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Background: Postoperative physiotherapy is a cornerstone of Enhanced Recovery After Surgery (ERAS) programs, especially following lung resection. Despite its importance, the literature lacks clear recommendations and guidelines, particularly regarding the role of incentive spirometry (IS). This study aims to determine whether incentive spirometry offers additional benefits over early ambulation alone in patients undergoing lung resection for primary lung cancer. Methods: We conducted a retrospective case–control study at the European Institute of Oncology (IEO) involving patients who underwent lung resection from June 2020 to June 2022. Patients were divided into two cohorts: early ambulation alone (control group) and early ambulation with IS (IS group). The primary endpoint was the rate of postoperative pulmonary complications. Secondary endpoints included length of hospital stay and time to chest drain removal. A propensity score-matched analysis was performed based on age, sex, and BMI. Data were compared using Chi-squared and Student's t-tests as appropriate. Results: A total of 304 patients were included, with 153 in the intervention group and 151 in the control group. After propensity-score matching, 52 patients from each cohort were compared. No significant differences were found between the groups regarding postoperative oxygen requirement, fever, atelectasis, residual pleural space, need for bronchoscopy toilette, and re-hospitalization rate. IS group showed trends toward shorter hospital stays and lower time to chest drain removal, though without reaching statistical significance. Conclusions: IS did not significantly improve postoperative outcomes compared to early ambulation alone in patients undergoing lung resection for primary lung cancer. More extensive, prospective, randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Malignant pleural effusion is the presence of malignant cells within the pleural fluid, representing the second most common cause of pleural exudate. Although diagnostic methods and management techniques for malignant pleural effusion have dramatically improved over the decades, the current treatment is still palliative, aiming to remove pleural fluid, possibly prevent its recurrence, and alleviate symptoms through a wide range of available procedures. Treatment should be tailored to the individual patient, considering comorbidities, size of the effusion, rate of fluid accumulation, underlying cardiac or respiratory conditions, rate of recurrence, presence of loculations or trapped lung, tumor characteristics, cancer type, and patient preferences. This manuscript aims to review the available literature and to present the latest evidence on malignant pleural effusion management in order to provide an updated perspective on its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: We aimed to evaluate the role of adjuvant chemotherapy in patients who undergo pneumonectomy for pN1 NSCLC. We found no significant differences after 5 years between two cohorts (adjuvant CT and no adjuvant CT) in terms of the overall survival (p: 0.31), cancer-specific survival (p: 0.59), disease-free survival (p: 0.94), and relapse rate (p: 0.76). Patients with pN1 NSCLC that was completely resected through pneumonectomy and radical lymphadenectomy may represent a particular cohort, which could be strictly followed up without adjuvant chemotherapy. Introduction: We aimed to assess our 25-year experience in order to evaluate the role of adjuvant chemotherapy in patients who undergo pneumonectomy for pN1 NSCLC. Materials and Methods: We retrospectively reviewed the outcomes and medical records of patients undergoing pneumonectomy for NSCLC with pathological diagnosis of pN1, excluding all patients who underwent neoadjuvant treatment. We compared patients treated with adjuvant chemotherapy with patients who did not undergo neoadjuvant treatment during a follow-up soon after surgery. Gray's test was used to assess differences in the cumulative incidence of relapse or CSS between the different groups. Kaplan–Meier methods were used for drawing overall survival (OS) plots. In order to assess differences in survival between the groups, the log-rank test was used. The cumulative incidence of relapse, CSS, and OS were calculated at 1, 2, 3, 4, and 5 years of follow-up. Results: The 30-day and 90-day mortality rates of our cohort were 6% and 11,6%. Excluding the first three months after surgery (deaths linked to postoperative comorbidity), after 5 years we found no significant differences between the two cohorts (adjuvant CT and no adjuvant CT) in terms of the overall survival (OS) (p: 0.31), cancer-specific survival (CSS) (p: 0.59), disease-free survival (DFS) (p: 0.94), and relapse rate (p: 0.76). Conclusions: Patients with pN1 NSCLC that was completely resected through pneumonectomy and radical lymphadenectomy may represent a particular cohort, which could be strictly followed up without adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Background: anatomic lung segmentectomies allow accurate resection of pulmonary lesions, maximizing healthy tissue preservation, and reducing unnecessary loss of lung function. In this setting, accurate preoperative planning is crucial. We present our early experience, detailing the successful use of 3D-CT models in tailoring therapeutic strategies for three patients undergoing complex anatomical lung resections due to neoplastic diseases. Case Presentation: (1) 60-year-old male patient with significant pulmonary functional impairment underwent successful right lower lobe bi-segmentectomy (S7–S8) for carcinoid, stage IA1. (2) 65-year-old female patient with previous left lung resection and functional impairment underwent uneventful right upper lobe bi-segmentectomy (S1–S2) for double lung adenocarcinoma, stage IIb. (3) 67-year-old male with previous ipsilateral lung resection underwent left lower lobe segmentectomy (S8) for metastatic colic adenocarcinoma without any complications. Conclusion: 3D-CT imaging, particularly through VPTM platform, enhances the safety and precision of complex lung segmentectomy, providing a valuable surgical map for improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Low-dose computed tomography-based lung cancer screening (LCS) has demonstrated efficacy in reducing lung cancer mortality. However, concerns about overdiagnosis and overtreatment hinder global LCS implementation. Methods: Here, we report the unique case of a slow-growing 1 cm pure ground-glass opacity (GGO) of the lung, known for 15 years, which unexpectedly developed into a 5 cm mixed GGO within 1 year, with an increased solid component and FDG-PET uptake. Results: The patient, asymptomatic, underwent right upper lobectomy and lymphadenectomy, even complicated with postoperative chylothorax, later revealing to be affected by only an unchanged adenocarcinoma in situ (AIS). Conclusions: This case serves as a reminder of the potential behavior of pre-invasive lesions, which can mimic invasive neoplasia and may lead to overtreatment, and underscores the challenge of distinguishing indolent lesions from potentially aggressive malignancies in LCS, highlighting the need for the ongoing refinement of LCS protocols to mitigate this risk. [ABSTRACT FROM AUTHOR]

Pulmonary cancer is often associated with systemic inflammation and poor nutritional status and these two aspects are strongly correlated and related to the scarce infiltration of a tumor by immune cells. We reviewed all English literature reviews from 2000 to 2024 from PubMed, Scopus and Google Scholar, including original articles, review articles, and metanalyses. We excluded non-English language articles and case reports/case series. Generally speaking, nutritional and inflammatory status largely affect medium and long-term prognosis in lung cancer patients. A correct stratification of patients could improve their preoperative general functional nutritional and inflammatory status, minimizing, therefore, possible treatment complications and improving long-term prognosis. [ABSTRACT FROM AUTHOR]

Simple Summary: Bronchopleural fistula after lobectomy for lung cancer is a rare and life-threatening complication. Recognizing and managing this complication in time is often very complex for the clinicians and surgeons. Several surgical and endoscopic therapeutic approaches were described for the management of broncho-pleural fistula during the time period under study; however, the various instituted treatments depend much more on the experiences of individual centers than on a codified algorithm. Indeed, at present, there are no codified guidelines in the literature for its treatment. On the basis of our 25 years of experience, we tried to outline a diagnostic and therapeutic algorithm to help clinicians in the management of this feared complication Backgrounds: Our goal is to evaluate the correct management of broncho-pleural fistula (BPF) after lobectomy for lung cancer. Methods: We retrospectively reviewed our 25-years' experience and reported our strategies and our diagnostic algorithm for the management of post-lobectomy broncho-pleural fistula. Results: Five thousand one hundred and fifty (5150) patients underwent lobectomy for lung cancer in the period between 1998 and 2023. A total of 44 (0.85%) out of 5150 developed post-operative BPF. In 11 cases, BPF was solved by non-invasive treatment. In nine cases, direct surgical repair of the bronchial stump allowed BPF resolution. In 14 cases, a completion intervention was performed. In six cases, we performed open window thoracostomy (OWT) after lobectomy; in two cases, the BPF was closed by percutaneous injection of an n-butyl cyanoacrylate glue mixture. In two cases, no surgical procedure was performed because of the clinical status of the patient at the time of fistula developing. Thirty-day and ninety-day mortality from fistula onset was, respectively, 18.2% (eight patients) and 22.7% (ten patients). Thirty-day and ninety-day mortality after completion pneumonectomy (12 patients) was, respectively, 8.3% (one patient) and 16.6% (two patients). Conclusions: The correct management of BPF depends on various factors: timing of onset, size of the fistula, anatomic localization, and the general condition of the patient. In the case of failure of various initial therapeutic approaches, completion intervention or OWT could be considered. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrast-enhanced ultrasound (CEUS) has been widely applied for reproductive imaging in humans and animals. This structured literature review aims to analyze the usefulness of CEUS in canine reproduction. Articles from 1990 to 2022 about CEUS in canine testicles, prostate, uterus, placenta, and mammary glands were searched on PubMed and Scopus. Thirty-six total results were found. The analysis of these works enlightened the usefulness of CEUS in testicular abnormalities and neoplastic lesions, except for characterizing tumors. CEUS in dogs was studied in animal models for human prostatic cancer treatment, while in veterinary medicine it was used to study prostatic vascularization and to assess prostatic diseases, showing good specificity for adenocarcinomas. CEUS differentiated the follicular phases in ovaries. In CEH-pyometra syndrome, it differentiated endometrium and cysts, and highlighted angiogenesis. CEUS was shown to be safe in pregnant dogs and was able to assess normal and abnormal fetal–maternal blood flow and placental dysfunction. In normal mammary glands, CEUS showed vascularization only in diestrus, with differences between mammary glands. CEUS was not specific for neoplastic versus non-neoplastic masses and for benign tumors, except for complex carcinomas and neoplastic vascularization. Works on CEUS showed its usefulness in several pathologies as a non-invasive, reliable diagnostic tool. The use of contrast-enhanced ultrasound (CEUS) has been widely reported for reproductive imaging in humans and animals. This review aims to analyze the utility of CEUS in characterizing canine reproductive physiology and pathologies. In September 2022, a search for articles about CEUS in canine testicles, prostate, uterus, placenta, and mammary glands was conducted on PubMed and Scopus from 1990 to 2022, showing 36 total results. CEUS differentiated testicular abnormalities and neoplastic lesions, but it could not characterize tumors. In prostatic diseases, CEUS in dogs was widely studied in animal models for prostatic cancer treatment. In veterinary medicine, this diagnostic tool could distinguish prostatic adenocarcinomas. In ovaries, CEUS differentiated the follicular phases. In CEH-pyometra syndrome, it showed a different enhancement between endometrium and cysts, and highlighted angiogenesis. CEUS was shown to be safe in pregnant dogs and was able to assess normal and abnormal fetal–maternal blood flow and placental dysfunction. In normal mammary glands, CEUS showed vascularization only in diestrus, with differences between mammary glands. CEUS was not specific for neoplastic versus non-neoplastic masses and for benign tumors, except for complex carcinomas and neoplastic vascularization. Works on CEUS showed its usefulness in a wide spectrum of pathologies of this non-invasive, reliable diagnostic procedure. [ABSTRACT FROM AUTHOR]

Malignant Pleural Mesothelioma (MPM) is a highly aggressive disease whose diagnosis could be challenging and confusing. It could occur with atypical presentations on every examined level. Here, we present three unconventional cases of the complex diagnostic process of MPM that we have experienced during routine practice: a patient with reactive mesothelial hyperplasia mimicking MPM, an unexpected presentation of MPM with persistent unilateral hydropneumothorax, a rare case of MPM in situ. Then, we review the relevant literature on each of these topics. Definitive biomarkers to confidently distinguish MPM from other pleural affections are still demanded. Patients presenting with persistent hydropneumothorax must always be investigated for MPM. MPM in situ is now a reality, and this raises questions about its management. [ABSTRACT FROM AUTHOR]

Simple Summary: In the present work, we investigated the hypothesis that testicular tumor lesions of dogs could present a specific vascular pattern, which could be detected and differentiated by distinctive ultrasonography techniques. This is a relevant issue since it could contribute to determine their etiology based on the different vascular patterns before dogs undergo surgery. To this end, we implemented a multiple ultrasonographic approach consisting of B-Mode ultrasonography, color Doppler ultrasound, B-flow, and contrast enhanced ultrasound in 27 dogs with different testicular tumors, including leydigomas (n = 14), seminomas (n = 8), sertoliomas (n = 6), and mixed cells (n = 5). B-Mode ultrasonography did not differentiate tumor types. Pulsatility and resistive indexes of pampiniform and testicular arteries as assessed by pulse Doppler as well as the presence perilesional and/or perilesional/intralesional blood flow patterns as assessed by color and pulsed Doppler and B-flow differed between tumor types. In conclusion, despite the limited number of cases, we found that testicular tumors of dogs have subtly different vascular patterns. These architectural details are enhanced by multiparametric ultrasonography, which is highly recommended for the identification of their etiology. In this retrospective study, we assessed the accuracy of different blood flow imaging in diagnosing testicular tumor types in dogs. We recruited 27 dogs with leydigomas (14), seminomas (eight), sertoliomas (six), and mixed cells (five) confirmed histopathologically. In intact dogs, Pampiniform plexus and marginal arteries were scanned through pulsed Doppler. Blood flow and presence of intralesional/perilesional arteries were assessed by color and power Doppler, B-flow, and contrast-enhanced ultrasound. Tumor types did not differ by B-Mode ultrasonography characters. Pampiniform and testicular arteries of sertoliomas had higher (p < 0.05) pulsatility and resistive indexes. The proportion of leydigomas with a perilesional and/or perilesional/intralesional blood flow pattern detected by color and pulsed Doppler and B-flow was higher (p < 0.05) than that of the other tumors counted together. This resulted in a sensitivity of 81.8%, 83.3%, and 85.7%, a specificity of 76.5%, 56.3%, and 73.7%, and a correct classification rate of 78.6%, 67.9%, and 78.8%, respectively. While contrast enhanced ultrasound was highly effective in detecting all tumors, qualitative and quantitative parameters did not contribute to their differential diagnosis. In conclusion, results indicate that different testicular tumor types of dogs have subtly different vascular patterns, a condition that could help in identifying leydigomas. [ABSTRACT FROM AUTHOR]

The altered numbers and functions of cells belonging to immunoregulatory cell networks such as T regulatory (Tregs) and invariant Natural Killer T (iNKT) cells have been reported in Multiple Sclerosis (MS), an immune-mediated disease. We aimed to assess the frequencies of Tregs and iNKT cells in MS patients throughout a one-year treatment with fingolimod (FTY) and to correlate immunological data with efficacy and safety data. The percentage of Tregs (defined as Live Dead-CD3 + CD4 + FoxP3 + CD25++/CD127− cells) increased steadily throughout the year, while there was no significant difference in the absolute number or percentage of iNKT cells (defined as CD3 + CD14−CD19− Vα24-Jα18 TCR+ cells). However, out of all the iNKT cells, the CD8+ iNKT and CD4−CD8− double-negative (DN) cell percentages steadily increased, while the CD4+ iNKT cell percentages decreased significantly. The mean percentage of CD8+ T cells at all time-points was lower in patients with infections throughout the study. The numbers and percentages of DN iNKT cells were more elevated, considering all time-points, in patients who presented a clinical relapse. FTY may, therefore, exert its beneficial effect in MS patients through various mechanisms, including the increase in Tregs and in iNKT subsets with immunomodulatory potential such as CD8+ iNKT cells. The occurrence of infections was associated with lower mean CD8+ cell counts during treatment with FTY. [ABSTRACT FROM AUTHOR]

Simple Summary: Reproductive efficiency is a key aspect of all breeding species. Several factors, such as infective diseases, hormonal, and nutritional status could affect female fertility. As demonstrated by high numbers of newborns per litter and proper fetal development, nutritional status at mating, and correct nutritional management during pregnancy are fundamental. In this study, two diets with different ingredients (protein and lipid sources) and different macro and micronutrients concentrations (crude protein, fatty acids profile, vitamins, and mineral concentration) were administered from two months before the expected onset of proestrus to parturition to 18 bitches divided into two groups. The experimental diet, richer in protein, essential and polyunsaturated fatty acids and vitamins, when compared to control diet, seems able to guarantee better clinical presentation of estrus and embryonic development in the first third of pregnancy with a lower incidence of a fetal resorption. The close link between nutrition management and reproductive efficiency is well known, but there is very little data available concerning this topic in canine species. The present study aimed to compare the effect of two different diets upon the follicular period and gestation in bitches. Eighteen pluriparus medium and large size bitches were recruited and divided into control (CTR) and experimental (EX) groups and fed, respectively, with a commercial kibble diet and a specially formulated diet from two months before the expected onset of proestrus up to the end of the trial. It was possible to observe how the EX group had a better clinical presentation of the estrous phase, a higher number of ovarian follicles (p < 0.05), a lower percentage of fetal resorption (p < 0.05), and lower oxidative status, expressed by d-ROMs (p < 0.01), at the moment of pregnancy diagnosis compared to CTR group. Moreover, the EX group showed a lower fetal resorption rate and higher litter size (p < 0.05). These results highlight how a diet characterized by high protein and fat content and richer in essential fatty acids can improve reproductive performance in dogs. [ABSTRACT FROM AUTHOR]

Simple Summary: Pregnancy dramatically changes the metabolic status of bitches. As a consequence, malnutrition negatively affects both reproductive parameters and survival rates of puppies. Therefore, before mating and conception, as well as during pregnancy and lactation, it is necessary to satisfy the bitches' specific nutritional requirements. The present study aimed to compare the effects of two diets, Control (CTR) and Experimental (EX), which differ mainly as regards ingredients, energy, and protein contents, and which were administered to bitches of medium and large size from two months before the expected onset of proestrus up to 30 days after delivery. Bitches' weight, body condition score, litter size, milk yield and quality, and puppies' growth were evaluated. Considering the performance of the bitches and the puppies, it would seem that both the diets are adequate for bitches at these stages of their life cycle. In fact, after 30 days of lactation, all tested bitches showed a healthy status. Moreover, both the percentage of newborns mortality and puppies' growth kinetics fell within the normal physiological range for the species. The study aimed to compare two diets, Control (CTR) and Experimental (EX) (mainly differing as regards their ingredients, energy, and protein contents) administered to medium and large-sized bitches from two months before the expected proestrus and up to 30 days after delivery on mothers' weight, body condition score, litter size, milk quality, and puppies' growth. No differences were found for body weight during pregnancy, even if the BCS after delivery was significantly (p < 0.01) higher in the EX group than in the CTR one. Concerning the size effect, the percentage of weight gain on the initial body weight was double in medium-sized dogs compared to large dogs (p < 0.01). The number of puppies per litter was significantly higher (p < 0.05) for the EX group compared to the CTR one. Concerning puppies' weight, the CTR group showed a significantly (p < 0.01) higher body weight from the 21st day of life due to the significant (p < 0.01) higher daily weight gain during the suckling period. Considering the performance of bitches and puppies, both diets seem useful for these stages of their lives. In fact, after 30 days of lactation, all tested bitches showed a healthy status and both the percentage of newborns mortality and puppies' growth kinetics fell into the normal physiological range for the species. [ABSTRACT FROM AUTHOR]

Simple Summary: Ultrasound data are vital for monitoring and detecting problems in pregnancies, and although there is a significant amount of data for domestic species, data for marine mammals are scarce. In domestic species, the use of ultrasonography to monitor a pregnancy usually has the following aims: fetal movements, fetal heart rates, measurements of the skull and the thorax for the prediction of the birth date interval, the morphological aspects of the fetal organs, the appearance of the umbilical cord, and the placentation. The purpose of this study is to provide to the clinician additional relevant data on fetal development and well-being during a dolphin pregnancy that may also be useful for wild population monitoring. This study is the result of a retrospective analysis of 192 ultrasound scans over 10 years that, for the first time, describes the sonographic findings of the bottlenose dolphin organogenesis and their correlation with the stage of pregnancy, as well as the calf presentation at birth, according to its position within the uterus, and moreover a complete literature review. Ultrasonography is widely used in veterinary medicine for the diagnosis of pregnancy, and can also be used to monitor abnormal pregnancies, embryonic resorption, or fetal abortion. Ultrasonography plays an important role in modern-day cetacean preventative medicine because it is a non-invasive technique, it is safe for both patient and operator, and it can be performed routinely using trained responses that enable medical procedures. Reproductive success is an important aspect of dolphin population health, as it is an indicator of the future trajectory of the population. The aim of this study is to provide additional relevant data on feto-maternal ultrasonographic monitoring in bottlenose dolphin (Tursiops truncatus) species, for both the clinicians and for in situ population studies. From 2009 to 2019, serial ultrasonographic exams of 11 healthy bottlenose dolphin females kept under human care were evaluated over the course of 16 pregnancies. A total of 192 ultrasound exams were included in the study. For the first time, the sonographic findings of the bottlenose dolphin organogenesis and their correlation with the stage of pregnancy are described. Furthermore, this is the first report that forecasts the cephalic presentation of the calf at birth, according to its position within the uterus. [ABSTRACT FROM AUTHOR]

Simple Summary: In "no-kill policy" countries, many dogs live in shelters. Several social, environmental, and management challenges can put the welfare of shelter dogs at risk. More knowledge is still needed on how to assess shelter dog welfare. This study aimed to evaluate the state of welfare of a group of dogs entering a shelter using physiological and immunological parameters by exploring the value of some biological indicators obtained by non-invasive methods. Considering that early welfare assessment could improve the management of subjects more prone to developing distress, measurements were taken at the time of admission and four weeks after the dogs entered the shelter. A multivariate statistical approach was used to comprehensively evaluate the relationship between the variables investigated. A reduction in the values of the measured physiological and immune parameters over time suggested an improvement in the dogs' welfare after four weeks of being in the shelter compared to the initial capture and admission time. Findings also highlighted that some of the parameters investigated, such as neutrophils, lymphocytes, and fecal cortisol and lysozyme could be used for the welfare assessment of dogs entering a shelter. This study aimed to evaluate the state of welfare of a group of dogs during the first month after entering the shelter by using different stress parameters. Blood and fecal samples were collected from a group of 71 dogs at the time of admission to the shelter. In 46 of these dogs, sampling was repeated after four weeks. Well-recognized welfare biomarkers, such as fecal cortisol and leukocytes, as well as some innovative parameters (β-endorphin and lysozyme) were determined. Uni- and multivariate statistical analyses were used to evaluate their interactions and changes over time. Neutrophils (p < 0.01), lysozyme (p < 0.05), and fecal cortisol (p < 0.05) decreased, while lymphocytes (p < 0.05) increased after four weeks compared to the first days of being in the shelter, suggesting an improvement in the dogs' welfare over time. A principal component analysis extracted three bipolar components (PCs), explaining 75% of the variance and indicating negative associations between neutrophil and lymphocyte (PC1), lysozyme and β-endorphin (PC2), cortisol and lysozyme (PC3). The associations between these variables within each PC also confirmed the intricate relationships between the hypothalamic-pituitary-adrenal (HPA) axis and the immune system as well as the importance of a multiparametric approach in evaluating welfare. [ABSTRACT FROM AUTHOR]