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Electronic cigarettes (EC) are a novel product, marketed as an alternative to tobacco cigarette. Its effects on human health have not been investigated widely yet, especially in specific populations such as patients with asthma. With this review, we use the existing literature in order to answer four crucial questions concerning: (1) ECs’ role in the pathogenesis of asthma; (2) ECs’ effects on lung function and airway inflammation in patients with asthma; (3) ECs’ effects on asthma clinical characteristics in asthmatics who use it regularly; and (4) ECs’ effectiveness as a smoking cessation tool in these patients. Evidence suggests that many EC compounds might contribute to the pathogenesis of asthma. Lung function seems to deteriorate by the use of EC in this population, while airway inflammation alters, with the aggravation of T-helper-type-2 (Th2) inflammation being the most prominent but not the exclusive effect. EC also seems to worsen asthma symptoms and the rate and severity of exacerbations in asthmatics who are current vapers, whilst evidence suggests that its effectiveness as a smoking cessation tool might be limited. Asthmatic patients should avoid using EC.

Smoking habit is held responsible for several respiratory and metabolic diseases. Data from 1452 patients were recorded from our outpatient laboratory. The following parameters were recorded within several follow ups of our patients; smoking habit, respiratory functions, smoking cessation questionnaires, and administered drugs. The treatment administered to smokers throughout the period of inspection seems to also have a significant effect on dependence. In fact, varelicline causes a 50% reduction in smoking dependence in regards to nicotine substitutes (odds ratio: 0.48 (0.31-0,74), p=0.001) so displaying a substantial preponderance on the choice to fight smoking dependence.

Background In an effort to identify factors producing a finest mist from Jet-Nebulizers we designed 2 mouthpieces with 4 different internal designs and 1–3 compartments. Materials and methods Ten different drugs previous used with their “ideal” combination of jet-nebulizer, residual-cup and loading were used. For each drug the mass median aerodynamic diameter size had been established along with their “ideal” combination. Results For both mouthpiece, drug was the most important factor due the high F -values ( F large = 251.7, p F small = 60.1, p F large = 5.99, p = 0.001, F small = 1.72, p = 0.178). Cross designs create the smallest droplets (2.271) so differing from the other designs whose mean droplets were greater and equal ranging between 2.39 and 2.447. The number of compartments in the two devices regarding the 10 drugs was found not statistically significant ( p -values 0.768 and 0.532 respectively). Interaction effects between drugs and design were statistically significant for both devices ( F large = 8.87, p F small = 5.33, p Conclusion Based on our experiment we conclude that further improvement of the drugs intended for aerosol production is needed. In addition, the mouthpiece design and size play an important role in further enhancing the fine mist production and therefore further experimentation is needed.

Background: Asbestos exposure is related to serious adverse health effects. However, there is disagreement about the relationship between chrysotile exposure and mesothelioma or lung cancer. Objectives: Our aim was to investigate the mortality rate among workers exposed to relatively pure chrysotile in an asbestos cement factory. Patients and Methods: In an asbestos cement plant opened in 1968, we prospectively studied all 317 workers. A quantity of 2,000 tons of chrysotile, with minimal amphibole contamination, was used annually until 1 January 2005. Asbestos fiber concentration was measured regularly. Date and cause of death were recorded among active and retired workers. Results: Asbestos fiber concentration was always below permissible levels. Fifty-two workers died during the study. The cause was cancer in 28 subjects; lung cancer was diagnosed in 16 of them. No case of mesothelioma was reported. Death was attributed to cardiovascular diseases in 23 subjects and to liver cirrhosis in 1. Overall mortality rate was significantly lower than that of the Greek general population, standardized mortality ratio (SMR) was 0.71 (95% CI 0.53–0.93). Mortality due to cancer was increased (SMR 1.15, 95% CI 0.77–1.67), mainly due to lung cancer mortality (SMR 1.71, 95% CI 0.98–2.78), but not significantly. Conclusions: Occupational exposure to relatively pure chrysotile within permissible levels was not associated with a significant increase in lung cancer or with mesothelioma. Decreased overall mortality of workers indicates a healthy worker effect, which – together with the relatively small cohort size – could have prevented small risks to be detected.

Background: Expiratory flow limitation (EFL) is one of the main mechanisms contributing to dyspnea in patients with chronic obstructive pulmonary disease but has not been explored in patients with pleural effusion. Objectives: It was the aim of this study to determine whether patients with pleural effusion exhibit EFL and to investigate the effect of therapeutic thoracentesis on EFL. Patients and Methods: The study was performed on 21 patients with pleural effusion who were subjected to thoracentesis and measurement of pleural pressure (PP). Spirometry and estimation of flow limitation by the negative expiratory pressure technique were performed before and after thoracentesis. Results: Statistically significant differences were observed in all spirometric parameters. No correlation between the increase in lung volumes and flows and any of the aspirated fluid parameters was observed. Before thoracentesis, 14 out of 21 patients were flow limited, compared with 7 patients after thoracentesis (χ2 = 6.151, p = 0.013). Mean values of flow limitation before and after thoracentesis differed significantly. The decrease in flow limitation did not correlate with the increase in the spirometric parameters, the aspirated fluid volume or PP decrease. Conclusions: In the majority of patients with pleural effusion, flow limitation improves after thoracentesis. Flow limitation may be a contributing factor to the sensation of dyspnea in these patients.

Paul Zarogoulidis,1 Ioannis Kioumis,1 Sofia Lampaki,1 John Organtzis,1 Konstantinos Porpodis,1 Dionysios Spyratos,1 Georgia Pitsiou,1 Dimitris Petridis,2 Athanasia Pataka,1 Haidong Huang,3 Qiang Li,3 Lonny Yarmus,4 Wolfgang Hohenforst-Schmidt,5 Nikolaos Pezirkianidis,6 Konstantinos Zarogoulidis1 1Pulmonary Department-Oncology Unit, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece; 3Department of Respiratory Diseases, Shanghai Hospital, II Military University Hospital, Shanghai, People’s Republic of China; 4Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; 5II Medical Department, “Coburg” Regional Hospital, Coburg, Germany; 6Surgery Department, Private Cabinet, Serres, Greece Background: At this time, several antibiotics have been investigated as possibilities for aerosol administration, but local therapy has been found to be more efficient in several diseases. Materials and methods: The drugs linezolid (Zyvox), vancomycin (Voncon), and daptomycin (Cubicin) were tested with three jet nebulizers with seven different residual cups and different loadings. Moreover, three ultrasound nebulizers were again tested with these drugs, with different loadings and mouthpiece attachments. Results: When drugs are combined with particular cup designs, they significantly lower the droplet size to 1.60 and 1.80 µm, which represents the best combination of Zyvox and cup G and Cubicin and cup D, respectively. Cup design D is suggested as the most effective cup for lowering the droplet size (2.30 µm) when considering a higher loading level (8 mL). Conclusion: Modification of current drugs from dry powder to solution is possible, and the residual cup design plays the most important role in droplet size production when the nebulization systems have the same properties. Keywords: vancomycin, linezolid, daptomycin, aerosol, jet nebulizers, ultrasound nebulizers

This review is focused on the relationship between asthma, pneumothorax and pneumomediastinum while presenting a number of case reports that include these conditions. The association between pneumothorax and asthma is not widely known. While asthma includes a common disorder and is prevalent worldwide, its morbidity and mortality is high when is associated with pneumothorax. Furthermore, the delayed diagnosis of pneumothorax while focusing on asthma includes the higher risk of coincidental pneumothorax in asthmatic patients. In addition, pneumomediastinum is considered benign and self-limiting condition that responds to conservative therapy. Although it is rare, the concurrence of pneumomediastinum with pneumothorax may prove fatal during a serious asthma attack. In conclusion, the symptoms of chest pain, dyspnea or focal chest findings when presented in asthmatic patients, must always create suspicion of pneumothorax or pneumomediastinum to the physician.

Asthma and chronic obstructive pulmonary disease (COPD) are chronic diseases, very common in general population. These obstructive airway illnesses are manifested with chronic inflammation affecting the whole respiratory tract. Obstruction is usually intermittent and reversible in asthma, but is progressive and irreversible in COPD. Asthma and COPD may overlap and converge, especially in older people [overlap syndrome—asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)]. Although ACOS accounts approximately 15-25% of the obstructive airway diseases, is not well recognised because of the structure of clinical trials. COPD studies exclude asthma patients and asthma studies exclude COPD patients, respectively. It is crucial to define asthma, COPD and overlap syndrome (ACOS), as notable clinical entities, which they share common pathologic and functional features, but they are characterized from differences in lung function, acute exacerbations, quality of life, hospital impact and mortality.

Chronic obstructive pulmonary disease (COPD) is an inflammatory airway disease whose incidence and mortality increases every year. It is associated with an abnormal inflammatory response of the lung to toxic particles or gases (usually cigarette smoke). A central role in the pathophysiology has been shown to play a chronic inflammation of the airways that is expressed primarily by hypersecretion of mucus, stenosis of the smaller airways and the establishment of pulmonary emphysema. There is an increasing trend for assessing the inflammatory pattern of inflammatory airway diseases through mediators measured by noninvasive techniques. Markers in biological fluids and exhaled air have been the subject of intense evaluation over the past few years, with some of them reaching their introduction into clinical practice, while others remain as research tools. Of particular interest for the scientific community is the discovery of clinically exploitable biomarkers associated with specific phenotypes of the disease. Studying the effects of therapeutic interventions in these biomarkers may lead to targeted therapy based on phenotype and this is perhaps the future of therapeutics in COPD.

Aerosolized therapies have been used in everyday clinical practice for decades. Experimentation with different delivery systems have led to the creation of aerosolized insulin, antibiotics, gene therapy and chemotherapy. Several of these therapies are already clinically available while others are being investigated in active clinical trials. The main factors affecting the efficiency and safety of the aerosolized therapies are the production of the aerosol, distribution/deposition of the aerosol throughout the lung parenchyma, respiratory defense mechanisms and tissue/pharmaceutical molecule interactions. Current methods of aerosol production and distribution will be presented along with an overview of the respiratory defense mechanisms. In addition, methods of aerosol evaluation in conjunction with a future perspective of the potential development of aerosol therapies will be presented.

Background Inhaled bronchodilators and corticosteroids have been used for decades with different production systems. Materials and methods The following jet-nebulizers: (a) Invacare, (b) Sunmist, (c) Maxineb and ultrasound nebulizers: (a) GIMA, (b) OMRON and (c) EASY NEB II were used as production systems. The jet-nebulizers were used with different residual cups and volume filling, while the ultrasound nebulizers with different volume fillings and face mask versus inlet. Results Inhalation and ultrasound process detect significant differences between the factors and interactions considered, but each technique follows a specific pattern of magnitude effect. Thus the inhaled mechanism ranks the factor effects in decreasing order: residual cup > drug > nebulizer > loading (2, 3, 4 ml) and also drug > residual cup > nebulizer (loading 8 ml). The ultrasound mechanism orders as follows: nebulizer > drug > loading. In fact, varying micro environmental conditions created during the performance of the devices in both processes alternate the magnitude of factor significance allowing for unique capacities. Conclusions PULMICORT, MAXINEB, design cup J and loading 6 ml are the best options for the inhaled process. Optimal combinations are provided by FLIXOTIDE and cup B and also by MAXINEB and cup J. The incorporation of large residual cups suggests one out of six drugs, the SUNMIST nebulizer and design D as the best choices. Ultrasound performance informs for other optimal conditions: ZYLOREN, MAXINEB, 4 ml load and MAXINEB × loading 4 ml.

Cystic Fibrosis (CF), Ulcerative Colitis (UC), and Crohn's Disease (CD) manifest as various, multiple symptoms from malfunctioning and/or damaged gastrointestinal tract, which plague the patients. These symptoms result from the dysfunctional expression products of the specific mutations of the genes, which either manifest upon birth (CF) or later in life in immuno-genetically susceptible individuals as inflammatory bowel diseases (IBD). They all may potentially lead to malnutrition of the patients. Since only correcting the mutated genes, may cure these diseases permanently, the works on the future safe gene therapies continue vigorously. However, provision of the necessary nutrients to the suffering patients is the requirement for an effective, supportive care at present. In this realm, we have developed a model of the diseased gastrointestinal tract aimed to guide designing and testing various nutritional therapies.It is well known that inflammatory bowel diseases induce crypts within the patients' gastrointestinal tract. Therefore, we have bioengineered, a novel, three-dimensional model of the gastrointestinal tract to evaluate the rheology of different types of nutrients. The model was assembled out of the bio-inert polymer tube with openings leading to vials of different shapes and sizes, as the simulation of the gastrointestinal tract altered by the diseases to contain multiple crypts.The newly developed three-dimensional model effectively simulates the structure and functions of the gastrointestinal tract of the patients with mild and severe Ulcerative Colitis, Crohn's Disease, and Cystic Fibrosis. This model should allow us to design and test different nutritional supplements, with properties complementing the pathologically altered by the diseases functionalities of the patients' gastrointestinal tracts. Therefore, it should help us to design the effective supportive therapies; thus to prevent the patients' malnutrition.

Konstantinos Zarogoulidis,1 Efimia Boutsikou,1 Paul Zarogoulidis,1,2 Kaid Darwiche,2 Lutz Freitag,2 Konstantinos Porpodis,1 Dimitrios Latsios,1 Theodoros Kontakiotis,1 Haidong Huang,3,4 Qiang Li,4 Wolfgang Hohenforst-Schmidt,5 Maria Kipourou,1 J Francis Turner,6 Dionysios Spyratos11Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; 3Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, Detroit, MI, USA; 4Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People’s Republic of China; 5II Medical Clinic, “Coburg” Regional Hospital, University of Wuerzburg, Coburg, Germany; 6Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, NV, USABackground: To evaluate the benefit of second-line chemotherapy with platinum-based treatment in patients with recurrent small cell lung cancer (SCLC).Patients and methods: A total of 535 patients continued with follow-up or best supportive care if needed, and 229 patients who progressed after the completion of first-line chemotherapy were treated with second-line chemotherapy at the time of progression. In total, 103/229 patients received paclitaxel 190 mg/m2 and carboplatin 5.5 area under the curve while 126/229 patients received etoposide 200 mg/m2 and carboplatin 5.5 area under the curve every 28 days.Results: Patients administered second-line chemotherapy lived significantly longer, with a median survival of 422 days compared to 228 days in patients with best supportive care alone (P

Lung cancer first line treatment has been directed from the non-specific cytotoxic doublet chemotherapy to the molecular targeted. The major limitation of the targeted therapies still remains the small number of patients positive to gene mutations. Furthermore, the differentiation between second line and maintenance therapy has not been fully clarified and differs in the clinical practice between cancer centers. The authors present a segregation between maintenance treatment and second line and present a possible definition for the term “maintenance” treatment. In addition, cancer cell evolution induces mutations and therefore either targeted therapies or non-specific chemotherapy drugs in many patients become ineffective. In the present work pathways such as epidermal growth factor, anaplastic lymphoma kinase, met proto-oncogene and PI3K are extensively presented and correlated with current chemotherapy treatment. Future, perspectives for targeted treatment are presented based on the current publications and ongoing clinical trials.

Lung cancer is the leading cause of cancer death for male and the second most usual cancer for women after breast cancer. Currently there are available several non-specific cytotoxic agents and several targeted agents for lung cancer therapy. However; early stage diagnosis is still unavailable and several efforts are being made towards this direction. Novel biomarkers are being investigated along with new biopsy techniques. The occupational and environmental exposure to carcinogenic agents is an everyday phenomenon. Therefore until efficient early diagnosis is available, avoidance of exposure to carcinogenic agents is necessary. In the current mini-review occupational and environmental carcinogenic agents will be presented.

Anastasios Kallianos,1 Sotirios Tsimpoukis,2 Paul Zarogoulidis,3 Kaid Darwiche,4 Andriani Charpidou,2 Ilias Tsioulis,3 Georgia Trakada,5 Konstantinos Porpodis,3 Dionysios Spyratos,3 Athanasios Panoutspoulos,5 Lemonia Veletza,5 Konstantinos Kostopoulos,5 Charalampos Kostopoulos,4 Ilias Karapantzos,6 Kosmas Tsakiridis,7 Wolfgang Hohenforst-Schmidt,8 Konstantinos Zarogoulidis,3 Aggeliki Rapti,1 Konstantinos Syrigos21Second Pulmonary Clinic, Sotiria Hospital, 2Oncology Unit, Sotiria Hospital, Athens, Greece; 3Oncology Unit, G Papanikolaou General Hospital, Thessaloniki, Greece; 4Interventional Unit, Ruhrland Clinic, Essen, Germany; 5Pulmonary Laboratory, Alexandra Hospital, Athens, Greece; 6Ear, Nose, and Throat Department, Saint Luke Private Hospital, 7Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 8II Medical Clinic, Hospital of Coburg, Coburg, GermanyAbstract: Nitric oxide (NO) is a marker of airway inflammation and indirectly a general indicator of inflammation and oxidative stress. NO is a contributing factor in lung cancer at an early stage and also after chemotherapy treatment of lung cancer. We studied whether exhaled NO levels were altered by three cycles of chemotherapy at diagnosis and after chemotherapy, and whether, directly or indirectly, these changes were related to the course of disease. Also, a correlation of NO levels with other markers of inflammation was performed. We studied 42 patients diagnosed early: 26 men and 16 women with lung cancer. We analyzed blood tests for control of inflammatory markers, functional pulmonary tests, and alveolar exhaled NO. We recorded a decrease in exhaled NO after three cycles of chemotherapy in all patients, regardless of histological type and stage: there were 42 patients with mean 9.8 NO after three cycles (average 7.7). Also, a strong correlation appeared between NO measurements before and after chemotherapy and C-reactive protein (P < 0.05, r = 0.42, before) and (P < 0.045, r = 0.64, after). NO alveolar measurement as an indicator of airway inflammation indicates response to chemotherapy in lung cancer. Also, the inflammatory process in lung cancer was confirmed and indicated response to chemotherapy through an index that is sensitive to inflammatory disease of the airways.Keywords: nitric oxide, lung cancer, inflammation

Treatment with interferon (IFN) can precipitate a variety of inflammatory conditions, including sarcoidosis. Although many other systems can be affected, the clinical picture in this case mostly includes cutaneous and pulmonary symptoms. The prognosis is better than the idiopathic form of the disease, and the most effective treatment is considered the discontinuation of antivirus therapy alone or in combination with corticosteroid administration. The authors present the case of a 36-year-old man who developed sarcoidosis stage I after 2 years of IFNα therapy for polycythemia vera.

Background White asbestos (chrysotile) has been used in dentistry since 1930 when it was introduced as a lining material for casting rings. Methods All three patients presented with pleural plaques on chest X-rays as well as on CT-scans. They were working as dentists for 35–45 years. Under the instructions of the first dentist we represented precisely the whole process of manipulating a kind of paper that contained asbestos. In order to measure asbestos fibers concentration we used the membrane filter method and phase contrast optical microscopy. Dry asbestos sheets were scanned with x-ray diffraction and electron microscope. Results Analysis of the filter demonstrated 0.008 fibers/cm3 during the sampling period. X-ray diffraction analysis revealed that the material consisted of chrysotile exclusively. Electron microscope pictures confirmed the presence of chrysotile. Conclusion Everyday occupational exposure for many years even to low asbestos levels, under poor ventilation conditions in a closed space, could cause pleural lesions. Am. J. Ind. Med. 52:926–930, 2009. © 2009 Wiley-Liss, Inc.

The smoking habits of 9,276 high-school students (15-18 years old) in six cities of Northern Greece were studied using a questionnaire in order to determine the prevalence and possible risk factors for initiation of smoking. We observed that 29.6% of high-school students (32.6% of boys and 26.7% of girls) were current smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive behaviour towards parents’ and teachers’ advice (40.2%) and the existence of smoking friends (40.1%) were the main reasons of initiation. A well-planned integrated anti-smoking campaign is urgently required, especially among students and teachers.

Background The progress of pleural plaques in persons exposed to environmental asbestos in Almopia, Greece were studied prospectively. Methods During a 15-year period, 198 individuals, in whom pleural plaques had been observed during the period 1988–1990 were followed. Respiratory function was initially evaluated in 23. All were inhabitants of seven villages of Northern Greece, where rocks with high concentration in asbestos fibers were used for whitewashing until 1935. Results Out of this population, 126 survived and underwent chest X-ray in 2003 while respiratory function was retested in 18. New radiological findings were compared to previous ones using digital technology. Furthermore, the cause of death of the remaining 72 was recorded. Deterioration of X-ray findings was observed in all survivors. Not only did the surface area of previous plaques increase (8.66 ± 12.6 cm2, mean value ± SD) but new ones also appeared. Total lung capacity decreased from 95.6 ± 14.8 in 1998 to 76.5 ± 9.3% predicted in 2003. It was found that out of 72 deaths, 11 people died of malignant lung neoplasm, and 4 of mesothelioma. Conclusions Radiological appearance of pleural plaques and respiratory function of people previously exposed to asbestos environmental pollution worsens over the years. Prevalence of mesothelioma was found to be higher than expected. Am. J. Ind. Med. 2006. © 2005 Wiley-Liss, Inc.

Aim To define the prevalence of asthma and rhinitis in primary school children in the Polichni Municipality of the city of Thessaloniki Methods and results The parents of 2005 students living in the area of Polichni completed a questionnaire for the detection of pulmonary disease in childhood. Of 493 children who gave positive answers to the questions about allergies, asthma and rhinitis, 203 were excluded after an interview with the parents, because they suffered from either atopic dermatitis or drug allergy or had normal lgE levels.Of the remaining children, 290 were further examined: methacholine test was positive in 109, exercise test was positive in 67, nasal provocation test with histamine was positive in 244, and rhinodilation test with tramazoline was positive in 206. Skin prick tests were positive in 142 children (90 to grass-cereal pollen, 66 to acarea and 59 to Parietaria officinalis) Conclusions We found that 168 children suffered from rhinitis, 84 from both asthma and rhinitis concurrently and 38 from asthma alone. Only 37 % of the parents knew that their children suffered from asthma, while even fewer (32 %) knew that their children had rhinitis. The prevalence of asthma was 6.1 % and that of rhinitis was 12.6 % among children aged 9-12 years in the area of Polichni, Thessaloniki. Childhood rhinitis and asthma seem to be frequently underdiagnosed and undertreated

Dimitris Petridis,1 Paul Zarogoulidis,2,3 Anastasios Kallianos,4 Ioannis Kioumis,2 Georgia Trakada,5 Dionysios Spyratos,2 Antonis Papaiwannou,2 Konstantinos Porpodis,2 Haidong Huang,6 Aggeliki Rapti,4 Wolfgang Hohenforst-Schmidt,7 Konstantinos Zarogoulidis2 1Department of Food Technology, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece; 2Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; 42nd Pulmonary Department, "Sotiria" Hospital for Chest Diseases, Athens, Greece; 5Department of Clinical Therapeutics, Division of Pneumonology, Medical School, National University of Athens, Athens, Greece; 6Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People's Republic of China; 7II Medical Department, "Coburg" Regional Clinic, University of Wüerzburg, Coburg, Germany Background: Influenza A H1N1 and H3N2 are two influenza waves that have been identified in past years. Methods: Data from 77 inpatients from three tertiary hospitals were included and statistical analysis was performed in three different clusters. Results: Thirty-four patients (44.2%) had respiratory distress upon admission, 31.2% had a smoking history or were active smokers, 37.7% manifested disease symptoms, and 7.8% were obese (body mass index >41). The mean age of patients was 51.1 years. Cough was the most common symptom observed in 77.9% of the patients, accompanied by sputum production (51.9%) and fatigue (42.9%). Hemoptysis and vomiting were rarely recorded in the patients (9.1% and 16.9%, respectively). Oseltamivir administration varied between 0 and 10 days, giving a mean value of 2.2 days. In particular, 19 patients received no drug, 31 patients received drug for only for 1 day, 19 patients for 5 days, and 8 patients from 2 to 10 days. Conclusion: Clusters of symptoms can be used to identify different types of influenza and disease severity. Patients with vaccination had pneumonia, whereas patients without vaccination had influenza A. Patients more than 54.5 years old had H3N2 and patients less than 54.5 years had H1N1. White blood cell count values increased from normal to elevated in H3N2 patients but still remained abnormal in lower tract infection and H1N1 patients. Keywords: H3N2, H1N1, influenza outbreak, respiratory infection, vaccination

Zarogoulidis P, Kioumis I, Porpodis K, Spyratos D, Tsakiridis K, Huang H, Li Q, Turner JF, Browning R, Hohenforst-Schmidt W, Zarogoulidis K. Drug Des Devel Ther. 2013;7:1115–1134.Throughout the paper Microsprayer should have been cited as MicroSprayer® Aerosolizer (Penn-Century, Inc., Wyndmoor, PA, USA).On page 1127 and 1128 the paragraph on Azithromycin should not have been included in the paper.Read the original article.

Currently almost all antibiotics are administered by the intravenous route. Since several systems and situations require more efficient methods of administration, investigation and experimentation in drug design has produced local treatment modalities. Administration of antibiotics in aerosol form is one of the treatment methods of increasing interest. As the field of drug nanotechnology grows, new molecules have been produced and combined with aerosol production systems. In the current review, we discuss the efficiency of aerosol antibiotic studies along with aerosol production systems. The different parts of the aerosol antibiotic methodology are presented. Additionally, information regarding the drug molecules used is presented and future applications of this method are discussed. OA gold

Wolfgang Hohenforst-Schmidt,1 Paul Zarogoulidis,2,3 Kaid Darwiche,3 Thomas Vogl,4 Eugene P Goldberg,5 Haidong Huang,6 Michael Simoff,7 Qiang Li,6 Robert Browning,8 J Francis Turner,9 Patrick Le Pivert,10 Dionysios Spyratos,2 Konstantinos Zarogoulidis,2 Seyhan I Celikoglu,11 Firuz Celikoglu,11 Johannes Brachmann11II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany; 2Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; 4Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany; 5Biomaterials Science and Engineering, Department of Materials Science and Engineering, University of Florida, FL, USA; 6Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People's Republic of China; 7Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA; 8Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, USA; 9Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, USA; 10Interventional Drug Delivery Systems and Strategies (ID2S2), Medical Cryogenics, Jupiter, FL, USA; 11Pulmonary Department, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, TurkeyAbstract: Strategies to enhance the already established doublet chemotherapy regimen for lung cancer have been investigated for more than 20 years. Initially, the concept was to administer chemotherapy drugs locally to the tumor site for efficient diffusion through passive transport within the tumor. Recent advances have enhanced the diffusion of pharmaceuticals through active transport by using pharmaceuticals designed to target the genome of tumors. In the present study, five patients with non-small cell lung cancer epidermal growth factor receptor (EGFR) negative stage IIIa–IV International Union Against Cancer 7 (UICC-7), and with Eastern Cooperative Oncology Group (ECOG) 2 scores were administered platinum-based doublet chemotherapy using combined intratumoral-regional and intravenous route of administration. Cisplatin analogues were injected at 0.5%–1% concentration within the tumor lesion and proven malignant lymph nodes according to pretreatment histological/cytological results and the concentration of systemic infusion was decreased to 70% of a standard protocol. This combined intravenous plus intratumoral-regional chemotherapy is used as a first line therapy on this short series of patients. To the best of our knowledge this is the first report of direct treatment of involved lymph nodes with cisplatin by endobronchial ultrasound drug delivery with a needle without any adverse effects. The initial overall survival and local response are suggestive of a better efficacy compared to established doublet cisplatin–based systemic chemotherapy in (higher) standard concentrations alone according to the UICC 7 database expected survival. An extensive search of the literature was performed to gather information of previously published literature of intratumoral chemo-drug administration and formulation for this treatment modality. Our study shows a favorable local response, more than a 50% reduction, for a massive tumor mass after administration of five sessions of intratumoral chemotherapy plus two cycles of low-dose intravenous chemotherapy according to our protocol. These encouraging results (even in very sick ECOG 2 patients with central obstructive non-small cell lung cancer having a worse prognosis and quality of life than a non-small cell lung cancer in ECOG 0 of the same tumor node metastasis [TNM]-stage without central obstruction) for a chemotherapy-only protocol that differs from conventional cisplatin-based doublet chemotherapy by the route, target site, and dose paves the way for broader applications of this technique. Finally, future perspectives of this treatment and pharmaceutical design for intratumoral administration are presented.Keywords: cisplatin, lymph nodes, chemotherapy, intratumoral, lung cancer

Artificial pneumoperitoneum represents a therapeutic technique first applied in the treatment of pulmonary tuberculosis (TB) in prechemotherapy antimycobacterial era. A 25-year-old patient presented with pulmonary TB diagnosed during the 8th month of her pregnancy. She was febrile and in severe clinical condition. An antituberculous regimen of four primary drugs was initiated immediately after the caesarean section. There was no clinical improvement after 3 months despite full drug sensitivity of Mycobacterium tuberculosis isolates. An artificial pneumoperitoneum was applied along with the drug treatment for 6 months. Soon the patient became afebrile, her body weight increased and sputum smears gave negative results. The combination of the old technique of therapeutic pneumoperitoneum along with the current antituberculosis treatment proved to be effective in this advanced case of pulmonary TB initially unresponsive to drug therapy alone.