Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team

IN THE FIELD of thoracic surgery, one of the key problems in lung resection is the management and function of the residual lung, which has the potential to interfere with both the pulmonary and cardiovascular systems, and, therefore, influence surgical outcome in terms of morbidity and mortality. Between 2007 and 2013, 5 papers addressing preoperative evaluation and risk stratification were published.1-5 However, the members of the task forces responsible for these documents did not include all the professionals involved in the preoperative surgical evaluation, and the documents mainly addressed the stratification of respiratory risk

Stratificazione del rischio negli infarti senza onde-Q: ruolo dell'ecocardiografia a riposo e da sforzo

To assess the relation between the extent of myocardial necrosis and the presence of myocardium at risk in myocardial infarction without Q waves (NQMI) we studied by echocardiography the prevalence of jeopardized myocardium in a group of NQMI stratified on the basis of left ventricular wall motion (akinesis, hypokinesis, normal kinesis). We have studied 60 consecutive patients with non-Q myocardial infarction. Patients were examined by 2D echo at rest (V-VI day from the acute episode) and during symptoms limited bicycle ergometric test (ExT) (XX-XXX day). Regional left ventricular wall motion was evaluated as normal or asynergic (severe hypokinetic, akinetic) and the ExT was considered positive in case of new asynergic areas or ECG criteria. 2D echo at rest was technically satisfactory in 56 patients, 19 showed almost an akinetic segment (Aci) 17 had hypokinetic areas (Ipo) and 20 had normal left ventricle kinesis (Norc). Wall motion abnormalities were localized more frequently in the apex and lateral areas. During exercise 2D echo was performed in 46 patients (82%) with 23 positive tests (50%). Stratifying the population on the basis of left ventricle wall motion we observed a major number of positive tests in the group of patients with normal wall motion in comparison with those with asynergic areas at rest (Norc 66.6%, Ipo 35.7%, Aci 42.6% p less than 0.05 Nore vs Ipo and Nore vs Aci) despite the same CAD extension. These data show the heterogeneity of the NQMI that likely includes patients with transmural (asynergy group) and subendocardial MI (normal kinesis group), the latter with a higher degree of myocardium at risk

Role of minimally invasive surgery versus open approach in patients with early-stage uterine carcinosarcomas: a retrospective multicentric study

Objective: The aim of this retrospective study was to compare surgical and survival outcome in only patients with early-stage UCSs managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS). Methods: Data were retrospectively collected in four Italian different institutions. Inclusion criteria were UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system. Results: Between August 2000 and March 2019, the data relative to 170 patients bearing UCSs were collected: of these, 95 were defined as early-stage disease (stage I-II) based on the histological report at the primary surgery, and thus were included in this study. Forty-four patients were managed by LPT, and 51 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group (p value 0.021); the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value < 0.0001). The length of hospital stay days was shorter in the MIS patients (p value < 0.0001). Overall, there were eight (8.4%) post-operative complications; of these, seven were recorded in the LPT group versus one in the MIS group (p value 0.023). There was no difference in the disease-free survival (DFS) and overall survival (OS) between the two groups. Conclusion: There was no difference of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group

How to teach an old dog new (electrochemical) tricks: Aziridine-functionalized CNTs as efficient electrocatalysts for the selective CO<inf>2</inf> reduction to CO

© 2018 The Royal Society of Chemistry. The electrocatalytic conversion of CO2 to energy-rich chemicals or energy vectors is a highly challenging approach to cope with an ever increasing demand for energy storage and valorization of renewable resources. Herein we report on the electrocatalytic reduction of CO2 to CO using covalently N-decorated carbon nanotubes as highly efficient and chemoselective metal-free electrocatalysts. At odds with more conventional synthetic methods for the production of N-doped nanocarbons, chemical functionalization warrants a unique control of "surface N-defects" available for the process, ruling out any synergistic contribution to electrocatalysis coming from other surface or bulk N-containing groups. With a CO faradaic efficiency (FECO) close to 90% and productivity as high as 48 NLCO gN-1 h-1, NH-aziridine functionalized MWCNTs have shown CO2RR performance that is among the highest reported so far for related metal-free systems. At the same time, it has offered a unique view-point for the comprehension of the underlying structure-reactivity relationship

Treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized, prospective, double-blind study.

OBJECTIVE: Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI2) and nitric oxide (iNO) compared with those of intravenous vasodilators. METHODS: This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes x s x cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography. RESULTS: Hospital mortality was 3.4%. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI2 groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI2 groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group. CONCLUSIONS: Our data suggest that both iNO and iPGI2 are effective in the treatment of pulmonary hypertension. iPGI2 has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate

Direct Alcohol Fuel Cells: A Comparative Review of Acidic and Alkaline Systems

In the last 20 years, direct alcohol fuel cells (DAFCs) have been the subject of tremendous research efforts for the potential application as on-demand power sources. Two leading technologies respectively based on proton exchange membranes (PEMs) and anion exchange membranes (AEMs) have emerged: the first one operating in an acidic environment and conducting protons; the second one operating in alkaline electrolytes and conducting hydroxyl ions. In this review, we present an analysis of the state-of-the-art acidic and alkaline DAFCs fed with methanol and ethanol with the purpose to support a comparative analysis of acidic and alkaline systems, which is missing in the current literature. A special focus is placed on the effect of the reaction stoichiometry in acidic and alkaline systems. Particularly, we point out that, in alkaline systems, OH- participates stoichiometrically to reactions, and that alcohol oxidation products are anions. This aspect must be considered when designing the fuel and when making an energy evaluation from a whole system perspective