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Pneumothorax and persistent air leak (PAL) are documented complications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Patients that fall in this category are often poor candidates for invasive thoracic surgical intervention. Endobronchial valves offer an effective and less invasive treatment option and can successfully treat PAL and support the weaning of patients with SARS-CoV-2 pneumonia off ventilation.

Immune checkpoint blockade (ICB) has shown remarkable clinical success in boosting anti-tumor immunity. However, the breadth of its cellular targets and specific mode of action remain elusive. We find that T follicular regulatory (TFR) cells are present in high numbers in multiple tumors, inhibit anti-tumor immunity and are responsive to ICB. TCR-seq data, trajectory analyses and adoptive transfer studies indicate intratumoral TREG to TFR cell conversion. When compared to TREG cells, TFR cells exhibited enhanced suppressive capacity. In syngeneic tumor models, anti-PD-1 treatment increased the number of tumor-infiltrating TFR cells. Conditional knockout of TFR cells or depletion of TFR cells with anti-CTLA-4 antibody prior to anti-PD-1 treatment, improved tumor control in mice. Notably, in a cohort of melanoma patients, treatment with anti-CTLA-4 followed by anti-PD-1 at progression was associated with better long-term survival outcomes than anti-PD-1 or anti-CTLA-4 monotherapy, anti-PD-1 followed by anti CTLA-4 at progression or concomitant combination therapy.

Posterolateral thoracotomy is required to gain access to the thoracic cavity. The patient is placed on the operating table in a lateral decubitus position and a single-lung ventilation technique is employed by using a double-lumen endotracheal tube. The incision is made on the side of the chest towards the back between the ribs. Many thoracic surgical procedures can be performed using this approach including lung resections. Pneumonectomy is a surgical procedure to remove the whole lung and is usually performed by posterolateral thoracotomy. It can also be performed using a video-assisted (VATS) technique. Pneumonectomy is indicated where curative surgical resection is not possible with lesser resection. Prior to pneumonectomy, a thorough preoperative assessment of the patient is performed as per the British Thoracic Society guidelines. This procedure leads to considerable reduction in respiratory reserve and is also associated with significant morbidity and mortality. Common complications include arrhythmias, myocardial infarction, pulmonary embolism, pneumonia, empyema, respiratory failure and bronchopleural fistula. The perioperative mortality rate ranges between 6 and 8%. Very dedicated and careful postoperative management is required in specialized centres to avoid complications.

In this issue of Neuron, van Veluw et al. (2020) show that elimination of solutes from the brain along arterial walls is driven by low-frequency arteriolar oscillations and suggest that age-related reduction of this vasomotion may contribute to impaired clearance of Aβ.

Thoracoplasty is a technique used to obliterate residual intrapleural spaces after lung resection for infection or other causes. It involves multiple osteotomies on several ribs and then collapsing them into the space to be obliterated; however, this results in a distorted and asymmetrical chest wall. We report a case of a 34-year-old female with completely destroyed right upper lobe secondary to chronic Aspergillus infection. She underwent a completion right upper lobectomy and modified thoracoplasty with the use of a breast implant to obliterate the residual pleural space without any distortion of the chest wall, with an excellent outcome.

Endoscopic harvesting of the long saphenous vein has been introduced to decrease the morbidity of obtaining venous conduit for coronary artery bypass grafting. Herein is described an endoscopic method using carbon dioxide insufflation into the tissues around the vein. This has several advantages; improved vision, no physical retraction required, easier development of tissue planes, and improved hemostasis.