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Endotoxin exposure associated with respiratory health among European schoolchildren : the SINPHONIE study

2026-06-16T09:54:49Z

Title: Endotoxin exposure associated with respiratory health among European schoolchildren : the SINPHONIE study Authors: Baloch, Ramen Munir; Magyar, Donát; Rudnai, Peter; Pándics, Tamás; Remény-Nagy, Zsuzsanna; Moshammer, Hanns; Leppänen, Hanna; Hyvärinen, Anne; Täubel, Martin; Norbäck, Dan; Gabriel, Marta; Maio, Sara; Baldacci, Sandra; Sarno, Giuseppe; Viegi, Giovanni; Csobod, Eva; de Oliveira Fernandesi, Eduardo; Annesi-Maesano, Isabella; Szuppinger, Péter; Prokai, Réka; Farkas, Petur; Fuzi, Cecilia; Cani, Eduart; Draganic, Jasna; Réka Mogyorosy, Eszter; Korac, Zorica; Ventura, Gabriela; Madureira, Joana; Paciência, Inês; Martins, Anabela; Pereira, Ricardo; Ramos, Elisabete; Páldy, Anna; Dura, Gyula; Beregszászi, Tímea; Vaskövi, Éva; Magyar, Donát; Pándics, Tamás; Remény-Nagy, Zsuzsanna; Szentmihályi, Renáta; Udvardy, Orsolya; Varró, Mihály J.; Kephalopoulos, Stylianos; Kotzias, Dimitrios; Barrero-Moreno, Josefa; Mehmeti, Rahmije; Vilic, Aida; Maestro, Daniel; Hohenblum, Philipp; Goelen, Eddy; Stranger, Marianne; Spruy, Maarten; Sidjimov, Momchil; Hadjipanayis, Adamos; Katsonouri-Sazeides, Andromachi; Demetriou, Eleni; Kubinova, Ruzana; Kazmarová, Helena; Dlouha, Beatricia; Kotlík, Bohumil; Vabar, Helen; Ruut, Juri; Metus, Meelis; Rand, Kristiina; Järviste, Antonina; Nevalainen, Aino; Hyvarinen, Anne; Täubel, Martin; Järvi, Kati; Mandin, Corinne; Berthineau, Bruno; Moriske, Heinz-Joern; Giacomini, Marcia; Neumann, Anett; Bartzis, John; Kalimeri, Krystallia; Saraga, Dikaia; Santamouris, Mattheos; Assimakopoulos, Niki; Asimakopoulos, Vasiliki; Cattaneo, Andrea; Pulvirenti, Salvatore; Vercelli, Franco; Strangi, Fabio; Omeri, Elida; Piazza, Silvia; D’Alcamo, Andrea; Fanetti, Anna Clara; Sestini, Piersante; Kouri, Magdalini; Viegi, Giovanni; Sarno, Giuseppe; Baldacci, Sandra; Maio, Sara; Cerrai, Sonia; Franzitta, Vincenzo; Bucchieri, Salvatore; Cibella, Fabio; Simoni, Marzia; Maugeri, Salvatore; Neri, Margherita; Martuzevičius, Dainius; Krugly, Edvinas; Montefort, Stephen; Fsadni, Peter; Brewczyński, Piotr Z.; Krakowiak, Ewa; Kurek, Jolanta; Kubarek, Elżbieta; Wlazło, Agnieszka; Borrego, Carlos; Alves, Célia; Valente, Joana; Gurzau, Eugen; Rosu, Cristina; Popita, Gabriela; Neamtiu, Iulia; Neagu, Cristina; Norback, Dan; Bohms, Michel; Van Den Hazel, Peter; Cassee, Flemming; de Bruin, Yuri Bruinen; Bartonova, Alena; Yang, Aileen; Halzlová, Katarína; Jajcaj, Michal; Kániková, Milada; Miklankova, Olga; Vítkivá, Marianna; Jovasević-Stojanovic, Milena; Zivkovic, Marija; Stevanovic, Zarko; Lazovic, Ivan; Stevanovic, Zana; Zivkovic, Zorica; Cerovic, Sofija; Jocic- Stojanovic, Jasmina; Mumovic, Dejan; Tarttelin, Paula; Chatzidiakou, Lia; Chatzidiakou, Evangelia Abstract: Background: Evidence on the association between endotoxin exposure and respiratory health in children remains inconsistent, with limited research addressing school environments— key settings for daily exposure. This study investigates the relationship between classroom endotoxin levels and respiratory health among European schoolchildren.; Methods: Within the EU-funded SINPHONIE project, endotoxin concentrations were measured in 285 classrooms across 102 schools in 22 European countries. A total of 5,140 children completed a standardized health questionnaire; 4,633 had endotoxin data, 4,170 performed spirometry, and 746 underwent fractioned exhaled nitric oxide (FeNO) testing.; Findings: Endotoxin levels varied geographically, with the highest averages in Italy and the lowest in Finland. After adjusting for confounders, exposure to endotoxin levels at or above the median was associated with higher odds of upper and lower respiratory symptoms—runny nose, nasal obstruction, cough, dry throat, breathing difficulty, and feverishness—as well as reduced lung function (p < 0.05). Meta-analysis by WHO European clusters confirmed these associations, though region-specific analyses indicated a possible protective effect of endotoxin exposure in Northern Europe.; Interpretation: Findings from SINPHONIE highlight classroom endotoxin as a potential environmental determinant of respiratory health. Reducing exposure in schools—currently an overlooked setting—may support respiratory well-being in children and inform future public health policies.

Mortality and recurrence following surgically treated primary lung malignancy

2026-06-15T13:04:15Z

Title: Mortality and recurrence following surgically treated primary lung malignancy Abstract: Primary lung malignancy comprised 10.3% of all new cancers detected in Malta in 2020. Our study examines patient outcomes and mortality rates following surgically resected primary lung malignancy.; We retrospectively analysed the electronic records of 126 patients who underwent surgical resection of their primary lung malignancy between 2016 and 2020.; Our study included 126 patients with an average age of 66.4 years and 64.3% were male (n=81). 71 .4% of patients underwent lobectomy (n=90). The median time from date of histological diagnosis to date of resection was 51 days. Adenocarcinoma was the commonest histological diagnosis (71.4%, n=90). Pre-operative radiological staging underestimated the tumour's stage in 27.0% (n=34) of cases. A majority had Stage IA disease (51.6%, n=65) according to TNM Classification 8th Edition, and these patients had the best 2-year survival at 96.9% (n=63). Overall survival was 87.3% at two years. At the time of data analysis 26.2% of patients (n=33) had died. Most commonly, death was attributed to progression of malignancy (57 .6%, n=19). Our study identified recurrent disease in 40.5% (n=51) of patients, with a progression free survival (PFS) of 34.4 months. 70.6% (n=24) of wedge resections were carried out in Stage IA disease. PFS was 49.5 months for lobectomy vs 48.9 months for wedge resections of Stage IA disease. 28.6% (n=36) of patients had a second malignancy, with the most common being colorectal (22.2%, n=8).; Our results correlate well with international data regarding survival and outcomes postlobectomy and limited resection in Stage IA disease. There is limited data regarding the incidence of other primary tumours in patients with early-stage lung cancer.

A Maltese study in determining the presence of chronic obstructive pulmonary disease in metabolic syndrome

2026-06-15T12:55:39Z

Title: A Maltese study in determining the presence of chronic obstructive pulmonary disease in metabolic syndrome Authors: Gauci, Jonathan; Gauci Pullicino, Stephanie; Caruana, Emma; Petroni Magri, Vanessa; Formosa, Melissa Marie; Fenech, Anthony G.; Fava, Stephen; Montefort, Stephen; Fsadni, Peter Abstract: Introduction: Both Chronic Obstructive Pulmonary Disease (COPD) and Metabolic Syndrome (MetS) are pro-inflammatory states, and while the diagnosis of MetS in COPD has been extensively studied, the diagnosis of COPD in MetS is poorly studied. The study focuses on determining the presence of COPD in persons living with diabetes and MetS in Malta, and aims to identify differences in biomarkers between MetS subjects with and without COPD.; Materials and Methods: Diabetic MetS subjects at Malta’s main general hospital were assessed through St George’s Respiratory Questionnaire for COPD (SGRQ-C), modified Medical Research Council scale (mMRC), COPD Assessment Test (CAT), Centre for Epidemiological Studies Depression scale (CES-D), Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue scale, Spirometry, Six Minute Walk Test (6MWT), BODE index (composed of Body Mass Index, Obstruction, Dyspnoea, Exercise capacity) and routine blood tests. They were divided into three groups: the main study group consisted of MetS subjects with COPD, one control group consisted of MetS subjects with a smoking history but not COPD, and the other control group consisted of diabetic MetS subjects with no smoking history.; Results: A total of 67 MetS subjects were included. Those with COPD had significantly worse outcomes in SGRQ-C scores, mMRC, CAT, spirometry, BODE, CES-D and FACIT Fatigue scale than smokers without COPD and non-smokers. 25-hydroxy-vitamin D levels were significantly lower in MetS subjects with COPD compared to smokers without COPD (p=0.030) and non-smokers (p=0.043). C-reactive protein (p=0.036), triglycerides (p=0.023) and total cholesterol (p=0.039) were significantly higher in MetS subjects with COPD compared to smokers without COPD.; Discussion: Screening for depression and fatigue in subjects with COPD and MetS is recommended. Low vitamin D, high CRP, high triglyceride and high total cholesterol levels are correlated with a COPD diagnosis within the local MetS population, and monitoring these parameters would enable timely management.

Radiological manifestations of lymphangioleiomyomatosis : a local patient cohort analysis

2026-06-15T12:54:44Z

Title: Radiological manifestations of lymphangioleiomyomatosis : a local patient cohort analysis Authors: Conti, Luca; Mercieca, Darlene; Gatt, Gianluca; Sant Fournier, Luca; Fsadni, Peter Abstract: Background: Lymphangioleiomyomatosis (LAM) is an ultra-rare neoplastic cystic disease primarily affecting females of reproductive age, characterized by the infiltration of smooth muscle cells into the lungs and the formation of cystic lesions. This study aims to compare the radiological findings in patients with sporadic LAM (s-LAM) and those with LAM associated with tuberous sclerosis complex (TSC-LAM) in the Maltese population.; Methods: A retrospective observational study was conducted at Mater Dei Hospital, Malta, involving eight patients diagnosed with LAM between 2014 and 2024. Thoracic and abdominal CT scans were reviewed, and findings were categorized based on the presence of s-LAM or TSC-LAM.; Results: The cohort included five patients with s-LAM and three with TSC-LAM, alongside 15 patients with tuberous sclerosis complex (TSC) but no LAM. All LAM patients exhibited diffuse thin-walled cysts, with sizes ranging from 7 to 72 mm. Notably, chylous pleural effusions were observed only in the s-LAM group. The TSC-LAM group demonstrated significant extra-pulmonary manifestations, including renal angiomyolipomas, with some requiring intervention.; Conclusion: This study highlights the distinct radiological features and complications associated with s-LAM and TSC-LAM. The findings underscore the necessity for vigilant screening and monitoring in TSC patients to manage potential LAM-related complications effectively. A multidisciplinary approach is essential for optimizing patient outcomes and addressing the broader implications of TSC and LAM on health.