Background: Diaphragmatic ultrasound emerges as a valuable non-invasive method for assessing diaphragm functionality in patients with amyotrophic lateral sclerosis (ALS). This study aimed to evaluate diaphragmatic ultrasound parameters in ALS, compare them with respiratory function tests, and determine whether they are associated with the need for non-invasive ventilation (NIV). Methods: This was a prospective, descriptive, and multicenter study across five centers, enrolling patients with recent diagnoses of ALS. At three-monthly visits, participants underwent both diaphragmatic ultrasound and pulmonary function testing. The following variables were analyzed: withdrawal from this study due to NIV or death, excursion, velocity, thickness, thickening fraction, and spirometric and respiratory muscle function values. Results: A total of 41 patients were included. A total of 24 (61.5%) patients left this study before the final year: 17 due to initiation of NIV, 4 due to clinical deterioration without NIV, and 3 due to death. Statistically significant moderate correlations were observed between diaphragmatic excursion and velocity and FVC and supine FVC (p < 0.001) and with MIP and the SNIP test (p < 0.05). No correlation was observed with thickening fraction. Additionally, lower baseline values in excursion were significantly associated with study withdrawal, along with reduced lung function (FVC, supine FVC, and MEP (p < 0.001). Conclusions: assessing diaphragmatic excursion by ultrasonography may serve as a useful tool for monitoring patients with ALS.

Background/Objectives: Recent advances in the treatment of non-small cell lung cancer (NSCLC) have shifted from conventional chemotherapy to targeted therapies aimed at specific genetic mutations, particularly in the adenocarcinoma subtype. These therapies have improved overall survival and quality of life. However, some patients still face barriers to accessing these treatments due to challenges in diagnosing advanced-stage NSCLC. Limited tumor cellularity in small biopsies and cytological samples hinders the ability to perform further molecular analyses. Additionally, the increasing number of genetic alterations requiring testing complicates the diagnostic process. To overcome this challenge, we propose combining endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with next-generation sequencing (NGS) and immunohistochemistry for PD-L1. Methods: A total of 120 EBUS-TBNA samples were consecutively collected during the first year of integrating NGS at a reference hospital in Castilla y León, Spain. Depending on the histology and patient characteristics, a total of 67 NGS analyses and 116 PD-L1 determinations were performed. Results: The cytological sample obtained in these cases successfully achieved the triple objective proposed by the NCCN for lung cancer (diagnosis, staging, and molecular analysis in a single procedure) in 97% of instances. Conclusions: Our study highlights the effectiveness of EBUS-TBNA as a comprehensive, cost-effective, and safe diagnostic tool for NSCLC, successfully achieving the triple objective of diagnosis, staging, and molecular analysis in 97% of cases. The procedure consistently provided high-quality samples for NGS and PD-L1 testing, with minimal complications, reinforcing its value as a reliable approach for optimizing personalized treatment strategies.

Background: Diaphragmatic ultrasound could be useful for the non-invasive evaluation of diaphragm functionality in Amyotrophic Lateral Sclerosis (ALS). Our study objective is to evaluate the diaphragmatic ultrasound characteristics of ALS patients and compare them with respiratory function test measurements and if there is any relationship with need for non-invasive ventilation (NIV). Methods: A prospective, descriptive, multicenter study including patients with recent diagnosis of ALS in 5 centers. Underwent diaphragmatic ultrasound and lung function at each visit every 3 months. Variables: age, sex, withdrawal from the study due to NIV or death, excursion, velocity, thickness, thickening fraction and spirometry and respiratory muscles function values. Results: 39 patients were included. 24 (61.5%) patients left the study before the year: 17 due to the onset of NIV, 4 due to clinical worsening without NIV, and 3 due to death. Statistically significant correlation was obtained between excursion and velocity and FVC and supine FVC (p<0.001) and with MIP and the snip test (p<0.05). Correlation between worse values in excursion and lung function (FVC, supine FVC and MEP) at the baseline visit and withdrawal from the study was observed (p<0.001). Conclusions: Assessing diaphragmatic excursion by ultrasonography can be a useful for monitoring ALS patients.

Introduction: The indwelling pleural catheter (IPC) may produce spontaneous pleurodesis (SP) so it can be withdrawn. The standard procedure to assess SP is lung expansion >80% in chest radiography or a chest CT scan. Our goal was to evaluate the thoracic ultrasounds (EcoT) performed by the pulmonologist responsible for the decision as the main tool to assess SP, and compare it with EcoT performed by radiologist. The Gold Standard was the chest CT scan Methods: Prospective, observational, multidisciplinary and multicenter study. We collected all patients with non-functional IPC (Jun 2015-Dec 2018). When there was no lung expansion >80%, a CT scan and EcoT were performed. The decision was firstly made according to EcoT, and definitively according to CT scan. We compared both decisions and calculate the concordance (kappa index) between them. Also compared the results between the EcoT by pulmonologist and radiologist Results: 41 IPCs were assessed. 22 (54%) were withdrawn due to lung expansion >80%. One was retired by patient’s request. Of the remaining 18, on every case EcoT and CT scan were made. In 61% also a radiologist performed the EcoT The decisions made according to the EcoT and those according to TC were concordant in the 78% of the cases. From these, in 43% the IPC was withdrawn. In the four discordant cases, the TC shown a pleural chamber, but the IPC was outside of it. In all these cases the IPC was withdrawn. The kappa index was 0.57. Comparing with the EcoT performed by a radiologist, the decision concurs in all of them Conclusion: The EcoT has a good correlation with the TC in the assessment of the withdrawal of the IPC, so it can be used as the main tool