Evaluation of a new ultrasonic device for surgical dissection in lung lobectomy and lymphadenectomy for lung cancer

Objective To assess and compare surgical electric hook vs Harmonic ACE Plus\uae impact on short-term postoperative outcomes after video-assisted thoracoscopic (VATS) lung lobectomy and lymphadenectomy for non-small cell lung cancer (NSCLC). Materials and methods We prospectively collected data of 120 consecutive patients [60% male; median age: 71 (62-76 IQR:) years] undergoing lung lobectomy and lymphadenectomy by VATS for NSCLC in our Center from October 1st 2016 to July 31th 2019. Patients were divided in two groups based on the device used for tissue dissection: the electric hook (Group A) in 68 cases and the Harmonic ACE Plus\uae (Group B) in 52. Multivariable analysis by binary logistic regression was performed in order to test the energy device as possible risk factor for pleural effusion volume at 48 hours after surgery and for postoperative chest tube duration. Results No intraoperative complications due to energy device were recorded in both groups. Chylothorax incidence was higher in Group A with no statistically significant difference between the two groups (3% vs 0%; p-value=0.50). Pleural effusion volume during the first 48 postoperative hours was significantly higher in Group B: 253 ml (IQR: 149-405) vs 408 (IQR: 294-508) ml (p-value<0.01). However, chest tube duration was similar in the two groups: 4 (IQR: 3-8) vs 5 (IQR: 4-8) days (p-value=0.39). At multivariable analysis energy device was not independently associated with pleural effusion volume at 48 hours after surgery and with postoperative chest tube duration. Conclusions Electric hook or Harmonic ACE Plus\uae use during VATS lobectomy for NSCLC is safe and leads to similar postoperative short-term outcomes

The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient

In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board

Block-Copolymers Enable Direct Reduction and Structuration of Noble Metal-Based Films

Noble metal nanostructured films are of great interest for various applications including electronics, photonics, catalysis, and photocatalysis. Yet, structuring and patterning noble metals, especially those of the platinum group, is challenging by conventional nanofabrication. Herein, an approach based on solution processing to obtain metal-based films (rhodium, ruthenium (Ru) or iridium in the presence of residual organic species) with nanostructuration at the 20 nm-scale is introduced. Compared to existing approaches, the dual functionality of block-copolymers acting both as structuring and as reducing agent under inert atmosphere is exploited. A set of in situ techniques has allowed for the capturing of the carbothermal reduction mechanism occurring at the hybrid organic/inorganic interface. Differently from previous literature, a two-step reduction mechanism is unveiled with the formation of a carbonyl intermediate. From a technological point of view, the materials can be solution-processed on a large scale by dip-coating as polymers and simultaneously structured and reduced into metals without requiring expensive equipment or treatments in reducing atmosphere. Importantly, the metal-based films can be patterned directly by block-copolymer lithography or by soft-nanoimprint lithography on various substrates. As proof-of-concept of application, the authors demonstrate that nanostructured Ru films can be used as efficient catalysts for H-2 generation into microfluidic reactors

ENSINO PÚBLICO RELIGIOSO E CONFESSIONAL: APONTAMENTOS A PARTIR DA AÇÃO DIRETA DE INCONSTITUCIONALIDADE 4.439

The aim of this article is to prove, from arguments debated in the Direct Unconstitutionality Action 4.439, that democratic secularity does not exclude religious sphere. With this background, we try to demonstrate that in order to claim the optionality, the non-confessional structure and the separation between State and Church, in favor of religious freedom itself, which includes the right not to profess any faith. Teaching could be, when ministered, “about” religions, not “of” religions. Finally, note that a critical-methodological line was adopted. In this sense, the arguments presented by the Ministers of the Supreme Court were read by the lenses of a Critical Constitutional Theory.El objetivo del artículo es demostrar, a partir de argumentos debatidos en la Acción Directa de Inconstitucionalidad nº 4.439, que la laicidad democrática no excluye la esfera religiosa. En ese transfondo, buscamos discutir que con la finalidad de afirmar la facultatividad, la estructura no confesional, y la separación entre Estado e Iglesia, en favor de la propia libertad religiosa, la cual incluye el derecho de no profesar fe alguna, la enseñanza puede ser, cuando sea impartida, "sobre" religiones, no "de" religiones. Se registra, por fin, que adoptamos una línea crítico-metodológica. En ese sentido, los argumentos presentados por los Jueces del Supremo Tribunal se han leído por la lente de una Teoría Crítica de la Constitución.O objetivo do artigo é comprovar, a partir de argumentos debatidos na Ação Direita de Inconstitucionalidade n.º 4.439, que a laicidade democrática não exclui a esfera religiosa. Com esse pano de fundo, procuramos demonstrar que a fim de afirmar a facultatividade, a estrutura não-confessional, e a separação entre Estado e Igreja, em favor da própria liberdade religiosa, a qual inclui o direito de não professar fé alguma, o ensino pode ser, quando ministrado, “sobre” religiões, não “de” religiões. Registre-se, por fim, que adotamos uma linha crítico-metodológica. Nesse sentido, os argumentos apresentados pelos Ministros do Supremo Tribunal foram lidos pela lente de uma Teoria Crítica da Constituiçã

Nanoscale electrical analyses of axial-junction GaAsP nanowires for solar cell applications

Axial p-n and p-i-n junctions in GaAs0.7P0.3 nanowires are demonstrated and analyzed using electron beam induced current microscopy. Organized self-catalyzed nanowire arrays are grown by molecular beam epitaxy on nanopatterned Si substrates. The nanowires are doped using Be and Si impurities to obtain p- and n-type conductivity, respectively. A method to determine the doping type by analyzing the induced current in the vicinity of a Schottky contact is proposed. It is demonstrated that for the applied growth conditions using Ga as a catalyst, Si doping induces an n-type conductivity contrary to the GaAs self-catalyzed nanowire case, where Si was reported to yield a p-type doping. Active axial nanowire p-n junctions having a homogeneous composition along the axis are synthesized and the carrier concentration and minority carrier diffusion lengths are measured. To the best of our knowledge, this is the first report of axial p-n junctions in self-catalyzed GaAsP nanowires

Pathological and clinical features of multiple cancers and lung adenocarcinoma: a multicentre study

OBJECTIVES: Lung cancer is increasingly diagnosed as a second cancer. Our goal was to analyse the characteristics and outcomes of early-stage resected lung adenocarcinomas in patients with previous cancers (PC) and correlations with adenocarcinoma subtypes.METHODS: We retrospectively reviewed data of patients radically operated on for stage I-II lung adenocarcinoma in 9 thoracic surgery departments between 2014 and 2017. Overall survival (OS) and time to disease relapse were evaluated between subgroups.RESULTS: We included 700 consecutive patients. PC were present in 260 (37.1%). Breast adenocarcinoma, lung cancer and prostate cancer were the most frequent (21.5%, 11.5% and 11.2%, respectively). No significant differences in OS were observed between the PC and non-PC groups (P = 0.378), with 31 and 75 deaths, respectively. Patients with PC had smaller tumours and were more likely to receive sublobar resection and to be operated on with a minimally invasive approach. Previous gastric cancer (P = 0.042) and synchronous PC (when diagnosed up to 6 months before lung adenocarcinoma; P = 0.044) were related, with a worse OS. Colon and breast adenocarcinomas and melanomas were significantly related to a lower incidence of high grade (solid or micropapillary, P = 0.0039, P = 0.005 and P = 0.028 respectively), whereas patients affected by a previous lymphoma had a higher incidence of a micropapillary pattern (P = 0.008).CONCLUSIONS: In patients with PC, we found smaller tumours more frequently treated with minimally invasive techniques and sublobar resection, probably due to a more careful follow-up. The impact on survival is not uniform and predictable; however, breast and colon cancers and melanoma showed a lower incidence of solid or micropapillary patterns whereas patients with lymphomas had a higher incidence of a micropapillary pattern

Impact of High‑Grade Patterns in Early‑Stage Lung Adenocarcinoma: A Multicentric Analysis

Objective The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a signifcantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components on long-term outcomes in early-stage lung adenocarcinomas. Methods We retrospectively collected data of consecutive resected pT1-T3N0 lung adenocarcinoma from nine European Thoracic Centers. All patients who underwent a radical resection with lymph-node dissection between 2014 and 2017 were included. Diferences in Overall Survival (OS) and Disease-Free Survival (DFS) and possible prognostic factors associated with outcomes were evaluated also after performing a propensity score matching to compare tumors containing non-highgrade and high-grade patterns. Results Among 607 patients, the majority were male and received a lobectomy. At least one high-grade histological pattern was seen in 230 cases (37.9%), of which 169 solid and 75 micropapillary. T1a-b-c without high-grade pattern had a signifcant better prognosis compared to T1a-b-c with high-grade pattern (p=0.020), but the latter had similar OS compared to T2a (p=0.277). Concurrently, T1a-b-c without micropapillary or solid patterns had a signifcantly better DFS compared to those with high-grade patterns (p=0.034), and it was similar to T2a (p=0.839). Multivariable analysis confrms the role of T descriptor according to high-grade pattern both for OS (p=0.024; HR 1.285 95% CI 1.033–1.599) and DFS (p=0.003; HR 1.196, 95% CI 1.054–1.344, respectively). These results were confrmed after the propensity score matching analysis. Conclusions pT1 lung adenocarcinomas with a high-grade component have similar prognosis of pT2a tumors

Systematic review and critique of circulating miRNAs as biomarkers of stage I-II non-small cell lung cancer

Selected circulating microRNAs (miRNAs) have been suggested for non-invasive screening of non-small cell lung cancer (NSCLC), however the numerous proposed miRNA signatures are inconsistent. Aiming to identify miRNAs suitable specifically for stage I-II NSCLC screening in serum/plasma samples, we searched the databases \u201cPubmed\u201d, \u201cMedline\u201d, \u201cScopus\u201d, \u201cEmbase\u201d and \u201cWOS\u201d and systematically reviewed the publications reporting quantitative data on the efficacy [sensitivity, specificity and/or area under the curve (AUC)] of circulating miRNAs as biomarkers of NSCLC stage I and/or II. The 20 studies fulfilling the search criteria included 1110 NSCLC patients and 1009 controls, and were of medium quality according to Quality Assessment of Diagnostic Accuracy Studies checklist. In these studies, the patient cohorts as well as the control groups were heterogeneous for demographics and clinicopathological characteristics; moreover, numerous pre-analytical and analytical variables likely influenced miRNA determinations, and potential bias of hemolysis was often underestimated. We identified four circulating miRNAs scarcely influenced by hemolysis, each featuring high sensitivity (&gt; 80%) and AUC (&gt; 0.80) as biomarkers of stage I-II NSCLC: miR- 223, miR-20a, miR-448 and miR-145; four other miRNAs showed high specificity (&gt; 90%): miR-628-3p, miR-29c, miR-210 and miR-1244. In a model of two-step screening for stage I-II NSCLC using first the above panel of serum miRNAs with high sensitivity and high AUC, and subsequently the panel with high specificity, the estimated overall sensitivity is 91.6% and overall specificity is 93.4%. These and other circulating miRNAs suggested for stage I-II NSCLC screening require validation in multiple independent studies before they can be proposed for clinical application