Commentary: coronavirus disease 2019 (COVID-19) and the airway: how can surgery help?

a large number of cases of benign tracheal stenosis is eventually expected because of the prolonged intubation and/or tracheostomy performed to manage the severe respiratory impairment occurring in many patients with COVID-19. The authors reported the presence of a process of coagulative necrosis in the tissue of the resected airway (documented at the pathologic examination), thus confirming the recently published literature that points out the systemic effect of the COVID-19 that sometimes leads to multiorgan involvement

Thoracic surgery for malignancy and emergency irrespective of COVID-19

until March 24, 2020, a COVID-19 test by nasopharyngeal swab was offered to the patients presenting with symptoms of COVID-19. However, from April 2, 2020, we changed that policy, offering 2 COVID-19 tests by nasopharyngeal swab to everyone undergoing thoracic surgery for malignancies before admission to our general university hospital, even if asymptomatic

Bronchovascular reconstruction in the era of mini-invasiveness

bronchovascular reconstruction in the era of mininvasivenes

A high-volume thoracic surgery division into the storm of the COVID-19 pandemic

Since the coronavirus 2019 (COVID-19) crisis broke out in Italy at the end of February 2020, days before the World Health Organization declared the pandemic,1,2 two crucial issues urgently emerged and needed to be addressed by our institution. First was the containment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic together with the restructuring of national public and private health care to face the spread of the new viral disease among the population. Second, central as well, was to maintain the offer of medical and surgical treatments to the patients who still presented with other severe diseases—of these in particular, oncologic patients

The advantage of sleeve lobectomy over pneumonectomy

Answer to Dr. Ludwig about lower sleeve lobectomy, the so-called “Y” sleeve

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Relevance of pharmacogenomics and multidisciplinary management in a young-elderly patient with KRAS mutant colorectal cancer treated with first-line aflibercept-containing chemotherapy

Introduction: Intensive oncological treatment integrated with resection of metastases raised the clinical outcome of metastatic colorectal cancer (MCRC). In clinical practice, complex evaluation of clinical (age, performance status, comorbidities), and biological (tumoral genotype, pharmacogenomic) parameters addresses tailored, personalized multidisciplinary treatment strategies. Patients with MCRC unsuitable for first-line intensive medical treatments are prevalent and showed worse clinical outcome. After progression to oxaliplatin-based chemotherapy, aflibercept/FOLFIRI significantly improved clinical outcome, even if no survival benefit was reported in adjuvant fast relapsers by aflibercept addition. The case reported a young-elderly (yE) patient with KRAS mutant colorectal cancer rapidly progressing to adjuvant chemotherapy, unfit owing to comorbidities, with multiple pharmacogenomic alterations, who gained long-term survival in clinical practice by multidisciplinary treatment strategy consisting of first-line and re-introduction of aflibercept-containing chemotherapy and two-stage lung metastasectomies. Case presentation: A 71-years-old yE patient, unfit for intensive oncological treatments owing to Cumulative Illness Rating Scale (CIRS) stage secondary, affected by KRAS c.35 G>T mutant colorectal cancer, rapidly progressing with lung metastases after adjuvant XelOx chemotherapy, reached long-term survival 66 months with no evidence of disease after first-line and re-introduction of tailored, modulated aflibercept (4 mg/kg) d1,15-irinotecan (120 mg/m2) d1,15-5-fluorouracil (750 mg/m2 /day) dd1–4, 15–18; and secondary radical bilateral two-stage lung metastasectomies. Safety profile was characterized by limiting toxicity syndrome at multiple sites (LTS-ms), requiring 5-fluorouracil discontinuation and aflibercept reduction (2 mg/kg), because of G2 hand-foot syndrome (HFS) for >2 weeks, and G3 hypertension. Pharmacogenomic analyses revealed multiple alterations of fluoropyrimidine and irinotecan metabolism: severe deficiency of fluorouracil degradation rate (FUDR), single nucleotide polymorphisms of UGT1A1* 28 variable number of tandem repeats (VNTR) 7R/7R homozygote, ABCB1 c.C3435T, c.C1236T, MTHFR c.C667T homozygote, DPYD c.A166G, TSER 28bp VNTR 2R/3R heterozygote. Conclusions: In clinical practice, a complex management evaluating clinical parameters and RAS/BRAF genotype characterizing an individual patient with MCRC, particularly elderly and/or unfit owing to comorbidities, is required to properly address tailored, multidisciplinary medical and surgical treatment strategies, integrated with careful monitoring of superimposing toxicity syndromes, also related to pharmacogenomic alterations, to gain optimal activity, and long-term efficacy

Red coral (Corallium rubrum) populations and coralligenous characterization within "Regno di Nettuno MPA" (Tyrrhenian Sea, Italy)

Red coral is one of the most important species belonging to the coralligenous habitats, being a structuring organism and highly sensitive to human pressure. The presence of red coral populations is historically well documented along the Campania coast (Tyrrhenian Sea), and, due to its high economic value, it has been commercially overharvested since ancient times. Red coral populations along several cliffs on the "Regno di Nettuno" MPA of the Gulf of Naples were investigated using ROV-imaging techniques. Coralligenous habitats were characterized in terms of percent cover and number of morphological groups. Pizzaco site showed the richest and most diverse community. Density of red coral colonies was calculated and compared with morphometric parameters. Results show an inversely correlated trend between colonies density and their size. Finally, fishing pressure was estimated through frequency of lost fishing gears, and S. Angelo site resulted the most stressed one. Anthropic stress plays a key role in the degradation of coralligenous habitats and the dramatic reduction of red coral populations recorded in recent years allows to suspect a more extensive degradation of the entire community. An assessment of the distribution and state of the populations can provide useful information to take measures for a better MPAs management

Muscle sympathetic nerve activity in patients with acromegaly

Muscle sympathetic nerve activity was measured in nine acromegalic patients (age, 35 +/- 4 yr; body mass index, 28 +/- 2 kg/m2) and eight healthy subjects (age, 32 +/- 3 yr; body mass index, 25 +/- 2 kg/m2) by combining the forearm arterial-venous difference technique with the tracer method [infusion of tritiated norepinephrine (NE)]. Muscle NE release was quantified both at rest and during physiological hyperinsulinemia while maintaining euglycemia (approximately 90 mg/dL) by means of the euglycemic clamp. Arterial plasma NE was similar in the two groups at rest (197 +/- 28 and 200 +/- 27 pg/mL (-1) and slightly increased during insulin infusion. Forearm NE release was 2.33 +/- 0.55 ng x liter(-1) x min(-1) in healthy subjects and 2.67 +/- 0.61 ng x liter(-1) x min(-1) in acromegalic subjects in the basal state and increased to a similar extent during insulin infusion in both groups (3.13 +/- 0.71 and 3.32 +/- 0.75 ng x L(-1) x min(-1), P < 0.05 vs. basal), indicating a normal stimulatory effect of insulin on muscle sympathetic activity. In contrast, insulin-stimulated forearm glucose uptake was markedly lower in acromegalic patients (2.3 +/- 0.4 mg x L(-1) x min(-1)) than in control subjects (7.9 +/- 1.3 mg x L(-1) x min(-1), P < 0.001), indicating the presence of severe insulin resistance involving glucose metabolism. Our data demonstrate that patients with long-term acromegaly have normal sympathetic activity in the skeletal muscle in the basal, postabsorptive state and normal increments in NE spillover in response to the sympatho-excitatory effect of insulin. Thus, the presence of severe insulin resistance in acromegaly is not accounted for by adrenergic mechanisms