Airway disease in cystic fibrosis (CF) is characterised by impaired mucociliary clearance, persistent bacterial infection and neutrophilic inflammation. Lipoxin A 4 (LXA 4 ) initiates the active resolution of inflammation and promotes airway surface hydration in CF models. 15-Lipoxygenase (LO) plays a central role in the ''class switch'' of eicosanoid mediator biosynthesis from leukotrienes to lipoxins, initiating the active resolution of inflammation. We hypothesised that defective eicosanoid mediator class switching contributes to the failure to resolve inflammation in CF lung disease.Using bronchoalveolar lavage (BAL) samples from 46 children with CF and 19 paediatric controls we demonstrate that the ratio of LXA 4 to leukotriene B 4 (LTB 4 ) is depressed in CF BAL (p,0.01), even in the absence of infection (p,0.001).Furthermore, 15-LO2 transcripts were significantly less abundant in CF BAL samples (p,0.05). In control BAL, there were positive relationships between 15-LO2 transcript abundance and LXA 4 /LTB 4 ratio (p50.01, r50.66) and with percentage macrophage composition of the BAL fluid (p,0.001, r50.82), which were absent in CF.Impoverished 15-LO2 expression and depression of the LXA 4 /LTB 4 ratio are observed in paediatric CF BAL. These observations provide mechanistic insights into the failure to resolve inflammation in the CF lung. @ERSpublications Reduced 15-LO2 expression in the lower airways of children with CF, associated with a depressed LXA 4 /LTB 4 ratio http://ow.ly/tzZWa This article has supplementary material available from

P Pu ur rp po os se e: : The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation.M Me et th ho od ds s: : This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. R Re es su ul lt ts s: :The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily.C Co on nc cl lu us si io on n: : There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.

Two cases of hyperthyroidism successfully treated with a preparation of intravenous MMI are described.

This study suggests that, in young non-expectorating children with CF, routine surveillance bronchoscopy allows the detection of significant lower airway pathogens and provides the opportunity for targeted treatment of sub-clinical infection.