No abstract

clinicaltrials.gov (NCT02910453).

Normal human platelets aggregated by thrombin undergo the release reaction and are not readily deaggregated by the combination of inhibitors hirudin, chymotrypsin, and prostaglandin E1 (PGE1). In contrast, thrombin-induced aggregates of platelets from patients with delta-storage pool deficiency (delta-SPD), which lack releasable nucleotides, are readily deaggregated by the same combination of inhibitors. The ease with which delta-SPD platelets are deaggregated is caused by the lack of stabilizing effects of released ADP, since: (1) exogenous adenosine diphosphate (ADP) (10 mumol/L), but not serotonin (2 mumol/L), abolishes the ability of these inhibitors to deaggregate delta-SPD platelets; (2) thrombin-induced aggregates of platelets from a patient (V.R.) (whose platelets have a severe, selective impairment of sensitivity to ADP, but normal amounts of releasable nucleotides) can be readily deaggregated, and addition of ADP does not stabilize the platelet aggregates; (3) apyrase or creatine phosphate (CP)/creatine phosphokinase (CPK), added before thrombin, make control platelets more easily deaggregated by hirudin, chymotrypsin, and PGE1, and do not change the deaggregation response of delta-SPD platelets and of V.R.'s platelets. Thrombin-induced aggregation and release of beta- thromboglobulin in control, delta-SPD, and in V.R.'s platelets was similar and not inhibited by apyrase or CP/CPK. The stabilizing effect of ADP on platelet aggregates is specific, since epinephrine in the presence of apyrase to remove traces of released ADP does not stabilize the aggregates of control, delta-SPD, or of V.R.'s platelets. Because epinephrine increases fibrinogen binding to thrombin-stimulated platelets to a greater extent than ADP, but does not stabilize the aggregates, it is unlikely that the additional fibrinogen binding sites induced by ADP have a major role in inhibiting deaggregation by the combination of inhibitors.

Background: The usefulness of 18FDG PET/CT scan in the evaluation of thymic epithelial tumours (TETs) has been reported by several authors, but data are still limited and its application in clinical practice is far from being defined. Methods: We performed a narrative review of pertinent literature in order to clarify the role of 18FDG PET/CT in the prediction of TET histology and to discuss clinical implications and future perspectives. Results: There is only little evidence that 18FDG PET/CT scan may distinguish thymic hyperplasia from thymic epithelial tumours. On the other hand, it seems to discriminate well thymomas from carcinomas and, even more, to predict the grade of malignancy (WHO classes). To this end, SUVmax and other PET variables (i.e., the ratio between SUVmax and tumour dimensions) have been adopted, with good results. Finally, however promising, the future of PET/CT and theranostics in TETs is far from being defined; more robust analysis of imaging texture on thymic neoplasms, as well as new exploratory studies with “stromal PET tracers,” are ongoing. Conclusions: PET may play a role in predicting histology in TETs and help physicians in the management of these insidious malignancies.

It is well known that the "gold standard" procedure for surgically resectable early-stage non-small cell lung cancer (NSCLC), is pulmonary lobectomy. Even though sublobar resections (SLR), particularly segmentectomy, seem attractive as an alternative to lobectomy in early stage lung cancers, they are still debated procedures. The aim of this study is to answer to the question: "Is VATS lung segmentectomy an underused option?" To obtain an answer to this query, the authors carried out a review of the "state of the art" as follows: (I) performing a non-systematic review of the literature; (II) analyzing the review articles published; (III) looking at the ongoing studies, the results of which have not yet published; (IV) scanning the technical aspect of lung segmentectomy. After completing the multi-step revision, we can conclude that there is a lack of evidence about the oncological value of segmentectomy in early stage NSCLC. Although VATS segmentectomy is feasible and performed by many thoracic surgeons, it's currently not yet world-wide adopted. Among the trials now being recruited in some countries and, aimed to clarify the role of SLR in the treatment of early stage lung cancer, a European prospective randomized study is advocated to implement the scientific knowledge on this issue.

No abstract

In lung cancer accurate assessment of the mediastinal lymph node status is of paramount importance for the stage assignment as well as crucial for the therapeutic plan. TAC and positron emission tomography (PET) are valuable tools to achieve a preliminary picture of the mediastinal staging but Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is considered the first choice for investigating mediastinal lymph nodes as recommended by updated guide-lines. Despite the EBUS-TBNA sensitivity is satisfactory, it is not high enough to exclude mediastinal lymph node metastases; therefore devices and technologies were implemented to increase its sensitivity. The purpose of this narrative review is to describe the tools aimed at correctly interpreting sonographic patterns during EBUS and maximizing the diagnostic accuracy of TBNA. The bibliographic research identified 354 articles potentially related to the purpose of the current review and after accurate reading we selected 21 articles. Eight articles focused on the sonographic features of lymph nodes found during EBUS, 2 papers considered the Doppler patterns and, finally, 18 studies analyzed the advantages of ultrasound elastography. Sonographic features, vascular patterns and ultrasound elastography have proved to be helpful in directing the operator to biopsy the most suspect lymph node, especially in patients with CT-negative and/or PET-negative mediastinum.

Highlights Spontaneous diaphragmatic rupture has multifactorial etiopathogenesis related to anatomical defect and thoracoabdominal pressure gradient. Spontaneous diaphragmatic rupture has no pathognomonic symptoms and could be difficult to be detected with standard radiological exams. Diaphragmatic rupture with abdominal herniation could be a life-threatening surgical emergency due to hernia strangulation or incarceration. It is fundamental to maintain a high suspicion index in high-risk patients and approach these diseases in a multidisciplinary setting.