Objective: To assess the utility of VNS within our center in reducing the utilization of benzodiazepine rescue medications, status epilepticus, and ER visits. Background: Starting in January 2017, the University of Rochester Epilepsy Center began to place responsive VNS devices (Aspire®, SenTiva®) in pediatric patients primarily with LGS diagnoses, creating a cohort of patients in a dedicated VNS clinic with extensive pre- and post-treatment data, standardized advancement of VNS programming, and uniform assessment of efficacy of the intervention. Design/Methods: Charts of patients with VNS placed at URMC from Jan2017–Aug2019 were reviewed for seizure frequency, medication adjustments, utilization of rescue medications (confirmed with pharmacy information), frequency of ER visits or hospitalizations, adverse events, side effects, and VNS programming and operating parameters. Patient information was compared to their own historical seizure frequency, benzodiazepine usage, etc, in the 3–6 months prior to VNS placement noted in their pre-implantation and immediate post-operative visits. Results: During this period 30 pediatric patients underwent placement of responsive VNS generators (8 were battery replacements). 3 patients (10%) experienced significant adverse events (including failure of the device, infection/sepsis, etc). There was a decrease in utilization of benzodiazepine-based rescue medications with increase in the voltage and decrease in off-time of the VNS in the majority of patients. Frequency of ER visits and seizure related hospitalization was low, and not determined to be significantly different. No specific quality of life (QOL) evaluation was utilized during this treatment period, but patients and families reported improved subjective QOL in the VNS clinic setting after the intervention. Conclusions: Responsive VNS is an effective intervention in the URMC pediatric epilepsy population to reduce exposure to rescue medications and the frequency of seizure cluster and status epilepticus. Duration of treatment at URMC may be too short to show reduction in seizure frequency for patients with the most complex epilepsy syndromes. Disclosure: Dr. Brumfield has nothing to disclose. Dr. Socha has nothing to disclose. Dr. Hughes has nothing to disclose.

Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the market and in clinical practice, mainly for the diagnosis of mediastinal lymph adenopathies and peripheral lung nodules. Bronchoscopic sampling tools have not changed significantly in the last three decades, with the sole exception of cryobiopsy. We carried out a non-systematic, narrative literature review aimed at summarizing the scientific evidence on the main indications/contraindications, diagnostic yield, and safety of the available bronchoscopic sampling techniques. Performance of bronchoalveolar lavage, bronchial washing, brushing, forceps biopsy, cryobiopsy and needle aspiration techniques are described, focusing on indications and diagnostic accuracy in the work-up of endobronchial lesions, peripheral pulmonary abnormalities, interstitial lung diseases, and/or hilar-mediastinal lymph adenopathies. Main factors affecting the diagnostic yield and the navigational methods are evaluated. Preliminary data on the utility of the newest sampling techniques (i.e., new needles, triple cytology needle brush, core biopsy system, and cautery-assisted transbronchial forceps biopsy) are shown. TAKE HOME MESSAGE: A deep knowledge of bronchoscopic sampling techniques is crucial in the era of technological bronchoscopy for an optimal management of respiratory diseases.

Utility and safety of bronchoscopy during the SARS-CoV-2 outbreakhttps://bit.ly/3ish52k

Although the serum lipidome is markedly affected by COVID-19, two unresolved issues remain: how the severity of the disease affects the level and the composition of serum lipids and whether serum lipidome analysis may identify specific lipids impairment linked to the patients' outcome. Sera from 49 COVID-19 patients were analyzed by untargeted lipidomics. Patients were clustered according to: inflammation (C-reactive protein), hypoxia (Horowitz Index), coagulation state (D-dimer), kidney function (creatinine) and age. COVID-19 patients exhibited remarkable and distinctive dyslipidemia for each prognostic factor associated with reduced defense against oxidative stress. When patients were clustered by outcome (7 days), a peculiar lipidome signature was detected with an overall increase of 29 lipid species, including—among others—four ceramide and three sulfatide species, univocally related to this analysis. Considering the lipids that were affected by all the prognostic factors, we found one sphingomyelin related to inflammation and viral infection of the respiratory tract and two sphingomyelins, that are independently related to patients' age, and they appear as candidate biomarkers to monitor disease progression and severity. Although preliminary and needing validation, this report pioneers the translation of lipidome signatures to link the effects of five critical clinical prognostic factors with the patients' outcomes.

In patients affected by Acute Respiratory Distress Syndrome (ARDS), Chronic Obstructive Pulmonary Disease (COPD) and Coronavirus Disease 2019 (COVID-19), unclear mechanisms negatively interfere with the hematopoietic response to hypoxia. Although stimulated by physiological hypoxia, pulmonary hypoxic patients usually develop anemia, which may ultimately complicate the outcome. To characterize this non-adaptive response, we dissected the interplay among the redox state, iron regulation, and inflammation in patients challenged by either acute (ARDS and COVID-19) or chronic (COPD) hypoxia. To this purpose, we evaluated a panel of redox state biomarkers that may integrate the routine iron metabolism assays to monitor the patients’ inflammatory and oxidative state. We measured redox and hematopoietic regulators in 20 ARDS patients, 20 ambulatory COPD patients, 9 COVID-19 ARDS-like patients, and 10 age-matched non-hypoxic healthy volunteers (controls). All the examined pathological conditions induced hypoxia, with ARDS and COVID-19 depressing the hematopoietic response without remarkable effects on erythropoietin. Free iron was higher than the controls in all patients, with higher levels of hepcidin and soluble transferrin receptor in ARDS and COVID-19. All markers of the redox state and antioxidant barrier were overexpressed in ARDS and COVID-19. However, glutathionyl hemoglobin, a candidate marker for the redox imbalance, was especially low in ARDS, despite depressed levels of glutathione being present in all patients. Although iron regulation was dysfunctional in all groups, the depressed antioxidant barrier in ARDS, and to a lesser extent in COVID-19, might induce greater inflammatory responses with consequent anemia.