Non-Intubated Thoracic Surgery: Standpoints and Perspectives

Non-intubated video-assisted thoracic surgery (NI-VATS) combines the advantages of a non-intubated surgery with the benefits of a minimally invasive approach. First, NI-VATS is performed in the case of fragile patients when general anesthesia and/or orotracheal intubation can be foreseen as inconvenient. However, NI-VATS indications have been increasingly extended to different patient conditions, considering the increasingly assessed safety and feasibility of the procedure. Currently, the NI-VATS approach is used worldwide for different thoracic surgery procedures, including the management of malignant pleural effusion, surgical treatment of empyema, anatomical and non-anatomical lung resection, and other indications. In fact, this approach has shown to be less impactful than VATS under general anesthesia, allowing for shortened hospitalization and faster recovery after surgery. Besides, NI-VATS is associated with fewer pulmonary complications, less respiratory distress, and a mild systemic inflammatory reaction. For these reasons, this approach should be considered not only in patients with poor cardiac or respiratory function (general functional reserve), but also in other eligible conditions. We explored the anesthetic and surgical aspects of such an approach, including the management of analgesia, cough reflex, depth of sedation, and intraoperative technical issues to put this approach in perspective

Performance of the ALICE experiment at the CERN LHC

ALICE is the heavy-ion experiment at the CERN Large Hadron Collider. The experiment continuously took data during the first physics campaign of the machine from fall 2009 until early 2013, using proton and lead-ion beams. In this paper we describe the running environment and the data handling procedures, and discuss the performance of the ALICE detectors and analysis methods for various physics observables

Subterraniphyllum and free-living Neogoniolithon (coralline algae)from the Oligocene reef facies of Costa d’Ovada (Tertiary Piedmont Basin, Alessandria, NW Italy)

The present study examines the siliciclastic sediments and reef limestone of the Oligocene transgressive event of the Tertiary Piedmont Basin outcropping in the area of Costa d’Ovada (Alessandria, Southern Piedmont, NW Italy). Seven lithostratigraphic sections have been studied. On the basis of the lithostratigraphic evidence, sedimentary architectures and structures, and paleontological data a paleoenvironmental reconstruction is suggested. The reef of Costa d’Ovada rests on siliciclastic marine sediments and was buried by siliciclastic sandy and/or gravely shallow marine deposits. This reef was built in warm tropical or subtropical, clear and very shallow waters, on sandy gravely, moderately exposed bottoms. It might be interpreted as a patch reef developed close to the coastline. In the depicted paleoenvironmental frame, an unusual, for the Tertiary Piedmont Basin, Neogoniolithon-dominated coralline algae association is described and interpreted. This association is characterised by the common occurrence of freeliving thalli of Neogoniolithon raripunctatum and intergenicula of Subterraniphyllum thomasii. Finally, the paleoecological meaning of these species is discussed

EFFECTIVENESS OF INDOCYANINE GREEN FLUORESCENCE FOR THE IDENTIFICATION OF THORACIC DUCT IN RECURRENT IDIOPATHIC CHYLOTHORAX

In this Video we present the intraoperative use of indocyanine green lymphography in a patient with recurrent idiopathic chylothorax refractory to conservative therapy. In those patients, a thick mediastinal pleura, caused by prior surgery and/or inflammatory adhesions, could make the identification of the thoracic duct challenging. The indocyanine green (often called ICG) quickly allows to discriminate between thoracic duct and adhesions, which do not present infrared signal. Following the fluorescence signal, the thoracic duct is finally identified and prepared along its course. Indocyanine green is injected 30’ before surgery in the inguinal lymph nodes bilaterally combined with albumin. TD is clearly identified between the adhesions using the D-LIGHT mode of the camera while its identification with normal light view is difficult. In addition, we also administered a fatty meal before surgery. However, no chylous leakage was evident with normal light view in this case. Only the ICG fluorescence allows to identify the leaking spot in the context of pleural adhesions just above the diaphragm. The injection of ICG was performed under general anesthesia after intubation by a dedicated radiologist. In order to optimize the lymphatic drainage, ¾ of the ICG were injected in the peri-nodal region and ¼ into the core of the lymph node. This thecnique provides a clear and long-lasting signal of the TD course both under D-light mode and SPECTRA A mode. The lesion is finally well identified and the thoracic duct is repaired so that the leaking stops. The recovery was uneventful and the patient was discharged on postoperative day 5. At 1-year follow up there is no sign of recurrence

False memories in relapsing remitting multiple sclerosis patients: a preliminary investigation with the DRM paradigm

Background: Memory impairment is one of the most frequently and early detected impairment in multiple sclerosis (MS) patients. Several authors have argued that when a failure occurs in the retrieval of lexical in- formation, this might be due to a reduction of the lexical pool, related to semantic memory. Here we further investigated memory alteration in MS patients, by focusing on memory distortions (i.e., false memories) for semantically-related material. Methods: A group of 40 consecutive relapsing remitting MS (RRMS) patients and a matched control group of 40 healthy controls performed the Deese-Roediger-McDermott (DRM), a false memory task for lists of associated words. Results: At recall, RRMS patients reported a reduced number of false recalls for semantically-related but non- presented items (i.e., critical false recalls) compared to HCs; at recognition, RRMS patients showed a reduced level of confidence for false recognitions of critical items. Conclusion: We found a reduced susceptibility to false memories in RRMS patients compared to HCs. The po- tential mechanisms underlying this effect are discussed in light of the alterations in the structure of semantic memory