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Distance education, technological devices, life style and also conduct of kids and their loved ones through the COVID-19 lockdown inside Lombardy: a study.
We report a case of cervical tracheomalacia successfully treated by tracheoplasty, with the resection of redundant posterior tracheal tissue performed via a novel minimally-invasive transoral approach.
Aortic homografts have been used in young patients requiring aortic valve replacement(AVR). Currently, they are generally reserved for aortic valve endocarditis with or without root abscess, however, longitudinal data are lacking. Our aim was to assess the long-term safety and durability of homograft implantation.

All adult patients undergoing aortic homograft implantation at a single institution from 1992-2019 were included. Outcomes of interest included all-cause mortality and AV reoperation, studied over a median follow-up duration of 19 years.

A total of 252 patients were included, with a mean age of 49 years. Infective endocarditis was the primary indication for surgery in 95(38%) patients. The endocarditis group had a higher prevalence of NYHA III-IV(56% vs. 26%), chronic kidney disease(CKD)(22% vs. 1%), prior cardiac surgery(40% vs. 10%), and emergency status(7% vs. Erastin chemical structure 0%) compared to those without endocarditis(all p<.001). Operative mortality was higher among endocarditis patients(16% vs. 0.6%, ke those without endocarditis.Aortic root abscess is one of the most catastrophic complications of aortic valve endocarditis. Complete debridement is recommended regardless of the kind of infected lesion. A 37-year-old man with extensive aortic root abscess due to prosthetic aortic valve endocarditis was surgically treated. The main lesion was the aorto-mitral continuity extending to the commissure between the left and right coronary cusps. After debridement, the aortic annulus underneath the left coronary artery was reconstructed using a handmade aorto-mitral monobloc valve without aortic annuloplasty. This valve is required for the extensive root abscess of the left and non-coronary sinus to achieve complete debridement.
Paraplegia remains one of the most devastating complications of descending and thoracoabdominal aortic repair. The aim of this review is to outline the current state of art in the rapidly developing field of spinal cord injury (SCI) research.

A review of PubMed and Web of Science databases was performed using the following terms and their combinations spinal cord, injury, ischemia, ischemia-reperfusion, ischemic spinal cord injury, paraplegia, paraparesis. Articles published before July 2019 were screened and included if considered relevant.

The review focuses on the topic of SCI and the developments concerning methods of monitoring, diagnostics and prevention of SCI.

Translation of novel technologies from bench to bedside and into everyday clinical practice is challenging, however each of the developing areas hold great promise in SCI prevention.
Translation of novel technologies from bench to bedside and into everyday clinical practice is challenging, however each of the developing areas hold great promise in SCI prevention.
The treatment of NSCLC is based, when suitable, on surgical resection. Pneumonectomy has been considered the standard surgical procedure for locally advanced lung cancers but it is associated with high mortality and morbidity rates. Reconstruction of the pulmonary artery, associated with parenchyma sparing techniques, is meant to be an alternative to pneumonectomy.

This retrospective single-centre study is based on a detailed and comprehensive analysis of the clinical and oncological data of patients treated between 2004 and 2016 through pneumonectomy or lobectomy with reconstruction of the pulmonary artery. A propensity score weighting approach, based on the pre-operative characteristics of two groups of 124 patients each was performed. The subsequent statistical analysis evaluated long and short-term clinical outcomes together with risk factors analysis.

The comparison between pneumonectomy and pulmonary artery reconstructions showed a higher 30-days (p=0.02) and 90-days (p=0.03) mortality rate in the pneumonectomy group, together with a higher incidence of major complications (p=0.004). Long term results have shown comparable outcomes, both in terms of 5-years disease free survival (52.2% in pneumonectomy vs 46.0% in pulmonary artery reconstructions, p=0.57) and overall 5-years survival (41.9% vs 35.6% respectively, p=0.57). Risk factors analysis showed that cancer specific survival was related to lymph node status (p<0.01) and absence of adjuvant therapy (p=0.04). Lymph node status also influenced the risk of recurrence (p<0.01).

Lobectomy with reconstruction of the pulmonary artery is a valuable and oncologically safe alternative to pneumonectomy, with lower short-term mortality and morbidity, without affecting long-term oncological results.
Lobectomy with reconstruction of the pulmonary artery is a valuable and oncologically safe alternative to pneumonectomy, with lower short-term mortality and morbidity, without affecting long-term oncological results.Due to the elevated presence of cytokines, the expressions of metabolic enzymes and drug transporters are altered in rheumatoid arthritis (RA). Given the high incidence of diabetes in patients with RA, the aim of the present study was to investigate the metformin pharmacokinetics of a single oral dose in rats with collagen-induced arthritis (CIA). Blood and urine samples were collected at different timepoints, and analyzed by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Tissue samples were also collected to investigate the expression of metabolic enzymes and drug transporters by quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and western blot. The results indicated that the bioavailability of metformin was markedly decreased in the CIA rats. Moreover, metformin was not metabolized by enzymes of rat liver microsomes, suggesting that the decreased bioavailability of metformin was independent of the liver metabolism. In addition, the mRNA, protein expression level and activity of the renal organic cation transporter 2 (OCT2) was markedly increased, suggesting that the enhanced renal clearance of metformin in CIA rats may be due to the up-regulated activity of OCT2. In conclusion, our study suggested that the reduced bioavailability of metformin in CIA rats is possibly related to the up-regulated function of the renal protein OCT2.
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