Nutritional status and lung transplantation : an intriguing problem

Pulmonary transplantation (LTx) is a viable treatment option for patients with final stage lung disease such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (1,2). Advances in surgical techniques, pre- and post-operative management have improved overall survival of lung-transplanted patients over the past decades. Despite these developments, lung transplantation has still significantly higher morbidity and mortality than transplants of other solid organs such as kidney and liver. For these reasons, several studies have been conducted to investigate factors that potentially affect the prognosis of patients who undergo LTx (3)

The Series on "How to Deal with Early Stage Lung Cancer: Sublobar Resections as A Possible Choice (Report of the 2019 Spring Meeting of Italian Society of Thoracic Surgery)?"

This series is the result of the work of different specialists from all around Italy and from Fudan University in Shanghai, who gathered in Milan on April 2019, to attend the Spring Meeting of Italian Society of Thoracic Surgery (SICT). The meeting discussed new evidences suggesting sublobar resection as the elective surgical treatment of early stage lung cancer

Letter to the Editor

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Selection of Candidates for Lung Transplantation: The First Italian Consensus Statement

Lung transplantation is a well-established treatment for selected patients with advanced chronic respiratory insufficiency. Recognizing those patients with end-stage lung disease who might benefit from lung transplantation is a crucial task. Considering the presence of inadequate evidence-based practice, international and national scientific societies provided consensus opinions regarding the appropriate timing of listing. The Study Group for Thoracic Organs Transplantation (branch of the Italian Society for Organs Transplantation) promoted and realized a Delphi conference among the Italian lung transplantation centers to provide guidance to clinical practice based on international recommendations. The experts from the nine Italian centers completed two rounds of standardized questionnaires (answer rate, 100%): 42 statements received a consensus >= 80%. The selected statements presented in this article are intended to assist Italian clinicians in selecting patients for lung transplantation

Lung transplantation from donation after controlled cardiocirculatory death: Systematic review and meta-analysis

Background: The interest in donation after cardiocirculatory death (DCD) donors for lung transplantation (LT) has been recently rekindled due to lung allograft shortage. Clinical outcomes following DCD have proved satisfactory. The aim of this systematic review is to provide a thorough analysis of published experience regarding outcomes of LT after controlled DCD compared with donation after brain death (DBD) donors. Methods: We performed a literature search in Cochrane Database of Systematic Reviews, PubMed and Web of Science using the items "lung transplantation" AND "donation after circulatory death" on November 1, 2018. The full text of relevant articles was evaluated by two authors independently. Quality assessment was performed using the NIH protocol for case-control and case series studies. A pooled Odds ratio (OR) and mean differences with inverse variance weighting using DerSimonian-Laird random effect models were computed to account for between-trial variance (tau 2). Results: Of the 508 articles identified with our search, 9 regarding controlled donation after cardiac death (cDCD) were included in the systematic review, including 2973 patients (403 who received graft from DCD and 2570 who had DBD). Both 1-year survival and 2 and 3-grade primary graft dysfunction (PGD) were balanced between the two cohorts (OR = 1.00 and 1.03 respectively); OR for airway complications was 2.07 against cDCD. We also report an OR = 0.57 for chronic lung allograft dysfunction (CLAD) and an OR = 0.57 for 5-year survival against cDCD. Conclusions: Our meta-analysis shows no significant difference between recipients after cDCD or DBD regarding 1-year survival, PGD and 1-year freedom from CLAD. Airway complications and long-term survival were both related with transplantation after cDCD, but these statistical associations need further research

Sniff test: does what we measure at the nose reflect what happens in the chest wall?

Nasal pressure measured during sniff (SNIP) is a technically simple voluntary test. Since the contraction of the diaphragm expands the abdomen, the volume variation during sniff manoeuvre should therefore be predominantly abdominal in order to be considered a specific index of diaphragm strength. We aimed to verify if and how SNIP varied according to thoraco-abdominal volume variations. We measured abdominal volume variations, using opto-electronic plethysmography, during quiet breathing (ABQB) and sniff manoeuvres (ABSN) in supine position on 30 patients (age: 42; FVC:47.5%; FEV1:30%) on the waiting list for lung transplant. SNIP was measured simultaneously with ABSN. 68 sniff were analysed and classified into 4 groups according to ABSN: 16 with thoracic paradox, 24 predominantly abdominal, 16 predominantly thoracic and 12 with abdominal paradox. By definition ABSN was different (p<0.001) among the 4 groups, whereas ABQB (~75%; p=0.373) and SNIP (~53 cmH2O, p= 0.792) were similar (figure 1). SNIP did not change with the different thoraco-abdominal strategies. The diaphragm was not weak and leaded inspiration, therefore ABSN varied because the patients misperformed the manoeuvre. In order to not misunderstand the clinical significance of a sniff test, care should be paid also in thoraco-abdominal movement because SNIP, per se, cannot differentiate between thoracic or diaphragmatic manoeuvre with the risk to lose its specificity

Hepatocellular Carcinoma in a non-Cirrhotic Liver of a HCV-Positive Woman with Sustained Viral Response

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First Italian Consensus Conference on VATS Lobectomy for NSCLC

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A valid academic path to promote respiratory physiotherapy

A one- year post- graduate Master in Physiotherapy and Pulmonary Rehabilitation has been offered within the University of Milan Medical School in collaboration with Associaz ione Italiana Riabilitatori dell\u2019Insufficienz a Respiratoria (ARIR). The aim is to cover a gap in Italian Physiotherapy academic curricula offering a course with theoretical and practical teaching that make students capable of using different techniques and procedures in respiratory physiotherapy. After the recognition by the International Education Recognition System (IERS), ARIR wanted to investigate if and how this course has affected students'attitude and their profession. METHODS A structured questionnaire made up of 15 multiple- choices items (8 on perceived quality of education and 7 on professional change) was sent by email to all physiotherapists who graduated in the previous four editions of the Master. One month was given for completion. Age, gender, year of degree and year of Master where considered as background variables. RESULTS We had a 78% response rate with 57 out of 73 physiotherapists sending the questionnaire back. Mean age was 37 years (23- 60) and women were the majority (78%). Forty- two students (74%) worked in the respiratory field at the time of application but only 15 (36%) dealt with respiratory patients only. Expectations were completely met at the end of Master for 71% of physiotherapists. 96% reported greater professional and clinical skills after the master with a 67% saying working team relationship has improved. 28% improved their job position thanks to the master degree and physiotherapy working in the respiratory field increased by 22%. CONCLUSIONS This course seems to meet students expectations and offer a solid knowledge to better work within the field of respiratory physiotherapy. It is also a way to promote the profession of respiratory physiotherapy in Italy

Hepatitis C Virus Infection Among non-IDU HIV-Infected and Uninfected Men who Have Sex with Men

In the Mediterranean countries, hepatitis C virus infection affect nearly 45% of HIV-1 infected individuals, consistently to the high proportion of patients with a history of intravenous drug use and exposed to the two viruses by parenteral route. Even in association with HIV-infection, HCV infection is rarely transmitted through sexual intercourse due to the lower efficiency of mucosal exposure to virus than that blood-borne. Thus, the incidence and prevalence of HCV infection are far lower among the non-intravenous drug users (IDU) at risk of sexually transmitted infections (STI). Two hypotheses may be taken in account to explain the lower prevalence rates observed in our seroprevalence study. The MSMs participating to our study could have less sexual contacts with IDU-MSMs than other gay community residents in other western countries. The non-IDU MSMs recruited in this study could have a lower frequency of at-risk sexual practices for HCV then the non-IDU MSMs enrolled in other studies