Long-term results after carinal resection for carcinoma: Does the benefit warrant the risk?

ObjectiveWe sought to determine whether the benefit warrants the risk in patients undergoing carinal resection for carcinoma.MethodsThis was a retrospective single-center study.ResultsBetween June 1981 and August 2004, 119 patients underwent carinal resection for carcinoma in our institution. Carinal pneumonectomy was performed in 103 cases (96 right and 7 left pneumonectomies), carinal resection plus right upper lobectomy in 3, carinal resection after left pneumonectomy in 2, and carinal resection without pulmonary resection in 11. Superior vena caval resection was combined with carinal pneumonectomy in 25 patients with bronchogenic carcinoma (13 patients had complete superior vena caval resection with graft interposition). Nine (7.6%) patients died in the hospital or within 30 days of the operation. Follow-up was complete for 117 (98%) patients up to August 2004 or to the date of death. The 5- and 10-year survivals were 44% and 25%, respectively, for patients with bronchogenic carcinoma (n = 100). However, survival was significantly better in patients with N0 or N1 disease (n = 73) than in those with N2 or N3 disease (n = 27; 53% vs 15% at 5 years, respectively). The 5- and 10-year survivals in the remaining 19 patients reached 66% and 48%, respectively, and were best in patients with neuroendocrine carcinoma (100% survival at 10 years) and adenoid cystic carcinoma (69% survival at 10 years).ConclusionsSurgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good long-term survival in selected patients. The presence of positive N2 disease should, however, be considered a potential contraindication to carinal resection in patients with bronchogenic carcinoma because of the poor long-term survival

Lung transplantation in neonates and infants:ESPNIC survey of European neonatologists and pediatric intensivists

Lung and heart & lung transplantations in neonates and infants are extreme treatments offered for some life-threatening conditions especially in some North-American centers with promising results. These transplantations are rarely performed in Europe, and we set up a continent-based survey to describe the attitude of European neonatologists and pediatric intensivists on the subject and identify the main indications for this transplantation and the obstacles for the realization of a European lung transplantation program. Conclusion: The main indications for lung transplantation program for neonates and infants are represented by congenital disorders, and physicians indicate as main obstacles the donors’ availability. European neonatologists and pediatric intensivists are interested to create a European network to overcome this problem and realize a lung transplantation program for neonates and infants.What is Known:• Lung transplantation in neonates and infants seems to slowly increase, and some North-American centers accumulated a relevant experience.What is New:• European neonatologists and pediatric intensivists are interested in creating a European network for a lung transplantation program for neonates and infants.• The main indications for lung transplantation program for neonates and infants are represented by congenital disorders and main obstacle to lung transplantation is the donors’ availability

Total laparoscopic abdominal aortic aneurysm repair with reimplantation of the inferior mesenteric artery

AbstractWe performed a total laparoscopic reimplantation of the inferior mesenteric artery (IMA) during laparoscopic infrarenal aortic aneurysm repair. The postoperative course was uneventful, and angiograms showed a patent IMA after reimplantation. To our knowledge, total laparoscopic reimplantation of the IMA in human beings has not previously been described

Endothelin A receptor blockade improves regression of flow-induced pulmonary vasculopathy in piglets

ObjectivesIn patients with chronic thromboembolic pulmonary hypertension, high flow in unobstructed lung regions may induce small-vessel damage responsible for persistent pulmonary hypertension after pulmonary thromboendarterectomy. In piglets, closure of an experimental aortopulmonary shunt reverses the flow-induced vascular lesions and diminishes the elevated levels of messenger RNA (mRNA) expression for endothelin-1 and endothelin receptor A (ETA). We wanted to study the effect of the ETA antagonist TBC 3711 on reversal of flow-induced pulmonary vascular lesions.MethodsTwenty piglets were studied. In 15 piglets, pulmonary vasculopathy was induced by creating an aortopulmonary shunt. After 5 weeks of shunting, some animals were studied (n = 5); others underwent shunt closure for 1 week with (n = 5) or without (n = 5) TBC3711 treatment. Anti-ETA treatment started 1 week before and ended 1 week after the shunt closure. The controls were sham-operated animals (n = 5).ResultsHigh blood flow led to medial hypertrophy of the distal pulmonary arteries (54.9% ± 1.3% vs 35.3% ± 0.9%; P < .0001) by stimulating smooth muscle cell proliferation (proliferating cell nuclear antigen) and increased the expression of endothelin-1, ETA or endothelin receptor type A or endothelin receptor A, angiopoietin 1, and Tie2 (real-time polymerase chain reaction). One week after shunt closure, gene expression levels were normal and smooth muscle cells showed increased apoptosis (terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling) without proliferation. However, pulmonary artery wall thickness returned to control values only in the group given TBC3711 (33.2% ± 8% with and 50.3% ± 1.3% without; P < .05).ConclusionsAnti-ETA therapy accelerated the reversal of flow-induced pulmonary arterial disease after flow correction. In patients with chronic thromboembolic pulmonary hypertension and severe distal pulmonary vasculopathy, anti-ETA agents may prove useful for preventing persistent pulmonary hypertension after pulmonary thromboendarterectomy

Gravity and observer&apos;s body orientation influence the visual perception of human body postures

Since human behavior and perception have evolved within the Earth&apos;s gravitational field, humans possess an internal model of gravity. Although gravity is known to influence the visual perception of moving objects, the evidence is less clear concerning the visual perception of static objects. We investigated whether a visual judgment of the stability of human body postures (static postures of a human standing on a platform and tilted in the roll plane) may also be influenced by gravity and by the participant&apos;s orientation. Pictures of human body postures were presented in different orientations with respect to gravity and the participant&apos;s body. The participant&apos;s body was aligned to gravity (upright) or not (lying on one side). Participants performed stability judgments with respect to the platform, imagining that gravity operates in the direction indicated by the platform (that was or was not concordant with physical gravity). Such visual judgments were influenced by the picture&apos;s orientation with respect to physical gravity. When pictures were tilted by 90-with respect to physical gravity, the human postures that were tilted toward physical gravity (down) were perceived as more unstable than similar postures tilted away from physical gravity (up). Stability judgments were also influenced by the picture&apos;s orientation with respect to the participant&apos;s body. This indicates that gravity and the participant&apos;s body position may influence the visual perception of static objects

Feeling numbness for someone else's finger

SummaryThe experience that our body and its parts belong to us and are not those of other people is a key aspect of the ‘self’ called body ownership [1]. In six experiments, we have investigated body ownership and its neurophysiology using a tactile illusion [2,3] that disrupts body ownership and tactile sensation robustly, repeatedly, and with no particular apparatus by inducing an illusory feeling of numbness for another person's finger — the ‘numbness illusion’ (NI). Our results show that the NI does not depend primarily on visual or motor signals, but on tactile inputs modulating activity in primary somatosensory cortex

Report on Innovative Financial Instruments for the Implementation of the SET Plan, First-Of-A-Kind projects

This report responds to the request of Commissioner Oettinger and the Cabinet of Commissioner Geoghegan-Quinn end of 2012, for an expert assessment and recommendations regarding the financing of first-of-a-kind commercial demonstration projects as prioritised in the roadmaps of the Strategic Energy Technology (SET) Plan. The expert group comprised representatives of financial organisations, i.e. the European Investment Bank, the European Venture Capital Association, the European Insurance and Re-insurance federation, the World Bank, and the Climate Change Capital. Six hearings with key stakeholders representing the SET Plan European Industrial Initiatives (EIIs), as well as the Fuel Cells and Hydrogen Joint Undertaking were held. These hearings provided information regarding their main barriers for implementation and the gaps as regards access to finance. Existing EU financial were evaluated too. The report concludes that a new financial instrument at EU level is not needed since existing financial instruments already provide equity, loans, or guarantees. However, until now, those instruments have not provided the financing required. As a response to this problem a set of changes to existing financial instruments and their utilisation were recommended.JRC.F.6-Energy systems evaluatio

Increased oxidative stress and severe arterial remodeling induced by permanent high-flow challenge in experimental pulmonary hypertension

<p>Abstract</p> <p>Background</p> <p>Involvement of inflammation in pulmonary hypertension (PH) has previously been demonstrated and recently, immune-modulating dendritic cells (DCs) infiltrating arterial lesions in patients suffering from idiopathic pulmonary arterial hypertension (IPAH) and in experimental monocrotaline-induced PH have been reported. Occurrence of perivascular inflammatory cells could be linked to local increase of oxidative stress (OS), as it has been shown for systemic atherosclerosis. The impact of OS on vascular remodeling in PH is still to be determined. We hypothesized, that augmented blood-flow could increase OS and might thereby contribute to DC/inflammatory cell-recruitment and smooth-muscle-cell-proliferation.</p> <p>Methods</p> <p>We applied a monocrotaline-induced PH-model and combined it with permanent flow-challenge. Thirty Sprague-Dawley rats were assigned to following groups: control, monocrotaline-exposure (MCT), monocrotaline-exposure/pneumonectomy (MCT/PE).</p> <p>Results</p> <p>Hemodynamic exploration demonstrated most severe effects in MCT/PE, corresponding in histology to exuberant medial and adventitial remodeling of pulmonary muscular arteries, and intimal remodeling of smaller arterioles; lung-tissue PCR evidenced increased expression of DCs-specific fascin, CD68, proinflammatory cytokines (IL-6, RANTES, fractalkine) in MCT/PE and to a lesser extent in MCT. Major OS enzyme NOX-4 was maximal in MCT/PE. Antioxidative stress enzymes Mn-SOD and glutathion-peroxidase-1 were significantly elevated, while HO-1 showed maximal expression in MCT with significant decrease in MCT/PE. Catalase was decreased in MCT and MCT/PE. Expression of NOX-4, but also of MN-SOD in MCT/PE was mainly attributed to a highly increased number of interstitial and perivascular CXCR4/SDF1 pathway-recruited mast-cells. Stress markers malonedialdehyde and nitrotyrosine were produced in endothelial cells, medial smooth muscle and perivascular leucocytes of hypertensive vasculature. Immunolabeling for OX62, CD68 and actin revealed adventitial and medial DC- and monocyte-infiltration; in MCT/PE, medial smooth muscle cells were admixed with CD68⁺/vimentin⁺cells.</p> <p>Conclusion</p> <p>Our experimental findings support a new concept of immunologic responses to increased OS in MCT/PE-induced PAH, possibly linking recruitment of dendritic cells and OS-producing mast-cells to characteristic vasculopathy.</p

ICAM-1 PROMOTES THE ABNORMAL ENDOTHELIAL CELLPHENOTYPE IN CHRONIC THROMBOEMBOLIC PULMONARYHYPERTENSION

International audienceBACKGROUND - Pulmonary endothelial cells play a key role in the pathogenesis of ChronicThromboembolic Pulmonary Hypertension (CTEPH). Increased synthesis and/or release ofIntercellular Adhesion Molecule 1 (ICAM-1) by pulmonary endothelial cells of patients withCTEPH has been recently reported, suggesting a potential role for ICAM-1 in CTEPH.METHODS - We studied pulmonary endarterectomy specimens from 172 patients with CTEPHand pulmonary artery specimens from 97 controls undergoing lobectomy for low-stage cancerwithout metastasis.RESULTS - ICAM-1 was overexpressed in vitro in isolated and cultured endothelial cells fromendarterectomy specimens. Endothelial cell (EC) growth and apoptosis resistance weresignificantly higher in CTEPH specimens than in controls (P<0.001). Both abnormalities wereabolished by pharmacological inhibition of ICAM-1 synthesis or activity. Overexpression ofICAM-1 contributed to the acquisition and maintenance of abnormal EC growth and apoptosisresistance via phosphorylation of SRC, p38 and ERK1/2 and overproduction of Survivin.Regarding the ICAM-1 E469K polymorphism, the KE heterozygote genotype was significantlymore frequent in CTEPH than in controls, but was not associated with disease severity amongpatients with CTEPH.CONCLUSIONS - ICAM-1 contributes to maintaining the abnormal endothelial cell phenotypein CTEPH

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

BACKGROUND: Right ventricular (RV) adaptation to acute and chronic pulmonary hypertensive syndromes is a significant determinant of short- and long-term outcomes. Although remarkable progress has been made in the understanding of RV function and failure since the meeting of the NIH Working Group on Cellular and Molecular Mechanisms of Right Heart Failure in 2005, significant gaps remain at many levels in the understanding of cellular and molecular mechanisms of RV responses to pressure and volume overload, in the validation of diagnostic modalities, and in the development of evidence-based therapies. METHODS: A multidisciplinary working group of 20 international experts from the American Thoracic Society Assemblies on Pulmonary Circulation and Critical Care, as well as external content experts, reviewed the literature, identified important knowledge gaps, and provided recommendations. RESULTS: This document reviews the knowledge in the field of RV failure, identifies and prioritizes the most pertinent research gaps, and provides a prioritized pathway for addressing these preclinical and clinical questions. The group identified knowledge gaps and research opportunities in three major topic areas: 1) optimizing the methodology to assess RV function in acute and chronic conditions in preclinical models, human studies, and clinical trials; 2) analyzing advanced RV hemodynamic parameters at rest and in response to exercise; and 3) deciphering the underlying molecular and pathogenic mechanisms of RV function and failure in diverse pulmonary hypertension syndromes. CONCLUSIONS: This statement provides a roadmap to further advance the state of knowledge, with the ultimate goal of developing RV-targeted therapies for patients with RV failure of any etiology