Non-intubated VATS for lung cancer—a focus on segmentectomy: a narrative review

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Stenosis of bronchus intermedius: an unusual complication after transplantation and its treatment

Complications related to ischemia are the most important cause of morbidity and mortality after lung transplantation. Ischemia suffered by large bronchi during topical cooling and transplantation of the graft is considered the possible pathogenic noxa for late stenosis as well as a possible cause of anastomotic leak or ulceration of the mucosa. It seems to emerge from the literature that the bronchus intermedius may be particularly prone to ischemia and may undergo stenosis late after transplantation

The EcoThermo project: key and innovative aspects

In this paper we present the most innovative aspects of the EC-FP7 EcoThermo project. The main aim of the project consists on innovating the technique of heat cost allocation in buildings with a centralized heating system, overcoming the heat cost allocator drawbacks for reliability, measurement reproducibility and traceability and contexts of applications. Given the complexity of the project, we will focus on its main aspects, such as the use of a virtual sensor to estimate the radiators heating power, the design of electronic valves fitted out with an energy harvesting system and the original wireless communication protocol

The EcoThermo project: key and innovative aspects

In this paper we present the most innovative aspects of the EC-FP7 EcoThermo project. The main aim of the project consists on innovating the technique of heat cost allocation in buildings with a centralized heating system, overcoming the heat cost allocator drawbacks for reliability, measurement reproducibility and traceability and contexts of applications. Given the complexity of the project, we will focus on its main aspects, such as the use of a virtual sensor to estimate the radiators heating power, the design of electronic valves fitted out with an energy harvesting system and the original wireless communication protocol

Pleural tissue repair with cord blood platelet gel

BACKGROUND: Prolonged air leak is the major cause of morbidity after pulmonary resection. In this study we used in vitro and in vivo experiments to investigate an innovative approach based on the use of human umbilical cord blood platelet gel. MATERIALS AND METHODS: In vitro, a scratch assay was performed to test the tissue repair capability mediated by cord blood platelet gel compared to the standard culture conditions using human primary mesothelial cells. In vivo, an iatrogenic injury was made to the left lung of 54 Wistar rats. Cord blood platelet gel was placed on the injured area only in treated animals and at different times histological changes and the presence of pleural adhesions were evaluated. In addition, changes in the pattern of soluble inflammatory factors were investigated using a multiplex proteome array. RESULTS: In vitro, mesothelial cell damage was repaired in a shorter time by cord blood platelet gel than in the control condition (24 versus 35 hours, respectively). In vivo, formation of new mesothelial tissue and complete tissue recovery were observed at 45\ub11 and 75\ub11 hours in treated animals and at 130\ub12.5 and 160\ub16 hours in controls, respectively. Pleural adhesions were evident in 43% of treated animals compared to 17% of controls. No complications were observed. Interestingly, some crucial soluble factors involved in inflammation were significantly reduced in treated animals. DISCUSSION: Cord blood platelet gel accelerates the repair of pleural damage and stimulates the development of pleural adhesions. Both properties could be particularly useful in the management of prolonged air leak, and to reduce inflammatio

Conversione precoce a tacrolimus a rilascio prolungato dopo trapianto di polmone

Riportiamo per la prima volta l\u2019esperienza di switch precoce a ER-tacrolimus. Abbiamo osservato bassi tassi di Cmin extra-range, senza registrare gravi effetti collaterali. Ulteriori ricerche analizzeranno l'insorgenza di lung allograft dysfunction. Introduzione: Il tacrolimus \ue8 il pi\uf9 utilizzato immunosoppressore nel trapianto polmonare (LuTx), attualmente off-label. Una formulazione a rilascio prolungato (ER), consentendone la somministrazione una volta al giorno, favorisce l'aderenza e riduce la concentrazione massima, con AUC-24h comparabile. Noi riportiamo l\u2019esperienza di switch precoce da tacrolimus somministrato due volte al giorno (-BID) a ERtacrolimus in pazienti stabili dopo LuTx. Metodologia: Abbiamo arruolato i pazienti adulti sottoposti a LuTx bilaterale nel 2016, con regolare decorso post-operatorio precoce; abbiamo escluso pazienti con degenza in terapia intensiva superiore a 14 giorni. Abbiamo estrapolato i dati dal nostro database dedicato. Il passaggio da tacrolimus-BID a ER-tacrolimus avveniva in 16ma giornata postoperatoria, con rapporto 1:1 e successivo aggiustamento in base alla valle sierica (Cmin). Consideriamo in range una Cmin= 10-15 ng/ml, accettabile 8-10 e 15-18 ng/ml, extra-range gli altri dosaggi. Abbiamo registrato la Cmin allo switch, il primo, il secondo giorno, a una, due, tre e quattro settimane e a 2 mesi. Risultati: Abbiamo osservato ventuno pazienti (et\ue0 mediana= 40 anni); indicazioni: fibrosi cistica, enfisema, interstiziopatia in 13, 3 e 8 casi, rispettivamente. La mortalit\ue0 a 3 mesi \ue8 stata del 4,7% (1 paziente). Escludendo due pazienti con insufficienza renale preoperatoria, abbiamo osservato una riduzione della funzionalit\ue0 renale in due pazienti. Discutiamo qui i dati clinici, il trend della funzionalit\ue0 respiratoria e delle Cmin dei pazienti dello studio. Conclusioni: Riportiamo per la prima volta l\u2019esperienza di switch precoce a ER-tacrolimus. Abbiamo osservato bassi tassi di Cmin extra-range, senza registrare gravi effetti collaterali. Ulteriori ricerche analizzeranno l'insorgenza di lung allograft dysfunction

Stenosi del bronco intermedio: riconoscimento di una singolare complicanza post-trapianto e suo trattamento

Scopo del lavoro: Le complicanze legate all'ischemia sono la causa pi\uf9 importante di morbidit\ue0 e mortalit\ue0 in seguito a trapianto di polmone. L'Ischemia sofferta dai grossi rami bronchiuali durante il trasposto ed il trapianto del graft oltre che essere la possibile causa di deiscenza anastomotica o ulcerazioni della mucosa, \ue8 ritenuta la possibile noxa patogeneticadella stenosi tardiva dei grossi bronchi nel periodo post-operatorio. Appare emergere dalla letteratura che il pronco intermedio possa essere particolarmente prono alla sofferenza ischemica e stenotizzarsi tardivamente dopo il trapianto

Impatto clinico del monitoraggio digitale delle perdite aeree dopo resezione polmonare

Scopo del lavoro: valutazione dell'impatto clinico del monitoraggio digitale delle perdite aeree dopo resezione polmonare nel contesto della gestione pianificata del drenaggio toracico; studio prospettico randomizzato, controllato con intento di trattament

Un raro caso di singola metastasi mediastinica da neoplasia mammaria

Le neoplasie della mammella sono le pi\uf9 frequenti del sesso femminile. I progressi nella diagnosi precoce, nelle terapie mediche e nei trattamenti combinati dei casi pi\uf9 avanzati hanno portato ad un allungamento della aspettativa di vita delle pazienti affette. In particolare, la terapia delle pazienti con metastasi \ue8 generalmente costituita da chemioterapia associata a radioterapia o altri trattamenti adiuvanti. Nei rari casi di metastasi singole, la letteratura raccomanda il trattamento chirurgico quando queste siano sintomatiche o in cui sia necessario ottenere dei campioni istologici a fini terapeutici (recidiva di malattia a distanza di diversi anni dal primitivo)

Immunoadsorption for Treatment of Antibody Mediated Rejection after Lung Transplantation

PURPOSE: Antibody mediated rejection (AMR) has recently emerged as an important risk factor for lung allograft dysfunction and mortality. Several clinical protocols have been proposed to try to remove donor specific antibodies (DSA) and prevent their future development, including intravenous immunoglobulin (IVIG), therapeutic plasma exchange (TPE), rituximab and other. Unlike traditional TPE, immunoadsorption (IAS) is a blood-purification technique that enables the selective removal of immunoglobulins from separated plasma through high-affinity adsorbers; advantageously, IAS does not remove other plasma components such as fibrinogen and compounds of the coagulation cascade, reducing potential adverse effects. Our centre implemented a multimodality strategy including steroids, immunoadsorbption, IVIG and Rituximab. METHODS: All adult lung transplant (LuTx) recipients receiving a diagnosis of AMR (based on 2016 ISHLT consensus definition), were considered eligible to receive this treatment: pulsed methylprednisolone (10 mg/Kg), 5 cycles of IAS, IVIG (2 g/Kg) and rituximab (375 mg/m^2). Of note, C4d staining is not currently available at our institution. RESULTS: Between 2016 and 2018, four patients received multimodality antibody directed therapy for AMR after LuTx. Details can be found in table 1. 2 out of the 4 patients qualified for chronic lung allograft dysfunction (CLAD) prior to protocol start (patient 1 and 3). No adverse events were registered during IAS procedures, but patient 3 suffered transfusion related acute lung injury while receiving IVIG. However, patient 3's death was attributed to progressive allograft failure and not to the therapy itself. CONCLUSION: Following this treatment, while the total number of the original DSA and the value of MFI of the originally observed DSA decreased, clinical outcomes were variable: 2 patients are experiencing long term clinical stability, but the others rapidly progressed to severe CLAD