Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures

Background: Whole lung lavage (WLL) is the current standard of care treatment for patients affected by pulmonary alveolar proteinosis (PAP). However, WLL is not standardized and international consensus documents are lacking. Our aim was to obtain a factual portrayal of WLL as currently practiced with respect to the procedure, indications for its use, evaluation of therapeutic benefit and complication rate. Methods: A clinical practice survey was conducted globally by means of a questionnaire and included 27 centers performing WLL in pediatric and/or adult PAP patients. Results: We collected completed questionnaires from 20 centres in 14 countries, practicing WLL in adults and 10 centers in 6 countries, practicing WLL in pediatric patients. WLL is almost universally performed under general anesthesia, with a double-lumen endobronchial tube in two consecutive sessions, with an interval of 1-2 weeks between sessions in approximately 50 % of centres. The use of saline warmed to 37 degrees C, drainage of lung lavage fluid by gravity and indications for WLL therapy in PAP were homogenous across centres. There was great variation in the choice of the first lung to be lavaged: 50 % of centres based the choice on imaging, whereas 50 % always started with the left lung. The choice of position was also widely discordant;the supine position was chosen by 50 % of centres. Other aspects varied significantly among centres including contraindications, methods and timing of follow up, use of chest percussion, timing of extubation following WLL and lung isolation and lavage methods for small children. The amount of fluid used to perform the WLL is a critical aspect. Whilst a general consensus exists on the single aliquot of fluid for lavage (around 800 ml of warm saline, in adults) great variability exists in the total volume instilled per lung, ranging from 5 to 40 liters, with an average of 15.4 liters/lung. Conclusions: This international survey found that WLL is safe and effective as therapy for PAP. However these results also indicate that standardization of the procedure is required;the present survey represents the a first step toward building such a document

Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures

Background: Whole lung lavage (WLL) is the current standard of care treatment for patients affected by pulmonary alveolar proteinosis (PAP). However, WLL is not standardized and international consensus documents are lacking. Our aim was to obtain a factual portrayal of WLL as currently practiced with respect to the procedure, indications for its use, evaluation of therapeutic benefit and complication rate. Methods: A clinical practice survey was conducted globally by means of a questionnaire and included 27 centers performing WLL in pediatric and/or adult PAP patients. Results: We collected completed questionnaires from 20 centres in 14 countries, practicing WLL in adults and 10 centers in 6 countries, practicing WLL in pediatric patients. WLL is almost universally performed under general anesthesia, with a double-lumen endobronchial tube in two consecutive sessions, with an interval of 1-2 weeks between sessions in approximately 50 % of centres. The use of saline warmed to 37 degrees C, drainage of lung lavage fluid by gravity and indications for WLL therapy in PAP were homogenous across centres. There was great variation in the choice of the first lung to be lavaged: 50 % of centres based the choice on imaging, whereas 50 % always started with the left lung. The choice of position was also widely discordant;the supine position was chosen by 50 % of centres. Other aspects varied significantly among centres including contraindications, methods and timing of follow up, use of chest percussion, timing of extubation following WLL and lung isolation and lavage methods for small children. The amount of fluid used to perform the WLL is a critical aspect. Whilst a general consensus exists on the single aliquot of fluid for lavage (around 800 ml of warm saline, in adults) great variability exists in the total volume instilled per lung, ranging from 5 to 40 liters, with an average of 15.4 liters/lung. Conclusions: This international survey found that WLL is safe and effective as therapy for PAP. However these results also indicate that standardization of the procedure is required;the present survey represents the a first step toward building such a document

Lifestyles and socio-cultural factors among children aged 6-8 years from five Italian towns: The MAPEC-LIFE study cohort

Background: Lifestyles profoundly determine the quality of an individual’s health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6–8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors. Methods: A questionnaire composed of 148 questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities (Torino, Brescia, Pisa, Perugia and Lecce) to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics. The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors. Results: The final cohort was composed of 1,164 children (50.9 boys, 95.4% born in Italy). Frequency of some factors appeared different in terms of the survey season (physical activity in the open air, the ways of cooking certain foods) and among the various cities (parents’ level of education and rate of employment, sport, traffic near the home, type of heating, exposure to passive smoking, ways of cooking certain foods). Exposure to passive smoking and cooking fumes, obesity, residence in areas with heavy traffic, frequency of outdoor play and consumption of barbecued and fried foods were higher among children living in families with low educational and/or occupational level while children doing sports and consuming toasted bread were more frequent in families with high socio-economic level. Conclusions: The socio-economic level seems to affect the lifestyles of children enrolled in the study including those that could cause health effects. Many factors are linked to the geographical area and may depend on environmental, cultural and social aspects of the city of residence

Photosynthetic Membranes Part 71. Laboratory-scale photomineralization of n-alkanols in aqueous solution by photocatalytic membranes immobilizing titianium dioxide

Kinetics of photocatalytic oxidn. of methanol, ethanol, n-propanol, n-heptanol, and n-decanol to yield intermediates, and photomineralization of intermediates to yield carbon dioxide and water, was studied in aq. soln. using a lab.-scale photoreactor and photocatalytic membranes immobilizing 30\ub13 wt.% of TiO2, in the presence of stoichiometric quantities of hydrogen peroxide as oxygen donor. The whole vol. of the irradiated soln. was 4.000\ub10.005 L, and the ratio between this vol. and the geometrical apparent surface of the irradiated side of the photocatalytic membrane 3.8\ub10.1 cm. A kinetic model was used, by which mineralization of substrate to CO2 was supposed to occur through one single intermediate (kinetic consts. k1), mediating the behavior of all the numerous real intermediates formed in the path from the substrate to CO2 (kinetic consts. k2). A competitive Langmuirian adsorption of both substrate and "intermediate" was also supposed to be operative, expressed by the apparent adsorption consts. K1 and K2. By Langmuir - Hinshelwood treatment of the initial rate data, the starting values of the k and K couples were obtained, from which, by a set of differential equations, the final optimized parameters, k1 and K1, k2 and K2 were calcd. While in the case of alkanoic acids, values of k1 and k2 were roughly coincident, in the case of n-alkanols investigated in this work, k2 values were higher than k1 of the same mols. This is interpreted on the basis of the closer behavior, from the photocatalytic point of view, of alkanols to hydrocarbons compared to their corresponding carboxylic acids. Furthermore, values of k2 for methanol were practically the same as those of k1 for the corresponding acid. This behavior confirms the suggestion of being methanoic acid the most representative intermediate for photodegrdn. of methanol

The role of endobronchial ultrasound transbronchial needle aspiration in patients candidate to pneumonectomy

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Incompiuto - la nascita di uno Stile

INCOMPIUTO: La nascita di uno Stile è la prima e unica indagine, frutto di dieci anni di ricerca sul campo, di un fenomeno molto discusso nel nostro paese ma non ancora completamente riconosciuto: la presenza massiccia sul territorio di edifici e infrastrutture la cui realizzazione non si è mai conclusa. La dimensione del fenomeno, l’estensione territoriale e le incredibili peculiarità architettoniche fanno dell’Incompiuto il più importante stile architettonico italiano dal dopoguerra a oggi. Questa è la tesi che sostiene, in modo provocatorio ma ineccepibile, il gruppo di lavoro che in questi anni ha raccolto migliaia di scatti, ha vagliato centinaia di segnalazioni su tutto il territorio nazionale, a partire dalla Sicilia, per poi risalire la penisola. INCOMPIUTO: La nascita di uno Stile accompagna il lettore in un moderno Grand Tour, tra le rovine contemporanee