The Role of Endoscopic Ultrasound in the Interventional Management of Mediastinal Collections: A Narrative Review

The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections

Uniportal robotic-assisted thoracoscopic surgery: resection of the first rib

A 39-year-old female patient presented with venous and neurogenic thoracic outlet syndrome, manifesting in positional pain and deep vein thrombosis (DVT) in the right upper extremity, accompanied by vascular redistribution. Her medical history was significant for surgical intervention for palmar hyperhidrosis (via a thoracoscopic approach) 15 years ago and second DVT in the right upper extremity in 2010, for which she received only limited anticoagulant treatment. She re-presented with symptoms suggestive of another DVT in the same region, meriting further investigation and management

Localized (solitary) fibrous tumors of the pleura: An analysis of 15 patients

AbstractBackgroundLocalized fibrous tumors of the pleura (LFTPs) are rare neoplasms, which are considered to originate from submesothelial connective tissue. The aim of this article is to present 15 new cases because of their different clinical behaviors and to discuss the treatment of choice of such neoplasms.MethodsThe records of 15 consecutive patients with LFTP operated at our Institution between 1995 and 2006 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all patients. Neoplasms were considered to be malignant if one or more of the following histologic features were present: increasing mitotic activity; high cellularity with crowding and overlapping of nuclei; necrosis; and pleomorphism.ResultsNo operative mortality was reported. The mean follow-up time was 76 months. Malignant transformation was seen in 1 patient 26 months after resection of a benign tumor. Six cases were pathologically considered to be malignant: 2 patients developed local recurrence. One of these underwent redo-surgery and required pneumonectomy; in the other one surgery is not indicated because at the time of diagnosis the patient was 85 years. Currently, all patients are alive and 13 disease-free.ConclusionsFor histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients. For malignant cases, complete surgical resection may be insufficient for the cure: further study should be performed to identify reliable prognostic factors to indicate and evaluate the effectiveness of systemic treatment

Cinética del crecimiento microbiano en residuos de la industria azucarera por fermentación en estado sólido para la producción de alimento animal

Microbial growth kinetics in manufacturing feedstuff by a solid state fermentation process is dealt with. Candida utilities yeast was used for sugar cane bagasse protein enrichment; besides, filter cake mud and molasses residuals from the sugar cane industry as well as other ingredients were added as nutrients to the culture medium. The system dynamic response within a temperature range from 25 0C to 45 0C was studied taking into account the true protein and the total reducing sugars variables. The fermentation process lasted 30 hours. A logistic model was applied to display experimental data by the Model Maker software. Data constants showed a temperature dependence which actually matched polynomials. The maximal growth specific constant ranged from 0,059 8 h-1 to 0,112 3 h-1, the biomass maximal concentration from 5,27 % to 5,90 %, and the biomass-substrate yield from 0,055 1 to 0,102 3. Optimal temperature to reach a maximum protein enrichment ranged from 30 0C to 33 0C . Parameters determined by the adjusted model agreed with those observed in similar systems according to the literature in this field.Se presenta la cinética del crecimiento microbiano en la producción de alimento para animales por fermentación en estado sólido. Se empleó la levadura Candida utilis para el enriquecimiento proteico de bagazo de caña de azúcar; además, se utilizaron los residuos de la industria azucarera cachaza y miel y otros elementos como nutrientes en el medio de cultivo. Se estudió la respuesta dinámica del sistema en función de la temperatura en un rango de 25 a 45 ºC, a través de las variables proteína verdadera y azúcares reductores totales. La fermentación duró 30 horas. Se empleó un modelo logístico para representar los datos experimentales utilizando el simulador Model Maker. Sus constantes mostraron dependencia con la temperatura, que se ajusta muy bien a polinomios. La constante específica de crecimiento máxima varía entre 0,059 8 y 0,112 3 h-1; la concentración máxima de biomasa está en un rango entre 5,27 y 5,90 % base seca y el rendimiento biomasa-sustrato entre 0,055 1 y 0,102 3. La temperatura óptima para alcanzar máximo enriquecimiento proteico está entre 30 y 33 ºC . Los parámetros determinados del modelo ajustado se corresponden con los observados en sistemas similares, según se reporta en la literatura

The natural-based antitumor compound T21 decreases survivin levels through potent STAT3 inhibition in lung cancer models

Lung cancer is the leading cause of cancer-related deaths worldwide; hence novel treatments for this malignancy are eagerly needed. Since natural-based compounds represent a rich source of novel chemical entities in drug discovery, we have focused our attention on tambjamines, natural compounds isolated from marine invertebrates that have shown diverse pharmacological activities. Based on these structures, we have recently identified the novel indole-based tambjamine analog 21 (T21) as a promising antitumor agent, which modulates the expression of apoptotic proteins such as survivin. This antiapoptotic protein plays an important role in carcinogenesis and chemoresistance. In this work, we have elucidated the molecular mechanism by which the anticancer compound T21 exerts survivin inhibition and have validated this protein as a therapeutic target in di erent lung cancer models. T21 was able to reduce survivin protein levels in vitro by repressing its gene expression through the blockade of Janus kinase/Signal Transducer and Activator of Transcription-3 (JAK/STAT3)/survivin signaling pathway. Interestingly, this occurred even when the pathway was overstimulated with its ligand interleukin 6 (IL-6), which is frequently overexpressed in lung cancer patients who show poor clinical outcomes. Altogether, these results show T21 as a potent anticancer compound that e ectively decreases survivin levels through STAT3 inhibition in lung cancer, appearing as a promising therapeutic drug for cancer treatment

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

Acute respiratory failure; High-flow nasal oxygenInsuficiencia respiratoria aguda; Oxígeno nasal de alto flujoInsuficiència respiratòria aguda; Oxigen nasal d'alt fluxBackground We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO). Methods In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range. Results Forty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups. Conclusions Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www.clinicaltrials.gov under the identifier NCT04965844.This study is partially supported by a research grant from Hamilton Medical AG. For each patient, an anonymised file containing the recorded data from the high-flow device was sent to Hamilton Medical AG, where these data were transformed into a database of raw data and sent back to the investigators for further analysis. Hamilton Medical AG did not have a role in statistical analysis beyond this point or data interpretation

Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study

Abstract Background and Objective Coronary heart disease (CHD) is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI) incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain. Methods Using a population-based registry (the REGICOR Study), we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively) by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA)/European Society of Cardiology (ESC) and the World Health Organization (WHO)-Monitoring trends and determinants in cardiovascular diseases (MONICA). Results In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively). Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers) showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition. Conclusions The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CH

Prognostic value of the preoperative lymphocyte-to-monocyte ratio for survival after lung cancer surgery

Background: Tthe aim of this study was to assess the effect of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on overall survival and disease-free survival in patients with lung cancer treated with radical surgery. Methods: we performed a retrospective review of patients with lung cancer who prospectively underwent radical resection between 2004 and 2012. Blood samples were taken as part of the preoperative workup. The inflammatory markers studied were absolute values of lymphocytes, monocytes, neutrophils and platelets, with subsequent calculation of ratios. Median follow-up was 52 months. Results: two hundred and sixty-eight patients underwent surgery, of whom 218 (81.3%) were men. Mean age was 62.9 ± 8.7 years. A lymphocyte-to-monocyte ratio ≥ 2.5 was independently associated with longer disease-free survival (hazard ratio [HR] 0.476 (0.307-0.738), p = 0.001) and longer overall survival (HR, 0.546; 95% CI: 0.352-0.846; p = 0.007), in models adjusted for age, sex, stage, and type of resection. No other systemic inflammatory marker showed a significant association. Conclusion: preoperative LMR is an independent prognostic factor of overall survival and recurrence-free survival in patients with surgically-resected early stage lung cancer