einer grosen Studie mit 7376 Patienten wurde demonstriert, dass COPD-Patienten, die Tiotropiumbromid erhalten, ein um 17 % geringeres Exazerbationsrisiko haben als eine mit Salmeterol behandelte Vergleichsgruppe. Der Phosphodiesterase-4-Hemmer Roflumilast reduzierte bei COPD-Patienten mit schwerer und sehr schwerer COPD und mehr als 2 Exazerbationen unabhangig von der inhalativen Begleitmedikation die Exazerbationsfrequenz. COPD-Patienten mit spirometrischem GOLD-Schweregrad III und IV zeigten im Rahmen einer 3-wochigen Rehabilitation bei Durchfuhren eines zusatzlichen Vibrationstrainings (Gerat mit nach rechts und links kippender Platte) zur standardisierten Trainingstherapie zusatzliche signifikante Trainingseffekte. Herzinsuffizienz und COPD kommen nicht selten gemeinsam vor. Eine gleichzeitig bei COPD vorliegende ventrikulare Dysfunktion kann einen negativen Einfluss auf das Uberleben haben. Bei COPD sollten deshalb Echokardiografien durchgefuhrt und das Brain-Natriuretische Peptid (BNP) im Serum untersucht werden.

Background A large proportion of COPD patients do not achieve the recommended level of physical activity. It is suggested that feedback on the level of activity by using an activity monitoring device (PAM) increases awareness and may stimulate patients to increase their physical activity in daily life. Our objective was to assess the validity and usability of a simple and low-cost physical activity monitor (Polar A300™) when compared with the validated and established Bodymedia-SenseWear™ (SWA) device. Methods To assess the diagnostic equivalent, two different PAM devices were used in parallel in 20 COPD patients GOLD I to IV during 3 consecutive days of daily life. Both systems were compared in terms of steps, calories burned, daily activity time and metabolic equivalents using linear regression analysis and Bland-Altman plots. Practical usability was examined by a 16-item-questionnaire. Results High correlations of both devices were observed with regard to the sensed step count (r = 0.96; p < 0.01) and calories burned (r = 0.74; p < 0.01), and a lower correlation of daily activity (r = 0.25; p < 0.01) was found. Data analysis over 3 days showed that 90% of the steps (95% CI -4223 to 1887), 100% of the calories (95% CI -2798 to 1887), 90% of the daily activity data (95% CI -12.32, 4065) and 95% of the MET (95% CI -3.11 to 2.75) were within the limits of agreement. A favorable usability (system-, information- and interface quality) of the A300™ device was shown (p < 0.01). Conclusion The A300™ device with easy practical usability was shown not to be inferior for assessment of physical activity time, step count and calorie consumption in COPD patients when compared with the SWA. It is suggested to consider widespread available devices as commonly used for monitoring recreational sporting activities also in patients for assessment of physical activity in daily life.

Allergische Erkrankungen der Lunge konnen die Atemwege, das Lungenparenchym und die Gefase der Lunge betreffen. Dazu gehoren das exogen-allergische Asthma bronchiale, die exogen-allergische Alveolitis, die allergische bronchopulmonale Aspergillose und das Churg-Strauss-Syndrom. In Bezug auf die Art der allergischen Reaktion und deren pathophysiologische Konsequenzen unterscheiden sich die Krankheitsentitaten stark. Das therapeutische Vorgehen hangt von der vorliegenden Erkrankung ab. In diesem Zusammenhang werden Biologika, die spezifisch und kausal in die Erkrankung eingreifen, zukunftig moglicherweise eine grosere Rolle spielen.

The common Z mutation (Glu342Lys) of α1-antitrypsin (A1AT) results in the polymerization and intracellular retention of A1AT protein. The concomitant deficiency of functional A1AT predisposes PiZZ subjects to early onset emphysema. Clinical studies have implied that, among the biomarkers associated with emphysema, matrix metalloproteinase 9 (MMP-9) is of particular importance. Increased plasma MMP-9 levels are proposed to predict the decline of lung function as well as greater COPD exacerbations in A1AT deficiency-associated emphysema. The aim of the present study was to investigate the effect of A1AT therapy (Prolastin) on plasma MMP-9 and myeloperoxidase (MPO) levels. In total 34 PiZZ emphysema patients were recruited: 12 patients without and 22 with weekly intravenous (60 mg/kg body weight) A1AT therapy. The quantitative analysis of A1AT, MMP-9 and MPO was performed in serum and in supernatants of blood neutrophils isolated from patients before and after therapy. Patients with Prolastin therapy showed significantly lower serum MMP-9 and MPO levels than those without therapy. However, parallel analysis revealed that a rapid infusion of Prolastin is accompanied by a transient elevation of plasma MMP-9 and MPO levels. Experiments with freshly isolated blood neutrophils confirmed that therapy with Prolastin causes transient MMP-9 and MPO release. Prolastin induced the rapid release of MMP-9 and MPO when added directly to neutrophil cultures and this reaction was associated with the presence of IgA in A1AT preparation. Our data support the conclusion that changes in plasma levels of MMP-9 and MPO mirror the effect of Prolastin on blood neutrophils.

In this paper we demonstrate the benefits of application involvement in operating system power management. We present Coop-I/O, an approach to reduce the power consumption of devices while encompassing all levels of the system---from the hardware and OS to a new interface for cooperative I/O that can be used by energy-aware applications. We assume devices which can be set to low-power operation modes if they are not accessed and where switching between modes consumes additional energy, e.g. devices with rotating components or network devices consuming energy for the establishment and shutdown of network connections. In these cases frequent mode switches should be avoided.With Coop-I/O, applications can declare open, read and write operations as deferrable and even abortable by specifying a time-out and a cancel flag. This information enables the operating system to delay and batch requests so that the number of power mode switches is reduced and the device can be kept longer in a low-power mode. We have deployed our concept to the IDE hard disk driver and Ext2 file system of Linux and to typical real-life programs so that they make use of the new cooperative I/O functions. With energy savings of up to 50%, the experimental results demonstrate the benefits of the concept. We will show that Coop-I/O even outperforms the "oracle" shutdown policy which defines the lower bound in power consumption if the timing of requests can not be influenced.