Modified blade: an interventional option in rigid bronchoscopy for non-resectable benign tracheal stenosis.

INTRODUCTION: Benign tracheobronchial stenosis is a abnormal tracheal lumen narrowing that may incur progressive dyspnea and life-threatening hypoxemia. There is no consensus on which patients should be treated with endoscopic or surgical method. This study investigates the outcomes of bronchoscopic dilatation in the treatment of benign tracheal stenosis using a device equipped with a blade to cut the stenotic lesions with dense fibrosis. MATERIALS AND METHODS: The procedure was carried out in an operating room under general anesthesia. All patients were intubated with a Rigid Bronchoscope (RB) placed just above the stenosis. Through Rigid Bronchoscopy combined modalities were used as needed: radial incisions of the mucosal stenosis with blade at the levels of 4, 8 and 12 o'clock, with back and forth movements, then the stenotic area was dilated more easily with a rigid bronchoscope. Dilatation was performed by passing the RB of increasing diameter through stenotic areas and then Balloon dilatation of increasing diameter. There were no complications during the procedure. RESULT: We conducted an observational, retrospective, single-centre study in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2011 to September 2021. We included all consecutive patients with benign tracheal stenosis inoperable. During the study period, 113 patients were referred to our department with benign tracheal stenosis inoperable. 61 patients were treated with the blade. During the follow-up, a recurrence of the stenosis was observed in 8 patients in the first month and in 4 patients in the third month. Instead in the patients treated with the use of laser (52 patients), during the follow-up a recurrence was observed in 16 patients in the first month and in 6 patients in the third month; no patient relapsed after 6 months and after 1 year. Long term successful bronchoscopic management with blade was attained by 99% in simple and 93% in mixed stenosis and in complex type stenosis. CONCLUSION: Our study underlines the importance of the use of the blade in bronchoscopic treatment as a valid conservative approach in the management of patients with inoperable benign tracheal stenosis as an alternative to the use of the laser, reducing the abnormal inflammatory reaction in order to limit recurrences.

Intraoperative ventilatory leak: Real-time guidance for management of air leak in lung cancer patients undergoing VATS lobectomy.

BACKGROUND: Persistent air leak (PAL) is a common complication after video-assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL. METHODS: This was an observational, retrospective, single-center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks. RESULTS: At the end of lobectomy performed in patients with non-small cell lung cancer, the lung was reinflated at a 25-30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks. CONCLUSION: VL is an independent predictor of PAL after VATS lobectomy; it provides a real-time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.

One-lung ventilation in obese patients undergoing thoracoscopic lobectomy for lung cancer.

BACKGROUND: We evaluated the safety and feasibility of one-lung ventilation in obese patients undergoing thoracoscopic lobectomy and whether obesity affected peri- and postoperative outcomes. METHODS: This was a retrospective single center study including consecutive patients undergoing thoracoscopic lobectomy between October 2019 and February 2022. Obese patients were statistically compared to a control group to evaluate any differences in relation to one-lung ventilation and peri- and postoperative outcomes. RESULTS: Our study population included 111 patients; of these, 26 (23%) were included in the obese group, while 85 (77%) were included within the nonobese group. To obtain one-lung ventilation in nonobese patients, a double-lumen tube was more frequently used than a single-lumen tube with bronchial blocker (61% vs. 39%; p = 0.02), while in obese patients a single-lumen tube with bronchial blocker was used more than a double-lumen tube (81% vs. 19%, p = 0.001). Intergroup comparison showed that a double-lumen tube was the preferred method in nonobese patients, while a single-lumen tube with bronchial blockers was the strategy of choice in obese patients (p = 0.0002). Intubation time was longer in the obese group than in the nonobese group (94.0 ± 6.1 vs. 85.0 ± 7.0 s; p = 0.0004) and failure rate of first attempt at intubation was higher in the obese group (23% vs. 5%; p = 0.01). Obesity was not associated with increased intra-, peri- and postoperative complications and/or mortality. CONCLUSIONS: One-lung ventilation is a feasible and safe procedure also in obese patients and obesity did not negatively affect peri- and postoperative outcomes after lung resection.

"Risk is in the air": Polycyclic aromatic hydrocarbons, metals and mutagenicity of atmospheric particulate matter in a town of Northern Italy (Respira study).

Air pollution has well-known harmful effects on human beings, causing both acute and chronic diseases. Some data suggest that genetic damage occurring early in life may influence the risk of having cancer and other chronic diseases in adulthood. Therefore, there is a growing interest in studying the genotoxic activity of air pollution, and especially particulate matter. The aim of this study was to analyze airborne particulate matter (PM10) collected in an industrialized town of Northern Italy. PM10 was sampled in six areas of the town, divided in three distinct dimensional classes (<0.5 µm; 0.5-3 µm and 3-10 µm), and analyzed for the quantification of polynuclear aromatic hydrocarbons and metals contents. A model-based approach using diagnostic ratios and toxic equivalency factor was also followed. Concurrently, biological assays were performed for the assessment of mutagenicity and genotoxicity in bacteria, human and plant cells. Mutagenicity was observed in bacteria and human cells, with a clear dose-response relationship, induced above all by the finest PM samples (PM0.5 and PM0.5-3), which contained the largest number of polycyclic aromatic hydrocarbons. DNA damage, such as chromosomal aberrations and micronuclei, was also found in Allium cepa root cells, but without a clear relationship with the tested doses. The in-vitro models utilized showed to be good indicators of air quality for mutagenicity. Chemical analyses evidenced high content of polycyclic aromatic hydrocarbons, metals and semi-metals in PM extracts. Polycyclic aromatic hydrocarbons, metals and mutagenicity can be ascribed mainly to vehicular traffic (in terms of both exhausted gases emission and mechanical losses), which represents a constant and ubiquitous source of human exposure, and to steel working, carried out within the urban area.

Licit and illicit drugs in a wastewater treatment plant in Verona, Italy.

The occurrence of 12 active substances among licit and illicit drugs was investigated over a 2 week period inflowing and outflowing in an activated sludge wastewater treatment plant in the city of Verona, Northern Italy. Chemical analyses were performed by means of on-line solid phase extraction coupled to high performance liquid chromatography-tandem mass spectrometry in order to minimize sample pre-treatment. Quantifiable concentrations, up to hundreds of ng/L, were detected in influent and in effluent only for carbamazepine, codeine and benzoylecgonine. Such values are in accordance with literature data, so as removal efficiencies: it was observed that there was pretty much no abatement for carbamazepine, while average removal percentages of about 60% and 90% were calculated for codeine and benzoylecgonine, respectively. These results provide useful information (also concerning some active principles never or rarely detected, up to now, such as lormetazepam) for integrated water cycle managing, also taking into account the specific characteristics of the receiving water basin.

Effect of biological and chemical oxidation on the removal of estrogenic compounds (NP and BPA) from wastewater: an integrated assessment procedure.

A major source of the wide presence of EDCs (Endocrine Disrupting Compounds) in water bodies is represented by direct/indirect discharge of sewage. Recent scientific literature reports data about their trace concentration in water, sediments and aquatic organisms, as well as removal efficiencies of different wastewater treatment schemes. Despite the availability of a huge amount of data, some doubts still persist due to the difficulty in evaluating synergistic effects of trace pollutants in complex matrices. In this paper, an integrated assessment procedure was used, based on chemical and biological analyses, in order to compare the performance of two full scale biological wastewater treatment plants (either equipped with conventional settling tanks or with an ultrafiltration membrane unit) and tertiary ozonation (pilot scale). Nonylphenol and bisphenol A were chosen as model EDCs, together with the parent compounds mono- and di-ethoxylated nonylphenol (quantified by means of GC-MS). Water estrogenic activity was evaluated by applying the human breast cancer MCF-7 based reporter gene assay. Process parameters (e.g., sludge age, temperature) and conventional pollutants (e.g., COD, suspended solids) were also measured during monitoring campaigns. Conventional activated sludge achieved satisfactory removal of both analytes and estrogenicity. A further reduction of biological activity was exerted by MBR (Membrane Biological Reactor) as well as ozonation; the latter contributed also to decrease EDC concentrations.