Introduction: Non-malignant pleural effusions (PE) are underrepresented in the literature despite their high prevalence. We report data collected on organ-failure related effusions (heart, renal and hepatic) by the ICE project. Aims: To report PE characteristics, prognostic features, refractory PE features, interventions and related complications in this cohort. Methods: 15 sites in 10 countries reported anonymised, retrospective data from 2004-2021. 755 cases were analysed: 560 cardiac, 131 hepatic and 64 renal. Results: Mean age was 74.3 (62% male). Commonest symptoms were dypsnoea (89%) and cough (32%). 302/755 (40%) PE were bilateral, 304 (40%) right- and 151 (20%) left-sided. Predominant cytological type was mesothelial 227/755 (30%) or lymphocytic 189 (25%). Overall 1 year survival was 73%. Renal and neutrophil-predominant PE conferred poorer prognosis. Atrial fibrillation was associated with survival benefit in cardiac PE. 383/755 (50.1%) of effusions recurred. Most PE were managed medically - 25% underwent repeated thoracentesis, 9% chest drainage and 5% indwelling pleural catheter insertion. The commonest management complication was electrolyte disturbance in 70/755 (8%). Conclusions: This large multinational study shows organ failure related PE, particularly renal PE, confer poor prognosis. Recurrence is common, requiring repeated interventions, but complication rates are low.

Background: We present findings from the International Collaborative Effusion (ICE) database, an ERS clinical research collaboration. Non-specific pleuritis (NSP) is a broad term that describes chronic pleural inflammation. Various aetiologies lead to this histological finding and pose a diagnostic challenge. A significant proportion of patients with this histology eventually develop a malignant diagnosis Methods: 12 sites across 9 countries contributed data on 175 patients. Descriptive and inferential statistics to answer the research questions proposed by the ICE database committee are presented. Results: The commonest aetiology for NSP was 9Idiopathic9 (80/175, 44%). This was followed by pleural infection (15%), benign asbestos disease (12%), malignancy (6%) and cardiac failure (6%). Malignant diagnoses were predominantly mesothelioma (6/11, 55%) and lung adenocarcinoma (4/11, 36%). The mean time to malignant diagnosis was 13.9 months (+/− 11.7 months). There was a signal towards greater asbestos exposure in the malignant NSP group compared to the benign disease group (0.63 vs 0.27, Fisher’s exact test, p=0.07). A 9difficult9 thoracoscopic procedure or recurrence of effusion were not associated with a false-negative biopsy. A CT finding of a mass lesion was the only imaging feature to demonstrate significant association (0.18 vs 0.01, p=0.02), though sonographic pleural thickening also suggested association (0.27 vs 0.09, p= 0.09), see Figure 1. Discussion: This is the first multi-centre study of NSP and its associated outcomes. Our findings support the existing literature and highlight areas for future research.

The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice.

The aim of this review was to evaluate comparative efficacy and tolerability of atomoxetine (ATX), bupropione (BUP), lisdexamfetamine (LDX), methylphenidate (MPH) and mixed amphetamine salts (MAS) in adults with attention deficit hyperactivity disorder (ADHD). A systematic search was conducted using MEDLINE, Clinical Trials Register, ClinicalTrials.gov and the Cochrane Library. Inclusion criteria were restricted to randomised, double-blind, parallel-group clinical trials with at least 2 weeks in duration. Studies in patients with severe comorbidities were excluded. The effect of MPH was separately assessed for immediate release (IR-MPH) and modified release (MR-MPH) formulation. The evaluated outcomes were severity of ADHD symptoms as measured by ADHD rating scale (ADHD-RS) and tolerability (the proportion of patients who left a study early due to adverse effects). OpenBUGS 3.2.3 was used to calculate pairwise Bayesian estimates of pooled standardized mean differences (SMD) for ADHD-RS and pooled odds ratios for tolerability. In total 31 studies were identified: 1 head-to-head study with two arms, 27 placebo-controlled studies with two arms and 3 studies with three arms. In 30 studies ADHD-RS was assessed, whereas in 27 studies the tolerability was reported. All investigated medicines were superior to placebo. IR-MPH (SMD vs. placebo: -0.94; 95% CI: -1.25 to -0.64), LDX (SMD vs. placebo: -0.90; 95% CI: -1.11 to -0.71) and BUP (SMD vs. placebo: -0.74; 95% CI: -0.96 to -0.52) were significantly more efficacious than MR-MPH (SMD vs. placebo: -0.48; 95% CI: -0.56 to -0.40) or ATX (SMD vs. placebo: -0.42; 95% CI: -0.51 to -0.33) but not than MAS (SMD vs. placebo: -0.64; 95% CI: -0.83 to -0.43). Inconsistency was not detected. Tolerability of the medicines was inferior to placebo. Methylphenidate and atomoxetine are most commonly investigated medicines for adults with ADHD. Further research is needed to better evaluate the efficacy of other medicines.

Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE) diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine diagnosis of PE. Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH), alpha amylase (AA), pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions. Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154) or infection (n = 108). In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %). Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005) and proteins (p < 0.0005), and higher pH (p < 0.0005) values in the paramalignant effusions. Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.

Abstract Using the (unweighted) average linkage clustering (UPGMA) method we classified 458 phytosociological relevés of Larix decidua forests in the Southeastern Alps into 25 clusters. Based on their analysis we described the following new subassociations: Rhodothamno-Laricetum deciduae geetosum rivalis, sorbetosum chamaemespili, piceetosum abietis, adoxetosum moschatellinae, cystopteridetosum fragilis, cyclaminetosum purpurascentis, dryadetosum octopetalae and sorbetosum ariae. The selected method proved adequate in identifying the differences between larch stands on potential subalpine spruce and beech sites, and larch forests on the upper forest line, as well as the differences between initial larch stages on the upper forest line and more stable development stages on better developed soils on promontories and ledges above the upper beech forest line. Larch forests occur mainly in the altitudinal belt between (1,500) 1,600 and 1,800 (1,900) m, on shady aspects and slopes that are steeper than 30°. They are some of the best preserved forest types in the Southeastern Alps, on smaller surface areas (Macesnje above the Beli Potok valley in the Julian Alps) even virgin forests, and their role as biotopes is exceptional.

Chloride conductance across the isolated skin of Rana pipiens shows a voltage-activated component (G(Cl)(V)) which requires the presence of mucosal Cl. G(Cl)(V) is normally low or dormant. It is stimulated by elevated intracellular cAMP, irrespective whether originating from application of ss-adrenergic agonists (isoproterenol), stimulators of the adenylyl-cyclase (forskolin), inhibitors of the phosphodiesterases (isobutyl-methyl-xanthine) or membrane-permeable cAMP analogues (CPT-cAMP). Baseline G(Cl) under inactivating conditions increases also with cAMP dose-dependently. The data indicate that cAMP is a central regulator of the passive, conductive chloride transport across amphibian skin.

The systemic model for floral induction, dubbed florigen, was conceived in photoperiod-sensitive plants but implies, in its ultimate form, a graft-transmissible signal that, although activated by different stimuli in different flowering systems, is common to all plants. We show that SFT ( SINGLE-FLOWER TRUSS ), the tomato ortholog of FLOWERING LOCUS T ( FT ), induces flowering in day-neutral tomato and tobacco plants and is encoded by SFT . sft tomato mutant plants are late-flowering, with altered architecture and flower morphology. SFT -dependent graft-transmissible signals complement all developmental defects in sft plants and substitute for long-day stimuli in Arabidopsis , short-day stimuli in Maryland Mammoth tobacco, and light-dose requirements in tomato uniflora mutant plants. The absence of donor SFT RNA from flowering receptor shoots and the localization of the protein in leaf nuclei implicate florigen-like messages in tomato as a downstream pathway triggered by cell-autonomous SFT RNA transcripts. Flowering in tomato is synonymous with termination of the shoot apical meristems, and systemic SFT messages attenuate the growth of apical meristems before and independent of floral production. Floral enhancement by systemic SFT signals is therefore one pleiotropic effect of FT orthologs.

The onset of active Na(+) transport and activated Cl(-) conductance (G(Cl)) across the skin epithelium of Pelobates syriacus was investigated during natural ontogenetic development. Structural features, including band three and Peanut lectin bindings were tested in parallel and structure-function relationships were attempted. The 22 specimens studied were divided into two tadpole, three juvenile, and two adult stages, corresponding to the Taylor-Kollros standard table, in accordance with external morphology of their developmental stage. Onset of transepithelial electrical potential and drop in conductance occurred abruptly, coinciding with metamorphosis climax of tadpoles into juveniles at about stage XXI of development. Amiloride-sensitive Na(+) transport occurred a little later at stage XXIII, followed by the appearance of activated Cl(-) conductance, G(Cl). Parallel structural examination showed that skin MR cells occurred upon metamorphosis, as the tadpole integument transformed into the adult epithelium and could be associated with the occurrence of activated G(Cl). It was not related temporally with the appearance of band three protein in MR cells. Our findings support the association of G(Cl) with MR cells, whereas band three may only be a corollary of G(Cl) and not necessarily essential for its manifestation.

Morphological, cytological and transport properties of the integument of Salamandra salamandra were investigated during natural ontogenetic development, from birth to adult. Three stages were operationally defined: I, larvae, from birth to metamorphosis; II, metamorphosis (judged externally by the colour change and loss of the gills); and III, post-metamorphosis to adult. Pieces of skin were fixed at various stages for immunocytochemical examinations, and the electrical properties were investigated on parallel pieces. Distinct cellular changes take place in the skin during metamorphosis, and lectin (PNA, WGA and ConA) binding indicates profound changes in glycoprotein composition of cell membranes, following metamorphosis. Band 3 and carbonic anhydrase I (CA I) were confined to mitochondria-rich (MR)-like cells, and were detected only in the larval stage. CA II on the other hand, was detected both in MR-like and in MR cells following metamorphosis. The electrical studies show that the skin becomes more tight (transepithelial resistance increases) upon metamorphosis, followed by manifestation of amiloride-sensitive short-circuit current (I(SC)) indicating that functional Na+ uptake has been acquired. The skin of metamorphosed adults had no finite transepithelial Cl- conductance, and band 3 was not detected in its MR cells. The functional properties of MR-like and MR cells remain to be established.

The anionic conductance across toad (Bufo viridis) skin was studied using the voltage-clamp technique following long-term (more than 10 days) acclimation to NaCl and KCl solutions. The non-specific baseline conductance was approximately 0.6 mS cm(-)(2) and was similar in skins from all acclimation conditions. The voltage-activated Cl(-) conductance (G(Cl)) was maximal in skins from distilled-water- and KCl-acclimated toads (>3 mS cm(-)(2)) and was greatly reduced following acclimation to NaCl solutions. Cyclic AMP (EC(50)=13 micromol l(-)(1)) and isobutylmethyl xanthine (IBMX) (EC(50)=69 micromol l(-)(1)) exerted different effects on the activated conductance. IBMX only sensitized the activated conductance, whereas cyclic AMP (CPTcAMP) at high concentrations induced an increase in anionic conductance that was insensitive to electrical potential. Furthermore, external Cl(-) was not required for the stimulatory effect of cyclic AMP, and the conductive pathway had low selectivity. The effects of the two agonists were reversible and depended on the acclimation conditions. Following electrical measurements, the skin of the toads was removed and stained with silver to measure mitochondria-rich cell density (D(mrc)). There was no correlation between D(mrc) and Cl(-) conductance in the present study.

The distribution and density (Dmrc) of mitochondria-rich cells (MR cells) in skin epithelium, were determined over the whole body surface in nine species of anuran Amphibia that live in a variety of habitats. It was found that the more terrestrial species (beginning with Hyla arborea) have a higher density of MR cells in their pelvic region. In the skin of aquatic (Xenopus laevis) or fossorial (Pelobates syriacus) species, Dmrc is evenly distributed over the whole body surface. In dorsal skin pieces of H. arborea that lack detectable MR cells, transepithelial voltage activation did not induce Cl− conductance as it did in ventral pieces. Skins from Bufo viridis and X. laevis, both have MR cells in their skin, differ markedly in their biophysical properties: a Cl− specific current conductance is predominant in the skin epithelium of B. viridis, and is absent in X. laevis. In the latter, anionic conductance is due to glandular secretion. The biophysical properties cannot therefore be related solely to the presence or density of MR cells. Mitochondria-rich cells are sites of Cl− conductance across the skin of those amphibians that show this property, but must have different function(s) in other species. It is suggested that the specific zonal distribution of MR cells in the species that were examined in this study could be due to ion exchange activity and water conservation in more terrestrial environments.

The objective of the present study was to investigate the rate of decline in the incidence of tuberculosis (TB) in residents (1985-1994) and in refugees and displaced persons (1992-1994) during prewar and war periods (1985-1994) in the region of Zagreb, Croatia, and to examine a possible change in the trend of decline in the resident population. Data on the incidence of TB were obtained from the Epidemiology Department, Institute for Lung Diseases, Zagreb, Croatia. The sample comprised two groups of subjects: residents (800,000-1,000,000 inhabitants) and all refugees and displaced persons temporarily residing in the Zagreb region (78,000-95,000 persons). Data were analysed by stepwise logistic regression. The most significant predictors of the TB incidence rate were the square of the year and residence status. The rate of TB incidence in nonresidents was significantly higher than in residents. The decline in incidence in residents was significantly slower than in the nonresident group. The results did not indicate a potential change in the natural decline of the incidence of tuberculosis in the resident population during the study periods. The difference between the regression trends of the incidence of tuberculosis in residents and nonresidents was the result of various concomitant factors, including artefacts of the war.

Patients' education belongs to the most efficient therapeutic measures in the management of asthma, chronic bronchitis and pulmonary emphysema. The following paper reports the experience in the educational programme at the Polyclinic for Respiratory Diseases in Zagreb. Each patient's education lasted 5 days, 3 lessons per day, in groups of 10-15 persons. The education was carried out by a teaching team consisting of pulmonologists, psychosomatologist, pharmacist, physiotherapist and biometeterologist. From March 1995 to February 1996 135 persons completed the educational programme, 65 of whom were asthma patients. Data on cough and dyspnoea, skills in inhaler and breathing technique were collected at the beginning and 3 months after the education in all asthma patients. Three months after the education the asthma patients showed a significant decrease in dyspnoea and a significant improvement in inhaler and breathing technique. A standard questionnaire was given to all patients at the end of the education and in more than 80% the education was well accepted by the patients. Initial results are encouraging and the programme should be expanded to all parts of Croatia.

This paper deals with echocardiographic changes in the heart in patients with active intrathoracic sarcoidosis. Heart changes were registered with 10 (38%) out of 26 patients, in all radiological stages of sarcoidosis. Out of 16 patients first radiological stage (BHL) was found with 4 (25%), out of 8 patients second radiological stage was found with 4 (25%), and third radiological stage was found with 2 patients. Out of 10 patients with echocardiographic changes in the heart 4 patients (40%) had increased echoes and hypokinesis of the proximal part of interventricle septum, 3 (30%) had significantly reduced diffusive capacity and pulmonary hypertension. Increased echoes of papillary muscles were registered in two cases, one of them with relatively mitral insufficiency. In one case dilatational incipient cardiomyopathy with second stage of relatively mitral insufficiency was found and in one case increased echoes and hypokinesis of the back wall of the left ventricle were registered. Changes in electrocardiogram were found with 5 (19%) patients suffering from pulmonary sarcoidosis.