Postpneumonectomy-Like Syndrome in an Infant With Right Lung Agenesis and Left Main Bronchus Hypoplasia

We report a 1-year-old child born with agenesis of the right lung who sustained an episode of acute respiratory failure related to a postpneumonectomy-like syndrome, with severe mediastinal shift and subsequent stretching and stenosis of the left main bronchus. The insertion of an expandable prosthesis in the right empty pleural space markedly improved the patient's clinical condition

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

[The HEAT-PPCI study]

Background. La bivalirudina, in associazione con l\u2019uso selettivo degli inibitori della glicoproteina (GP) IIb/IIIa, rappresenta uno standard di cura riconosciuto nell\u2019angioplastica coronarica primaria (PPCI). Scopo dello studio \ue8 stato quello di confrontare la terapia antitrombotica con bivalirudina o eparina non frazionata nel corso di tale procedura. Metodi e risultati. Tra il 7 febbraio 2012 e il 20 novembre 2013, sono stati randomizzati 1829 pazienti su un totale di 1917 pazienti sottoposti ad angiografia d\u2019emergenza presso il nostro centro (pari al 97% dei pazienti afferiti consecutivamente), di cui 1812 inclusi nell\u2019analisi finale. 751 pazienti (83%) dei 905 inclusi nel gruppo bivalirudina e 740 pazienti (82%) dei 907 inclusi nel gruppo eparina sono stati sottoposti ad angioplastica coronarica. Il tasso di utilizzo degli inibitori della GP IIb/IIIa era sostanzialmente simile nei due gruppi (122 pazienti [13%] nel gruppo bivalirudina e 140 pazienti [15%] nel gruppo eparina). L\u2019endpoint primario di efficacia si \ue8 verificato in 79/905 pazienti (8.7%) del gruppo bivalirudina e in 52/907 pazienti (5.7%) del gruppo eparina (differenza di rischio assoluto 3.0%; rischio relativo [RR] 1.52, IC 95% 1.09-2.13, p=0.01). L\u2019\uadendpoint\uad primario di sicurezza si \ue8 verificato in 32/905 pazienti (3.5%) del gruppo bivalirudina e in 28/907 pazienti (3.1%) del gruppo eparina (differenza di rischio assoluto 0.4%; RR 1.15, IC 95% 0.70-1.89, p=0.59). Conclusioni. Rispetto alla bivalirudina, l\u2019eparina riduce l\u2019incidenza degli eventi ischemici avversi maggiori nel contesto della PPCI, a fronte di nessun incremento delle complicanze emorragiche. L\u2019uso sistematico di eparina, invece che di bivalirudina, si tradurrebbe in una sostanziale riduzione dei costi correlati al farmaco. [Lancet 2014;384:1849-58

Indications for and results of video-assisted thoracic surgery.

Between January 1991 and February 1996, and February 1996, 222 videothoracoscopic operations were conducted in 215 patients. Indications for video-assisted thoracic surgery (Vats) have included management of pneumothorax, (91), pleural effusion (59), lung nodules (41), mediastinal biopsy (8), need for lung biopsy (10), small endothoracic masses (6), haemothorax (4), gangliectomy in Raynaud syndrome (1), the removal of jugular vein catheter (1), and middle lobectomy for A-V fistula (1). Fifteen procedures were converted to thoracotomy; nine conversions were made for more extensive resection after a diagnosis of primary lung malignancy. Other reasons for conversion were adhesions (6). There was one complication (haemothorax). There were no intraoperative deaths. Mean operative time was 60 min. (median line); the median chest tube duration was three days and hospital stay five days. The video-assisted thoracic surgery procedures were safe, and for patients the advantages included less pain and earlier post-operative mobilization

The impact of boards of directors\u2019 characteristics on cash holdings in uncertain times

This study examines the relationship between the board of directors and cash holdings before and during the global financial crisis. We focus on the main demographic characteristics of the board: CEO duality, independent directors, and board size. Employing a sample of listed Italian industrial firms over the period 2003\u20132013, our empirical findings show the different behaviors of the members of the board of directors in determining cash holdings in normal conditions and during a crisis. In normal periods, in line with agency theory, a vigilant board\u2014characterized by a high proportion of independent directors\u2014reduces cash holdings. Diversely, the presence of CEO duality and larger boards increase cash holdings. In times of crisis, members of the board of directors abandon their monitoring duties or opportunistic behavior and become more participative to help the firm to survive. The results suggest that the effects of the board of directors\u2019 characteristics are contingent on a firm\u2019s external environment

Liver Transplantation in a Monolung Patient: A Strategy of Sequential Treatments of Multiple Lung Tuberculosis Cavitations and Hepatocellular Carcinoma on Hepatitis B Related Virus Cirrhosis

The presence of extrahepatic infection is a contraindication for liver transplantation, even more if supported by an advanced pulmonary tuberculosis with persistent cavitation not curable with medical treatment. We report a case of a young patient with hepatocellular carcinoma on hepatitis B virus related liver cirrhosis and multiple lung tuberculosis cavitations. The patient was referred to our centre for liver transplantation. We adopted a strategy with sequential treatments. First a left extra-pericardial pneumonectomy was performed without opening the infected cavern, followed by a therapy with rifampicin, isoniazid and ethambutol for a period of nine months. After the cure of tuberculosis, the monolung patient eventually was listed for liver transplantation. An accurate planning of a multistep therapeutical strategy, an appropriate anesthetic man- agement and a meticulous surgical technique allowed to successfully transplant a young patient suffering from three life-threatening diseases: cavitary tuberculosis, hepatitis B virus cirrhosis and hepatocellular car- cinoma. Thirty months after liver transplantation the patient is in good health, with normal liver function, forced expiratory volume in one second of 42% (1.53 liters) and without any tuberculosis disease reactiva- tion