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The new lung allocation policy has led to an increase in distant donors and consequently enhanced logistical burden of procuring organs. Though early single-center studies noted similar outcomes between same-team transplantation (ST, procuring team from transplanting center) and different-team transplantation (DT, procuring team from different center), the efficacy of DT in the contemporary era remains unclear. In this study, we evaluated the trend of DT, rate of transplanting both donor lungs, 1-year graft survival, and risk of Grade 3 primary graft dysfunction (PGD) using the Scientific Registry of Transplant Recipient (SRTR) database from 2006 to 2018. A total of 21619 patients (DT 2085, 9.7%) with 19837 donors were included. Utilization of DT decreased from 15.9% in 2006 to 8.5% in 2018. Proportion of two-lung donors was similar between the groups, and DT had similar 1-year graft survival as ST for both double (DT, HR 1.108, 95% CI 0.894 – 1.374) and single lung transplants (DT, HR 1.094, 95% CI 0.931 – 1.286). Risk of Grade 3 PGD was also similar between ST and DT. Given our results, expanding DT may be a feasible option for improving lung procurement efficiency in the current era, particularly in light of the COVID-19 pandemic.

In November 2017, the donation service area (DSA) was removed as the primary unit of US donor lung allocation. Our primary objective was to evaluate the effect of this change on recipient characteristics, the use of pretransplant extracorporeal membrane oxygenation (ECMO), and on index hospitalization length of stay (LOS) and early posttransplant complications. We also assessed whether these outcomes differed in high and low competition centers, as defined by the Herfindahl-Hirschman Index. Following DSA removal, there was a 9-day decrease in median waitlist time (P = .001) and an increase in median lung allocation score (40 vs 42, P

The Lung Screen Uptake Trial tested a novel invitation strategy to improve uptake and reduce socioeconomic and smoking-related inequalities in lung cancer screening (LCS) participation. It provides one of the first UK-based ‘real-world’ LCS cohorts. Of 2012 invited, 1058 (52.6%) attended a ‘lung health check’. 768/996 (77.1%) in the present analysis underwent a low-dose CT scan. 92 (11.9%) and 33 (4.3%) participants had indeterminate pulmonary nodules requiring 3-month and 12-month surveillance, respectively; 36 lung cancers (4.7%) were diagnosed (median follow-up: 1044 days). 72.2% of lung cancers were stage I/II and 79.4% of non-small cell lung cancer had curative-intent treatment.

THE OBJECTIVE of our study was to increase the efficiency of treatment of tuberculosis postoperative reactivations in a previously operated lung, by clarifying the medical indications, improving surgical techniques and tactics when removing a previously resected lung.METHODS AND MATERIALS. We analyzed the results of treatment of 220 patients who, in the 2004–2017 timeframe in our institution, had pneumonectomies (76 cases) and pleuropneumonectomies (144 cases) for tuberculosis relapse in a previously operated lung. For more objective planning of surgical treatment and evaluation of its results, we identified three degrees of treatment radicalism: radical, conditionally radical, and palliative.RESULTS. 32 patients, who had carried a radical surgery, were diagnosed as having a complete clinical effect at the time of discharge (absence of destruction cavities in a single lung, bacterial excretion and illiquid complications) in 100 % of cases; in the group of patients operated conditionally radical, there were diagnosed 161 out of 168 (95.8 %) and in the group of patients operated palliative, there were distinguished only 3 cases out of 20 (15.0 %).CONCLUSION. The implementation of the completion pneumonectomy and pleurapneumonectomy is accompanied by high technical complexity and more frequent development of intraoperative and postoperative complications. At the same time, the high efficiency of treatment of tuberculosis relapses in a previously operated lung can be achieved using the recommended tactics and techniques of surgical treatment when performing radical and conditionally radical interventions.

To investigate the chest CT imaging characteristics and clinical manifestations of patients with COVID-19 pneumonia.This study included 150 patients with COVID-19 pneumonia diagnosed from January 10 to February 12, 2020 to analyze their clinical and CT imaging characteristics.The period between symptom onset and initial CT examination ranged from 1 to 8 days. There were 83 cases (55.33%) involving both lungs, 67 cases (44.67%) involving a single lung (left 25 cases and right 42 cases). There were 49 cases (32.67%) of single intrapulmonary lesion, 33 cases (22.00%) of multiple intrapulmonary lesions, 68 cases (44.00%) of diffused intrapulmonary lesions, 67 cases (44.67%) of subpleural lesions, 24 cases (16.00%) of lesions localizing along the bronchovascular bundles, and 59 cases (39.33%) with lesions in both locations. There were 18 cases (12.00%) exhibiting ground-glass nodules of 10 mm, 124 cases (82.67%) of patchy ground-glass opacities with or without consolidation, 8 cases (5.33%) of cord-like lesions, 6 cases (4.00%) of pleural effusion, and 2 cases (1.33%) of enlarged lymph nodes.The main manifestations of initial chest CT in COVID-19 pneumonia patients was ground-glass opacities, commonly involving single site in patients 35 years old and multiple sites and extensive area in patients 60 years old. The common lesion sites were the subpleural region and the posterior basal segments of the lower lobes, mostly showing thickening of the interlobular septum and mixed with consolidation.

Background We investigated the clinical value of accurate sublobectomy of pulmonary nodules using video‐assisted thoracoscopy (VATS). In June 2017 to June 2019, single lung nodule patients who accepted thoracoscopic resection were included. Palpation and intraoperative ultrasound (IU) were used to localize lung nodules, and the success rate, location time and safety compared. Performance of lung nodule ultrasound was assessed. The success rate of IU localization of pulmonary nodules with different properties was studied. Results A total of 33 cases with single pulmonary nodules were included in the study, and 32 cases (97%) were successfully located by IU as opposed to 16 cases (48.5%) located by palpation (P

INTRODUCTION: The ability to perform endotracheal intubation is one of the basic skills that paramedics should demonstrate. However, in some cases where lung or bronchial injuries have occurred, it may be necessary to separate the lung by attaching a bronchial blocker and ventilating single lung. The aim of the study was to evaluate the effectiveness of bronchial protection with VivaSight-EB bronchial blocker tube and one-lung ventilation by paramedics in conditions of simulated lung injury. MATERIAL AND METHODS: The study was a prospective randomized cross-over simulation trial in which 27 paramedics took part. In the study, paramedics performed endotracheal intubation with ETView SL and then introduced a VivaSight-EB bronchial blocker and one-lung ventilation. The bronchial protection procedure took place in two scenarios: (A) normal airway; (B) difficult airway. VivaSight-EB bronchial blocker introduction time (T1) and one-lung ventilation time (T2) and the efficacy of the procedure were analysed. RESULTS: The efficacy of endotracheal intubation with ETView SL tube was 100% during both Scenario A and Scenario B. The efficacy of endotracheal intubation with ETView SL tube was 100%. The effectiveness of the first attempt to protect the bronchi with a bronchial blocker was 26% for both scenarios and the total effectiveness of bronchial protection was 100% in both cases. Time T1 for endotracheal intubation was 18sec for Scenario A (IQR; 16.5–25) and 20 sec for Scenario B (IQR; 17–25). The time to perform one-lung ventilation (Time T2) in scenarios A and B was 43 sec (IQR; 38–62.5) vs. 43.5 sec (38–65). CONCLUSIONS: The simulation study confirmed the research hypothesis that the paramedics were able to perform one-lung ventilation using the ETView-Blocker® bronchial blocker tube after a short training.

Two-position measurement for fluorescence of a single cell captured in a microfluidic chip has been conducted manually. This paper describes the automation accomplished on moving the chip back and forth at two definite positions by a robotic arm controlled with a computer using Python codes. A single lung cancer cell was captured in the chip; measurements at two positions (cell and background) were automated to demonstrate the signal enhancement due to more accumulated reagents.

Regarding endocarditis prophylaxis, there is an increasing burden of enterococci related to antibiotic resistances. The testing of the bacterial milieu of the oral cavity before dental procedures may be promising to adjust the antibiotics.

We report a 6-year-old with single ventricle physiology secondary to tricuspid atresia who had cardiorespiratory failure who was not a candidate for further single ventricle palliation. The patient underwent planned staged left pneumonectomy for recurrent pneumonias secondary to bronchomalacia followed by orthotopic heart transplantation. This aggressive approach improved the patient candidacy for heart transplantation by removing the source of recurrent infection and respiratory failure (left lung).

OBJECTIVES Typically, single-lung ex vivo lung perfusion (SL-EVLP) is preferred when there is concern of contamination from the opposite lung. However, a comprehensive assessment of the SL-EVLP has not been completed. The purpose of this study is to compare the physiological parameters of SL-EVLP and double-lung EVLP (DL-EVLP) in the assessment of transplant suitability. METHODS Seven pairs of rejected donor lungs were perfused in cellular EVLP, with a tidal volume of 6 ml/kg ideal body weight and a perfusion flow of 70 ml/kg/min. The transplant suitability of each side was judged in the DL-EVLP. Subsequently, the tidal volume and flow were reduced by half. The right SL-EVLP was maintained for 10 min by clamping the left main pulmonary artery and the bronchus. Similarly, left SL-EVLP was performed. The physiological parameters were compared between SL-EVLP and DL-EVLP. RESULTS PO2/FiO2 ratio was significantly lower in SL-EVLP than in DL-EVLP [182.5 (127.5-309.5) vs 311.5 (257.5-377.0) mmHg, P

The clinical and imaging data belonging to 52 discharged novel coronavirus pneumonia (NCP) patients with positive nucleic acid retesting results during the follow-up period were collected from the First People’s Hospital, Xiaogan, Hubei Province, China, for analysis. These moderate NCP patients underwent a plain CT scan before the admission, at the time of discharge, and at re-admission due to the positive result of their COVID-19 nucleic acid retesting. The CT signs of these patients were analyzed in this study and a total of 32 (61.54%) patients presented with 123 lesions with patchy fuzzy shadows. In addition, 24 (75%) and 8 (25%) patients out of the 32 patients, had lesions distributed in both lungs and single lung, respectively. It is worth mentioning that the CT manifestations varied in discharged moderate NCP patients whose COVID-19 nucleic acid retest was positive in the follow-up period. Most patients presented with patchy fuzzy shadows and ground-glass opacity (GGO) lesions distributed in the lower lobe of both lungs. The results of the study indicated that some discharged moderate NCP patients with positive COVID-19 nucleic acid retest developed new patchy fuzzy shadows and GGO lesions. Moreover, the recurrence of NCP needs to be verified once patchy fuzzy shadows and GGO lesions appear and are not absorbed during the follow-up period. This study provided a reference for the follow-up NCP evaluation.

We present a novel case of a patient with nephrotic syndrome and previous left pneumonectomy who had a massive pulmonary embolism of his remnant right pulmonary artery. He underwent surgical embolectomy and veno-arterial extracorporeal membrane oxygenation (ECMO). Early embolectomy using retrograde pulmonary perfusion and post-operative ECMO helped the patient survive this catastrophic event.

Considering the insufficient understanding of pulmonary cryptococcosis (PC) with consolidation, 22 patients were evaluated based on the chest computed tomography (CT) images and clinical manifestation. The clinical symptoms were mild, mainly manifesting as cough and sputum. Pulmonary lesions mostly involved a single lobe in a single lung with multiple lesions. Specifically, single lung involvement was observed in 17 cases, single lobe in 16 cases and multiple lesions in 14 case. Fifteen cases were mainly distributed in the periphery and 17 cases in the long axis in parallel to the pleura. Nineteen cases had air bronchograms. Eight cases displayed cavitation inside the lesions and 18 cases had surrounding halo signs. Seventeen cases had pleural thickening, of which 10 cases had "pasting wall" signs. The clinical symptoms of PC with consolidation were relatively mild. Comprehensive clinical and imaging performance could improve the diagnosis of the disease.

Background The cold ischemia time (CIT) is a period of time between harvesting an organ for transplant and its reperfusion just after implantation. CIT may have an impact on frequency of complications after lung transplant that can be treated by means of bronchoscopic intervention. The aim of the study was to investigate the correlation between CIT and frequency of bronchoscopic intervention. Methods The retrospective study consists of 91 patients: 22 single lung recipients (24%) and 69 double lung recipients (76%) who underwent lung transplant from March 2012 to June 2019. All statistical analyses were performed in SPSS 25.0 and R 3.5.3. The P levels less than .05 were deemed statistically significant. Results The average CIT in single lung transplant was 5.91 hours, and in double lung transplant it was 8.61 hours. For the 4- to 8-hour CIT the percentages were 80.95% for single lung recipients and 46.38% for double lung recipients. For CIT longer than 8 hours, the following percentages were observed: 9.53% in single lung transplant and 53.62% in double lung transplant. Each subsequent hour of CIT exponentially increases the risk of intervention 1505 times (50.05%). Conclusions Prolonged CIT seems to be a risk factor for airway complication, especially in the double lung recipient group.

International audience; The first successful single-lung and double-lung transplantations were performed in the eighties. Since then both surgical and anesthesiological management have improved. The aim of this paper is to describe the surgical technique of lung transplantation: from the anesthesiological preparation, to the explantation and implantation of the lung grafts, and the preparation of the donor lungs. We will also describe the main surgical complications after lung transplantation and their management. Each step of the surgical procedure will be illustrated with photos and videos.

Background: The thoracoscopic approach has become a standard procedure in the field of lung resections. However, its advantage in single-lung patients has not yet been well studied. We describe a series of successful thoracoscopic wedge resections in patients presenting with lung cancer after contralateral pneumonectomy. Methods: Eight patients, with a previous pneumonectomy (5 right and 3 left) for lung cancer, underwent resection for a suspicious neoplasm on the remaining lung. All lesions were detected in the asymptomatic phase during regular follow-up after pneumonectomy based on repeated computer tomography (CT). Only single peripheral lesions less than 2 cm were eligible for wedge resection were eligible for surgery. Videoassisted thoracoscopic, margin-free tumor wedge resections, were performed during apnea windows with the lung in a deflated position. Results: All patients were treated by a wedge resections smaller than a single segment. Only one patient needed a mini-thoracotomy conversion to accomplish a safe margin-free resection. Median total surgical operative time was 37 minutes. There were no postoperative deaths, while morbidity was 12.5%. Conclusions: Thoracoscopic surgery represents a feasible surgical option in selected patients after contralateral pneumonectomy, with careful preoperative assessment and using short apnea windows in good collaboration with anesthesiologists. Histological definition, made possible by the surgical-procedure, gives patients the possibility to eventually undergo further targeted therapies. Randomized prospective trials are necessary to assess the best management of peripheral small lung nodules in single-lung patients, in particular to define which patients can benefit from a surgical approach.

Purpose Single lung transplantation (SLT) is an option for certain lung transplant recipients and allows for maximal utility of a limited donor pool. However, whether a single lung should be transplanted when the contralateral donor lung is too injured for transplant is a challenging clinical scenario. The introduction of ex vivo lung perfusion (EVLP) has improved donor lung assessment and we hypothesize that it has improved SLT outcomes in this setting. We examined outcomes in SLT recipients with and without the use of EVLP. Methods A retrospective single-centre review of all SLT performed between 2000 and 2017 was performed. To account for the introduction of EVLP in our program in 2008, we considered the years 2000-2008 the “pre-EVLP era” and 2009-2017 the “EVLP era”. SLT recipients were classified as Group 1 (Control) when both donor lungs were transplanted, Group 2 (Pre-EVLP era) when one lung was declined at the donor site and the other transplanted directly, Group 3a (EVLP era; non-EVLP) when one lung was declined at the donor site and the other transplanted directly, and Group 3b (EVLP era; EVLP utilized) when one lung was declined but the transplanted lung deemed acceptable using EVLP. The outcomes of interest were survival, time-to-extubation, and ICU and hospital stay. Results A total of 244 SLT were performed between 2000 and 2017. There were 143 SLT in Group 1, 21 in Group 2, 33 in Group 3a, and 47 in Group 3b. There was a significantly better 30-day mortality in the EVLP era (Table 1). Use of SLT increased from 12.7% of lung transplants pre-EVLP era to 16.8% in the EVLP era. Conclusion Though not every SLT with rejected contralateral lung necessitated evaluation by EVLP, the availability of EVLP allowed for additional evaluation of questionable single lungs. This has led to increased utilization rates and improved outcomes of SLT with a rejected contralateral lung in the EVLP era.

The number of patients who need cardiac support with a left ventricular assist device (LVAD) has increased over the last decade. However, the number of reports of organ retrieval from donors with an LVAD is still small. Successful lung retrieval for single lung transplantation was performed from a donor on LVAD support. This required special care not to injure the heart, great vessels, and the device, particularly the outflow conduit, because of significant conglutination around the device. A right single lung transplantation was performed successfully, with no postoperative complications. This means that patients on an LVAD could be potential donors for lung transplantation.

A cross sectional study was conducted to assess the prevalence and economic significance of bovine hydatidosis at Adama municipal abattoir. A total of 500 cattle were examined and 191 (38.2%) of them were found infected. Also, 253 visceral organs were found harboring one or more hydatid cyst. Prevalence of lung and liver cyst accounted for 94.5% and the involvement of other organs as many as 20 cysts were recovered from a single lung. Proportionally 35.7, 34.6, 20.8 and 8.82% of the cysts were calcified, small, medium and large sized, respectively. In addition, sterile and fertile cysts represent 46.2 and 18.1%, respectively. The rate of calcification is higher in liver than lungs, while that of most fertile cysts were recovered from lungs. The annual economic loss due to bovine hydatidosis at Adama abattoir is estimated to be about 171,436.36 Eth Birr (ETB). This information shows the risk of hydatid cyst distribution and economic significance in the study area. Therefore, appropriate control measures should be undertaken which include public awareness education program and a more aggressive effort that should include a reduction of stray dog population. Key words: Adama abattoir, economic significance, hydatid cyst, fertility, prevalence.

Glenn followed by Fontan are still the main two procedures for the treatment of patients with single ventricle. Some patients may be challenging due to unfavorable cardiopulmonary anatomy. In this report, we present Glenn shunt procedure in a patient with single pulmonary artery and congenitally agenetic lung.

[Radiofrequency ablation of lung metastases: experience of National Cancer Institute of Panama]ResumenIntroducción: La evidencia de la metastasectomía quirúrgica es poca y sin estudios aleatorizados. Morbilidad a corto plazo que puede ser responsable por pérdida de función permanente y con aumento de costos. En base a esto surge la necesidad de terapias de control local en pacientes que no podían ser sometidos a metastasectomía. Metodología: realizamos una revisión retropectiva de todos los pacientes tratados en el Instituto Oncológico Nacional de Panamá con ARF pulmonar entre 2013 a 2018. Se estudiaron variables demográficas, clínicas, terapéuticas y pronósticas. El método de Kaplan-Meier fue utilizado para analizar la supervivencia libre de progresión y supervivencia global. Resultados: Se analizaron 31 pacientes, la mediana de edad fue de 63 años, 54.8 % de sexo femenino. Los sitios primarios más frecuentes fueron colon, mama y recto. La mayoría con ECOG 1 y 1 sola lesión pulmonar. La mediana de tamaño de la lesión fue de 20 mm y sólo 19.4 % presentaba metástasis extrapulmonares previo al procedimiento. La mediana de PFS fue de 10 meses (7.5-12.5). La mediana de supervivencia global post procedimiento fue de 24 meses (21.1-26.8). La supervivencia Global a 3 años fue 16%. La tasa de respuesta fue de 96.7%, respuesta completa en 53% y respuesta parcial en 43 %. Las complicaciones más frecuentes fueron dolor pleurítico, neumotórax y efusión pleural, ocurrió 1 arresto cardiaco y 1 muerte asociada al procedimiento. Conclusión: La ARF pulmonar demostró ser una terapia local que logra prolongar la supervivencia de nuestros pacientes con una tasa de eventos adversos aceptable y con complicaciones manejables.Abstract Introduction: The evidence of surgical metastasectomy is small and without randomized studies. Short-term morbidity that may be responsible for permanent loss of time and with increased costs. Based on this, there is a need for local control therapies in patients who can not undergo metastasectomy. Methodology: we performed a retroactive review of all patients treated with pulmonary RFA between 2013 to 2018 in our institution. Demographic, clinical, therapeutic and prognostic variables were studied. The Kaplan-Meier method was used to analyze progression-free survival and overall survival. Results: 31 patients were analyzed, the median age was 63 years, 54.8% were female. The most frequent primary sites were Colon, breast and rectum. The majority with ECOG 1 and 1 single lung injury. The median size of the lesion was 20 mm and only 19.4% had extrapulmonary metastases at one year. The median PFS was 10 months (7.5-12.5). The median overall post-procedure survival was 24 months (21.1-26.8). Overall 3-year survival was 16%. The response rate was 96.7%, complete response 53% and partial response 43%. The most frequent complications were pleural pain, pneumothorax and pleural effusion, 1 cardiac arrest and 1 death associated with the procedure occurred.Conclusion: Pulmonary RFA proved to be a local therapy that managed to prolong the survival of our patients with an acceptable rate of adverse events and with manageable complications.

To improve the treatment of destructive tuberculosis of a single lung by using of collapse surgery.The authors analyzed an experience of collapse surgery for destructive tuberculosis of a single lung.Collapse surgery was effective in 77.5% of patients.Endoscopic surgical collapse improves the outcomes in patients with destructive tuberculosis of a single lung and expands the possibilities for surgery in these patients when resection is not applicable.Повышение эффективности лечения пациентов с деструктивным туберкулезом единственного легкого путем совершенствования коллапсохирургических операций.Проанализирован опыт применения коллапсохирургических операций по поводу деструктивного туберкулеза единственного легкого.У 77,5% пациентов операции коллапса были эффективны.Коллапсохирургические вмешательства при использовании рекомендуемых ВАТС-методик улучшают результаты лечения деструктивного туберкулеза единственного легкого и расширяют операбельность больных этой тяжелейшей категории в тех случаях, когда резекционная хирургия неприменима.

Objective: To describe indications for, and outcomes after, pneumonectomy in dogs and cats, including assessment of immediate postoperative respiratory function in comparison to dogs undergoing single lung lobectomy. Study Design: Retrospective case series. Animals: Dogs (n=16) and cats (n=7) with naturally occurring pulmonary disease. Methods: Medical records (1990–2014) of dogs and cats undergoing right or left pneumonectomy were reviewed. Data retrieved included signalment, history, preoperative diagnostics, operative descriptions, postoperative data including respiratory function, and postdischarge outcomes. For respiratory function comparisons, medical records of dogs having undergone a single lung lobectomy via median sternotomy (n=15) or intercostal thoracotomy (n=15) were reviewed. Results: Twenty-three cases (16 dogs, 7 cats) were included. Pneumonectomy was performed for congenital (1 dog, 1 cat), neoplastic (8 dogs, 1 cat), and infectious (7 dogs, 5 cats) disease. Postoperative aspiration pneumonia occurred in 2 dogs; 15 of 16 dogs (94%) and 6/7 cats (86%) survived to hospital discharge. After pneumonectomy, dogs had a significantly higher postoperative PaO2 on 21% oxygen (P=.033) and lower postoperative A-a gradient (P=.004) compared to dogs undergoing single lung lobectomy. Survival times (right-censored at last follow-up) for dogs ranged from 2 days to 7 years (estimated median=1,868 days) and for cats from 1–585 days. Conclusion: Dogs and cats have acceptable respiratory function immediately postoperatively and most have protracted long-term survival after pneumonectomy for a variety of pulmonary diseases.

Asthma is a chronic inflammatory lung disease characterized by reversible obstruction of airways and bronchial hyperresponsiveness. In recent years there has been a growing interest in the role of the small airways in asthma and there is increasing evidence that they contribute significantly to the clinical expression of asthma. Numerous studies have shown that inflammation is present in the small airways of patients with asthma and that it may be more intense than that found in the large airways, particularly in severe asthma, nocturnal asthma, coexisting asthma and obesity and asthma in smokers. Currently there is no accepted single lung function parameter to detect small airways dysfunction. Recent data show that impulse oscillometry is a promising diagnostic tool to assess the involvement of the small airways. The use of corticosteroids in extrafine formulation, whether alone or in fixed combinations with long-acting b2 agonists, improves drug distribution throughout the bronchial tree, enhancing the therapeutic effect with lower doses of drugs.

Objective: To provide reference for prevention and control of SARS-CoV-2 infection through analysis of related factors of patients diagnosed and suspected with COVID-19. Methods: Data of 40 confirmed cases and 24 suspected cases of COVID-19 admitted from January to February 2020 in the Second People's Hospital of Jingzhou City were collected, and the differences in indicators and related factors between the confirmed and suspected groups were compared. Results: There was no significant difference in patients age and APACHEⅡ score between the two groups (P> 0.05). Compared with the suspected group, WBC and Neut decreased in the diagnosed group, and the difference was statistically significant (p 0.05). There was no significant difference in the factors such as single lung lobe lesions and multiple lobe lesions (P> 0.05). Conclusion: There is no significant difference between the common COVID-19 patients and the suspected patients in terms of population characteristics, clinical manifestations and most laboratory tests.

Purpose Patients with end-stage heart failure and one functioning (Fx) lung are often referred for combined heart-lung transplantations (HLTx). However, this strategy carries significant waitlist & post-transplant mortality. Between 1987 and 2018, only 37% of the pediatric patients listed for HLTx were actually transplanted. This study aims to evaluate if heart transplant alone (HTx) remains a viable option for this patient population. Methods Using both the Pediatric Health Information System (PHIS) and United Network for Organ Sharing (UNOS) databases, HTx recipients with one Fx lung and congenital heart disease between 2006 and 2015 (n=19) were identified. All other HTx recipients in a merged PHIS-UNOS database during the same period were classified as two Fx lungs (n=2,625). Post-transplantation survival rates for recipients with one and two Fx lungs were compared using Kaplan-Meier analysis. Results HTx recipients with one Fx lung had lower post-transplantation survival rates than recipients with two Fx lungs (p=0.03) but comparable conditional 60-day survival rates (p=0.56). Recipients with one Fx lung had one- and five-year survival rates of 71% and 40% with 60-day conditional one- and five-year survival rates of 100% and 90%, respectively. Five out of the six deceased HTx recipients with one Fx lung died within 60 post-operative days and before being discharged. Renal dysfunction (GFR Conclusion HTx recipients with one Fx lung can do well but seem to have a high early post-operative mortality that usually indicates high-risk recipients with multiple risk factors. Patient selection and timing of transplantation referral will be key to improving these outcomes. Keeping in mind the low percentage of waitlisted patients who actually make it to HLTx, HTx appears to be the best option for patients with end-stage heart failure and one Fx lung.

Purpose Blood transfusion during lung transplantation (LT) surgery is common. There is little evidence to identify potential candidates for transfusion-free LT surgery. We describe patient and procedural characteristics of LT patients in the era of ECMO and identify predictors of a successful transfusion-free surgery. Methods In this single-center, retrospective analysis, all adult patients undergoing LT between 9/5/2016-2/28/2019 were included. Patients were grouped based on perioperative transfusions received over 72 hours; no products, 1-4 units PRBC, or >4 U PRBC. Donor and recipient characteristics were compared between the three groups by univariate and multivariate analysis. Results 241 LTs were performed over the time period; 235 were included and 6 multiorgan transplants were excluded. 41 patients (17.4%) received no blood transfusions, while 82.6% (N=194) received transfusions. Most patients (43%, N=101) received >4 U of product. Recipients requiring blood transfusions had associated prolonged ventilation, length of stay, PGD and worsened 1-year graft survival compared to those who did not. Donor characteristics were similar between groups (Fig 1). Older males with obstructive or restrictive lung disease undergoing an off-pump, single lung LT, with lower Lung Allocation Score (LAS), higher starting hemoglobin, shorter ischemic time and case length were associated with a transfusion free LT (Fig 1). In a multivariate analysis, positive predictors for transfusion-free LT included single LT (OR=6.27, p=0.0004), and higher preoperative hemoglobin (OR=1.35 per point, p.0231). Negative predictors included female sex (F v M, OR=0.13, p=0.0005) and higher LAS (OR=0.88 per point, p=0.0002). Conclusion Predictors of transfusion free LT surgery include older males undergoing a single, off-pump LT procedure, with lower LAS scores and higher starting hemoglobin. This may guide decision making in exploring candidacy for transfusion-free LT or blood refusal patients in the era of ECMO.

Purpose The purpose of this study was to examine outcomes and survival with extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LT) stratified by recipient age. Methods The United Network for Organ Sharing database was analyzed for patients aged ≥18 years who were bridged to a lung transplant with an ECMO between 2005 to 2018. Recipients were categorized into 3 age groups based on age at the time of listing. Baseline clinical characteristics and post-transplant in-hospital outcomes were compared among 3 age groups. The Kaplan Meier survival curves and the log rank test were used to estimate and compare survival among patient groups. Results During the study period, a total of 275 patients were bridged to LT with an ECMO. There were 154 (56%) patients aged 60 years. Mean wait-list time was comparable among patient groups (17 vs.18. vs.18 days, p =0.981). Compared to the younger patients, patients > 60 years had a higher incidence of tobacco usage, history of cardiac surgery and more likely to be transplanted for IPF, with a single lung. Mean LAS scores were lower in the >60year group than the other two patient groups. ( 60yrs. 73; p = 0.011). There was no difference in post-transplant in-hospital outcomes. Post-transplant survival at 1-year was significantly lower in the older age groups. ( 60yrs. 61%; Log rank test: p = 0.021). Conclusion Post-transplant survival after ECMO as a bridge to LT is significantly reduced in patients older than 60. Age should be strongly considered in the deciding whether to bridge patients to LT with ECMO.

We report for the first time in literature an exceptional case of a third-time lung transplantations (LTx) done on a single lung because of previous pneumonectomy in a cystic fibrosis 22-year-old female. Several hypotheses were advocate to explain the need of persistent continuous noninvasive ventilation occurred after left pneumectomy. Finally, chronic lung allograft dysfunction (CLAD) associated with near- diaphragmatic palsy secondary to lung distension was the retained diagnosis. Twenty-three months after third-time single lung retransplantation she is still alive, in good condition, with a Forced Expiratory Volume in 1 second (FEV1) measured at 47%, justifying the accepted risk and the technical difficulties of an exceptional procedure.

Background Single lung transplantation (SLT) and double lung transplantation (DLT) are associated with differences in morbidity and mortality, although the effects of transplant type on patient-reported outcomes are not widely reported and conclusions have differed. Previous studies compared mean health-related quality of life (HRQOL) scores but did not evaluate potentially different temporal trajectories in the context of longitudinal follow-up. To address this uncertainty, this study was designed to evaluate longitudinal HRQOL after SLT and DLT with the hypothesis that temporal trajectories differ between SLT and DLT. Methods Patients transplanted at a single institution were eligible to be surveyed at 1 month, 3 months, 6 months, and then annually after transplant using the Short Form 36 Health Survey, with longitudinal physical component summary (PCS) and mental component summary (MCS) scores as the primary outcomes. Multivariable mixed-effects models were used to evaluate the effects of transplant type and time posttransplant on longitudinal PCS and MCS after adjusting age, diagnosis, rejection, Lung Allocation Score quartile, and intubation duration. Time by transplant type interaction effects were used to test whether the temporal trajectories of HRQOL differ between SLT and DLT recipients. HRQOL scores were referenced to general population norms (range, 40 to 60; mean, 50 ± 10) using accepted standards for a minimally important difference (½ SD, 5 points). Results Postoperative surveys (n = 345) were analyzed for 136 patients (52% male, 23% SLT, age 52 ± 13 years, LAS 42 ± 12, follow-up 37 ± 29 months [range, 0.6 to 133]) who underwent lung transplantation between 2005 and 2016. After adjusting for model covariates, overall posttransplant PCS scores have a significant downward trajectory (p = 0.015) whereas MCS scores remain stable (p = 0.593), with both averaging within general population norms. The time by transplant type interaction effect (p = 0.002), however, indicate that posttransplant PCS scores of SLT recipients decline at a rate of 2.4 points per year over the total observation period compared to DLT. At approximately 60 months, the PCS scores of SLT recipients, but not DLT recipients, fall below general population norms. Conclusions The trajectory of physical HRQOL in patients receiving SLT declines over time compared with DLT, indicating that, in the longer term, SLT recipients are more likely to have physical HRQOL scores that fall substantively below general population norms. Physical HRQOL after 5 years may be a consideration for lung allocation and patient counseling regarding expectations when recommending SLT or DLT.

Background and Objective: Identifying abnormalities in chest CT scans is an important and challenging task, demanding time and effort from specialists. Different parts of a single lung image may present both normal and abnormal characteristics. Thus, detecting a single lung as healthy (normal) or not is inaccurate. Methods: In this work we propose dp-BREATH, a method capable of detecting abnormalities in pulmonary tissue regions and directing the specialist’s attention to the lung region containing them. It starts by highlighting regions that may indicate pulmonary abnormalities based on the healthy pulmonary tissue behavior using a superpixel-based approach and a heat map visualization. This is achieved by modeling regions of healthy tissue using a statistical model. All regions considered abnormal are modeled and classified according to their probability of containing each of the studied abnormalities. Further, dp-BREATH provides a better recognition of radiological patterns, with the likelihood of a selected lung region to contain abnormalities. Results: We validate the statistical model of healthy and abnormal detection using a representative dataset of chest CT scans. The model has shown almost no overlap between healthy and abnormal regions, and the detection of abnormalities presented precision higher than 86%, for all recall values. Additionally, the fitted models describing pulmonary radiological patterns present precision of up to 87%, with a high separation for three of five radiological patterns. Conclusions: dp-BREATH’s heat map representation and its list of radiological patterns probabilities provided are intuitive methods to assist physicians during diagnosis.

This chapter presents a historical milestone of lung transplantation from the early experimental studies and clinical attempts to the advances of the Toronto Group and Stanford Group to the most recent developments.

Objectives Treatment of central and ultra-central lung tumors with stereotactic ablative radiotherapy (SABR) remains controversial due to risks of treatment-related toxicities compared with peripheral tumors. Here we report our institution's experience in treating central and ultra-central lung tumor patients with SABR. Materials and Methods We retrospectively reviewed outcomes in 68 patients with single lung tumors, 34 central and 34 peripheral, all treated with SABR consisting of 50Gy in 4–5 fractions. Tumor centrality was defined per the RTOG 0813 protocol. We defined "ultra-central" tumors as those with GTV directly abutting the central airway. Results Median follow-up time was 18.4months and median overall survival was 38.1 months. Two-year overall survival was similar between ultra-central, central, and peripheral NSCLC (80.0% vs. 63.2% vs. 86.6%, P =0.62), as was 2-year local failure (0% vs. 10.0% vs. 16.3%, P =0.64). Toxicity rates were low and comparable between the three groups, with only two cases of grade 3 toxicity (chest wall pain), and one case of grade 4 toxicity (pneumonitis) observed. Patients with ultra-central tumors experienced no symptomatic toxicities over a median follow-up time of 23.6 months. Dosimetric analysis revealed that RTOG 0813 central airway dose constraints were frequently not achieved in central tumor treatment plans, but this did not correlate with increased toxicity rate. Conclusion Patients with central and ultra-central lung tumors treated with SABR (50Gy in 4–5 fractions) experienced few toxicities and good outcomes, similar to patients with peripheral lung tumors.

During lung development many internal and external factors can influence normal lung maturation. Mechanical ventilation and oxygen supplementation of preterm infants triggers bronchopulmonary dysplasia, a chronic lung disease characterised by enlarged septa thickness and less alveoli. Recently, several new methods for lung morphological analysis have been established, such as the stereological analysis of lungs embedded in plastic. A comparative, quantitative analysis of the structure of individual lung lobes has never been undertaken. In the present study, single lung lobes isolated from C57Bl/6 mice exposed to normoxia (21% O2) or hyperoxia (85% O2) from the day of birth for 14 days, were embedded in plastic, and analysed by stereology. For the whole-lung, the mean septal wall thickness was significantly increased from 10.2 μm in 21% O2 to 15.3 μm in 85% O2. In the single lobe study, the septa thickness was increased only in the caudal and left lobe from 11.4 μm in 21% O2 to 15.2 μm in 85% O2 and 11.6 μm in 21% O2 to 14.2 μm in 85% O2, respectively. The alveolar density in the whole-lung was decreased from 1.6 × 107 cm−3 in 21% O2 to 0.7 × 107 cm−3 in 85% O2. In contrast, the single lobe analysis revealed a higher alveolar density in the cranial lobe 2.2 × 107 cm−3 and in the middle lobe 2.0 × 107 cm−3 in 21% O2, which was also noted in the in 85% O2, at 1.3 × 107 cm−3 and 1.4 × 107 cm−3, respectively. The stereological study of each single lung lobe individually was more accurate and precise compared with the whole-lung analysis. Moreover, individual lung lobes in mice might follow a different development patterns, and this should be further investigated.

Computed Tomography (CT) scans are often employed to diagnose lung diseases, as abnormal tissue regions may indicate whether proper treatment is required. However, detecting specific regions containing abnormalities in a CT scan demands time and effort of specialists. Moreover, different parts of a single lung image may present both normal and abnormal characteristics, what makes inaccurate the classification of a single lung as healthy (normal) or not. In this paper we propose the BREATH method, capable of detecting abnormalities in lung tissue regions, highlighting them by means of a heat map visualization. The method starts by segmenting lung tissues using a superpixel-based approach, followed by the training of a statistical model to represent normal tissues and, finally, the generation of a heat map showing abnormal regions that require attention from the physicians. We validated our statistical model using a dataset with 246 lung CT scans, where 40 are healthy and the remaining present varying diseases. Experimental results show that BREATH is accurate for lung segmentation with F-Measure of up to 0.99. The statistical modeling of healthy and abnormal lung regions has shown almost no overlap, and the detection of superpixels containing abnormalities presented precision values higher than 86%, for all values of recall. These values support our claim that the heat map representation of BREATH for the abnormal detection can be used as an intuitive method to assist physicians during the diagnosis.

In 1902, the first successful kidney transplant ever was performed by E. Ullmann in Vienna. Also, the first clinical renal transplant in Austria was performed on June 17, 1965, by F. Piza in the same city. The first combined pancreas–kidney transplant was performed by R. Margreiter in 1979 in Innsbruck. H.J. Bohmig did the first liver transplant in 1972 in Vienna. The world’s first combined liver–kidney transplant was carried out by R. Margreiter in 1983 in Innsbruck. The same year as the first heart transplant, in 1985 the first combined heart–lung transplant and in 1986 the first double lung transplant were performed in Innsbruck by R. Margreiter and F. Gschnitzer, respectively. In 1989, for the first time, a single lung was transplanted in Vienna by W. Klepetko and E. Wolner. In 1989, the first successful multivisceral transplant including the entire small bowel worldwide took place in Innsbruck, with R. Margreiter and A. Konigsrainer being the surgeons. An isolated bowel transplant was performed in Vienna by F. Muhlbacher in 1983. The world’s second double-hand transplant was performed in Innsbruck in 2000 by a team led by H. Piza and R. Margreiter. These pioneering transplants led to three multiorgan- and two kidney-transplant programs in Austria and generated activities that are among the best worldwide in terms of volume, and also quality.

Rationale:High morbidity and high mortality are the main features of non-small cell lung cancer (NSCLC). Radiofrequency ablation, which produces a large amount of heat to kill tumor cells, is one effective way to treat this disease.Patient concerns:We report the case of a 74-year-old man who

Purpose From 1995 to 2013, 5.1% of single lung transplants and 3.4% of bilateral lung transplants reported to the ISHLT were retransplantations (ReLTx). The median survival was restricted to 2.5 years during the period. We investigated the corresponding results from our center. Methods A retrospective data collection was performed for all 635 patients who underwent a lung transplantation between 1991 and 2017 at our center. Recipient pre-, intra- and postoperative variables were compared between patients undergoing only primary lung transplantation (PLTx) and those undergoing both PLTx and later ReLTx. Time to death from the date of PLTx and ReLTX were compared using Kaplan-Meier technique. The risk of ReLTx on time to death as outcome variable was analyzed in unadjusted and adjusted Cox regression models. Data was adjusted in a stepwise manner. An interaction between type of transplantation, single/double, and PLTx/ReLTx was investigated. Results ReLTx was undertaken in 49 patients representing 7.7% of our total experience. Survival after ReLTx at 30 days, 1, 2 and 5-years were 90%, 76%, 71% and 55%. The corresponding survival after PLTx were 94%, 82%, 76% and 61% (Figure). A time-updated HR of 1.73 for ReLTx compared to PLTx on mortality was shown (95% CI 1.14-2.63, p=0.011). After adjustments for known risk factors the HR was reduced to 1.43 (CI 0.90-2.26 p=0.13). Eight of the 49 patients (16%) were re-transplanted within the first year after the PLTx. For this group one-year survival was 50% compared to 81% (p=0.18) in patients re-transplanted later than 1 year after the PLTx. One-year survival after double ReLTx was 60% (95% CI 25-83%) compared to 79% (95% CI 63-89%) for single ReLTx. Conclusion ReLTX could be a reasonable option for a selected number of patients. Ideally a number of well-established risk factors is avoided and the ReLTx done as a single lung transplant more than one year after the PLTx.