Minimally invasive double lung transplantation technique (Anteroaxillary approach)

Lung transplantation has been performed through several approaches in the past. Sternothoracotomy is the most widely used approach for double lung transplantation. Although bilateral anterolateral thoracotomy for double lung transplantation has been described in the past, this approach has not widely adopted worldwide. The 'anteroaxillary approach' utilizes a limited incision compared to others, preserves sternal anatomy as well as thoracic arteries, and provides an excellent exposure to hilum. We would like to present our standard approach at University of Pittsburgh through anteroaxillary incision

Donor lung selection criteria and surgical application at University of Pittsburgh

Lung transplantation is the standard treatment for patients with end-stage lung disease. Unfortunately scarce source of donor organs, particularly in lungs, limits this selected treatment to very few recipients each year. To decrease waiting list deaths and provide organs to more diverse recipient population, widening selection criteria of donor lungs was offered. Besides expanded criteria in organ selection to increase lung transplant surgery, donation after cardiac death and ex-vivo lung perfusion were introduced to current medicine. University of Pittsburgh in last decade doubled its lung transplant volume by extending the acceptance criteria for donor lungs for which many other centers would decline in first line or some selected centers may try ex-vivo perfusion protocols on these lungs. Nonetheless successful transplant surgery requires successful donor procurement surgery. Based on this practice, we wanted to review the Pittsburgh model of expanding lung donor selection criteria and surgery for donor lung procurement

EXTRACORPOREAL MEMBRANE OXYGENATION FOR STATUS ASTHMATICUS: A CASE REPORT ECMO FOR STATUS ASTHMATICUS

Technological advances in extracorporeal membrane oxygenation and emerging evidence that it improves survival in adults with reversible respiratory failure compared to conventional ventilation has lead to increased utilization of extracorporeal membrane oxygenation in adults, usually in the context of acute respiratory distress syndrome. Refractory status asthmaticus is an uncommon indication for extracorporeal membrane oxygenation. We present a case of near fatal respiratory failure and hypercapnia in a 48-year-old male in status asthmaticus not responsive to optimal ventilatory treatment. The use of veno-venous extracorporeal membrane oxygenation resulted in full recovery with return of normal respiratory function within nine days.

Effect of FMD vaccination schedule of dams on the level and duration of maternally derived antibodies

Vaccination against Foot and Mouth Disease (FMD) in pregnant cows is crucial to produce greater immunity in new born calves, especially in late gestation, as this directly affects neonatal immunity. Therefore, we aimed to investigate how late gestation FMD vaccination of pregnant cows affects the maternally derived antibodies in their offspring. Pregnant cows were vaccinated with and without booster vaccination during the 3rd months (early gestation vaccination, EGV) or the 6.5th months (late gestation vaccination, LGV). Their offspring were investigated for passive immunity transfer, maternal antibody duration, and the first vaccination age of calves (when the maternal antibody has waned sufficiently to allow the first vaccination). Antibody titers were analyzed by a virus neutralization test (VNT). A digital Brix refractometer (% Brix) was used to estimate passive antibody transfer efficiency measuring total protein (TP) content of calf blood sera and also colostrum IgG content. Two linear mixed effects models were fitted: one for the antibody titer values of the dams, and the other for the antibody titer values of calves before the vaccination. A marginal fixed effects model was also fitted to explore the effects of the dam titers on the antibody titers of the calves after their vaccinations. As a result, the average neutralizing antibody titers did not differ between the EGV and LGV groups nor were any differences detected between dams that received a booster and those that were not boosted. However, the LGV calves' mean maternally derived antibody titers were significantly higher (p-values = 0.0001 for both groups) and the duration was longer than that of the EGV calves (120 days in LGV, 60 days in EGV, p 8.4% in both calf groups (9.3 +/- 0.33 in LGV and 8.6 +/- 0.40 in EGV, p > 0.05) indicating that passive immunity transfer had occurred for both groups. In addition, we found that the % Brix mean colostrum IgG content of the LGV (25.8 +/- 1.30) was higher than the EGV (21.8 +/- 0.58) dams (p < 0.01) and a significant positive correlation found between the colostrum density of LGV dams and TP (% Brix) value of their offspring (r = 0.73, p < 0.01). Our results show that vaccination during the late gestation period increased the colostrum IgG content of dams of LGV in addition to the maternally derived antibody duration and potentially provided greater protection of the offspring

Pathophysiology and management of multivalvular disease

Multivalvular disease (MVD) is common among patients with valvular disease, and has a complex pathophysiology dependent on the specific combination of valve lesions. Diagnosis is challenging because several echocardiographic methods commonly used for the assessment of stenosis or regurgitation have been validated only in patients with single-valve disease. Decisions about the timing and type of treatment should be made by a multidisciplinary heart valve team, on a case-by-case basis. Several factors should be considered, including the severity and consequences of the MVD, the patient's life expectancy and comorbidities, the surgical risk associated with combined valve procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses, and the likelihood and risk of reoperation. The introduction of transcatheter valve therapies into clinical practice has provided new treatment options for patients with MVD, and decision-making algorithms on how to combine surgical and percutaneous treatment options are evolving rapidly. In this Review, we discuss the pathophysiology, diagnosis, and treatment of MVD, focusing on the combinations of valve pathologies that are most often encountered in clinical practice.SCOPUS: re.jinfo:eu-repo/semantics/publishe