Surgical embolectomy for acute massive pulmonary embolism: state of the art

Massive pulmonary embolism (PE) is a severe condition that can potentially lead to death caused by right ventricular (RV) failure and the consequent cardiogenic shock. Despite the fact thrombolysis is often administrated to critical patients to increase pulmonary perfusion and to reduce RV afterload, surgical treatment represents another valid option in case of failure or contraindications to thrombolytic therapy. Correct risk stratification and multidisciplinary proactive teams are critical factors to dramatically decrease the mortality of this global health burden. In fact, the worldwide incidence of PE is 60–70 per 100,000, with a mortality ranging from 1% for small PE to 65% for massive PE. This review provides an overview of the diagnosis and management of this highly lethal pathology, with a focus on the surgical approaches at the state of the art

Comment on Jaworska, J. et al. Consensus on the application of lung ultrasound in pneumonia and bronchiolitis in children

To the editor: [...

The Key Role of Lung Ultrasound in the Diagnosis of a Mature Cystic Teratoma in a Child with Suspected Difficult to Treat Pneumonia: A Case Report

To date, the diagnosis of mediastinal teratoma and mediastinal masses relies on the use of chest X-ray and CT. Lung and thoracic ultrasound is becoming increasingly used in the diagnosis and follow-up of many lung and thoracic diseases. Here, we report the case of a mature cystic teratoma in which the performance of lung ultrasound allowed to speed up the diagnostic workup and to provide the indication for the execution of CT of the thorax allowing the diagnosis

The Key Role of Lung Ultrasound in the Diagnosis of a Mature Cystic Teratoma in a Child with Suspected Difficult to Treat Pneumonia: A Case Report

To date, the diagnosis of mediastinal teratoma and mediastinal masses relies on the use of chest X-ray and CT. Lung and thoracic ultrasound is becoming increasingly used in the diagnosis and follow-up of many lung and thoracic diseases. Here, we report the case of a mature cystic teratoma in which the performance of lung ultrasound allowed to speed up the diagnostic workup and to provide the indication for the execution of CT of the thorax allowing the diagnosis

Performance evaluation of an autoencoder state estimator with realistic low voltage grids reconstructed from open data

International audienceDistribution systems operators' (DSO) upcoming challenge is to monitor and control low voltage (LV) grids. Real time measurements' acquisition from LV grids has become possible thanks to the deployment of smart meters (SM) but it is still limited by technical constraints. Thus, a real time state estimator (SE) is needed to ensure the LV grid's observability. A machine learning model can be trained using the SM historical data and then run in real time using few available measurements to estimate the system's state. For the purpose of evaluating the performance of a machine learning based SE on a realistic LV grid, an auto-encoder based SE is presented in this paper. An accuracy enhancement using pseudomeasurements is proposed and a method for reconstructing realistic LV grid models is also described

Lung Ultrasound: Its Findings and New Applications in Neonatology and Pediatric Diseases

Lung ultrasound has become increasingly used in both adult and pediatric populations, allowing the rapid evaluation of many lung and pleura diseases. This popularity is due to several advantages of the method such as the low cost, rapidity, lack of ionizing radiation, availability of bedside and repeatability of the method. These features are even more important after the outbreak of the SARS-CoV-2 pandemic, given the possibility of recognizing through ultrasound the signs of interstitial lung syndrome typical of pneumonia caused by the virus. The purpose of this paper is to review the available evidence of lung ultrasound (LUS) in children and its main applications in pediatric diseases

Lung ultrasound compared to chest X-ray for the diagnosis of CAP in children

Background: community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors focused on the application of ultrasound in lung diseases, but the role of Lung Ultrasound in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine LUS sensitivity and specificity in CAP diagnosis compared to CXR. Finally, we evaluated the role of LUS during the follow-up. Methods: We enrolled 68 children (<16 years old) hospitalized from October 2018 to September 2019 with a clinical and radiological diagnosis of CAP (cases, N=41), or with no respiratory diseases (controls, N=27), in whom a CXR was performed for clinical indication. All the children performed a LUS during hospitalization. The average time needed to perform LUS was 5-10 minutes for each child. 19/41 cases were re-evaluated by LUS and CXR 30 days after discharge. Results: LUS confirmed CAP diagnosis in 40/41 patients. Concordance between the two techniques was K=0.88 for the right lung and K=0.70 for the left lung. LUS showed a sensitivity of 97% and a specificity of 96% compared to CXR. At the follow-up, sensitivity raised to 100% while specificity was 94%. Conclusions: Our study showed a potential benefit of LUS compared to CXR in both the diagnosis and follow-up of CAP

The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle

Background: Rapid on-site evaluation (ROSE) improves the adequacy and accuracy of EUS-guided tissue acquisition, although it is not routinely widely available. Evidence suggested that core needles might overcome the absence of ROSE. The aim of this study was to evaluate the influence of ROSE on the adequacy and accuracy of EUS-guided tissue acquisition with core needles in patients with pancreatic solid lesions. Methods: Patients who underwent EUS-guided tissue acquisition of pancreatic mass lesions were retrospectively identified at three tertiary referral centers and those performed with the core needle were included. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without ROSE was the primary outcome measure. The diagnostic accuracy and tissue core acquisition were the secondary outcome measures. Results: A total of 333 patients with pancreatic solid mass lesions were included in the study; 140 cases sampled with ROSE and 193 cases without ROSE. The adequacy was 92.1\ua0% in the group sampled with ROSE and 88.1\ua0% in the group without ROSE (p\ua0=\ua00.227). In the ROSE group sensitivity, specificity, and accuracy were 90.7, 100 and 92.1\ua0%, respectively. In the group without ROSE, sensitivity, specificity, and accuracy were 87.2, 100, and 88.1\ua0%, respectively. No difference for all these figures was observed between the two groups. The tissue core was available in 61.4 and 53.4\ua0% of cases with and without ROSE, respectively (p\ua0=\ua00.143). Conclusion: In the absence of ROSE, EUS-based tissue acquisition with Core needle should be considered since it achieves comparable tissue sampling adequacy and accuracy