Next Generation Sequencing for miRNA Detection on the Exhaled Breath Condensate: A Pilot Study

Introduction:

Exhaled breath condensate (EBC) sampling has been suggested as a less-invasive and cost-effective method to detect biological macromolecules, including miRNA. To explore the feasibility of its use as a biomarker of early effects of asbestos exposure, we conducted a preliminary test on male volunteers by comparing the miRNA profile in the EBC and the plasma using 2 different sequencing platforms.

Methods:

Six male volunteers, all retired and unexposed to dust or fumes, participated in the test. RNA was extracted from 200 μL EBC samples and same-size plasma samples. Sample aliquots were processed in 2 laboratories using 2 different sequencing platforms: a MiSeq Illumina^® platform and a more performing HiSeq Illumina^® platform.

Results:

The HiSeq3000^® sequencing platform identified twice as many unique molecular indexes (UMI)-validated miRNA as the MiSeq^® platform. The Spearman’s correlation coefficient between EBC counts and plasma counts was significant in 5/6 subjects with either platform (MiSeq^® = 0.128-0.508, P = .026-<.001; HiSeq^® = 0.156-0.412, P = .001-<.001). The intraclass correlation coefficient confirmed the consistency of the miRNA profile over the 6 participants with both biospecimens. Exploring the agreement between the EBC and plasma samples with Bland-Altman plots showed that using the HiSeq3000^® platform substantially improved the EBC miRNA detection rate.

Conclusion:

Our preliminary study confirms that, when using the HiSeq^® sequencing platform, EBC sampling is a suitable, non-invasive method to detect the miRNA profile in healthy subjects.

Uniportal video-assisted thoracic surgery basal segmentectomy: a single-center retrospective cohort study

BACKGROUND

Uniportal video-assisted thoracic surgery (VATS) basal segmentectomy is technically challenging and requires a deep understanding of the segmental anatomy of the lung. This report describes the uniportal VATS segmentectomy of basal segments using a single-direction approach.

METHODS

A total of 49 patients who underwent uniportal VATS basal segmentectomy between April 2019 and April 2021 were included in this retrospective study. All the surgeries were conducted using a single-direction approach. The resections of segments 7-8 were mainly performed using the interlobar fissure approach, while the resections of segments 9-10 were performed using the inferior pulmonary ligament approach.

RESULTS

A total of 33 patients underwent a single basal segmentectomy and 16 patients underwent combined basal segmentectomy/sub-segmentectomy. The median operative time was 120 min (range, 60-180 min), and the median blood loss was 20 mL (range, 10-100 mL). The median chest tube duration was 2 days (range, 1-5 days), and the median hospital stay after surgery was 4 days (range, 2-15 days). The morbidity rate after surgery was 6.1% (3/49). There were no perioperative deaths. The pathological examinations revealed 3 cases of adenocarcinoma in situ (AIS), 33 cases of minimally invasive adenocarcinoma, and 13 cases of lepidic-predominant invasive adenocarcinoma. No recrudescence or mortality was reported during the median follow-up time of 7 months (range, 2-25 months).

CONCLUSIONS

Uniportal VATS basal segmentectomy is a feasible and reliable technique based on our experience. This single-direction method allows the uniportal VATS basal segmentectomy to be performed in an easy manner with the targeted segmental bronchi and vessels exposed from superficial to deep in order of their appearance while avoiding the repeated turnover of the lung.

Retrospective outcomes analysis of 99 consecutive uniportal awake lung biopsies: a real standard of care?

Background

Surgical lung biopsy for interstitial lung disease (ILD) is traditionally performed through video-assisted thoracic surgery (VATS) and general anesthesia (GA). The mortality and morbidity rates associated with this procedure are not negligible, especially in patients with significant risk factors and respiratory impairment. Based on these considerations, our center evaluated a safe non-intubated VATS approach for lung biopsy performed in ILD subjects.

Methods

Ninety-nine patients affected by undetermined ILD were enrolled in a retrospective cohort study. In all instances, lung biopsies were performed using a non-intubated VATS technique, in spontaneously breathing patients, with or without intercostal nerve blockage. The primary end-point was the diagnostic yield, while surgical and global operating room times, post-operative length of stay (pLOS), numeric pain rating scale (NPRS) after surgery and early mortality were considered as secondary outcomes.

Results

All the procedures were carried out without conversion to GA. The pathological diagnosis was achieved in 97 patients with a diagnostic yield of 98%. The mean operating room length-of-stay and operating time were 73.7 and 42.5 min, respectively. Mean pLOS was 1.3 days with a low readmissions rate (3%). No mortality in the first 30 days due to acute exacerbation of ILD occurred. Both analgesia methods resulted in optimal feasibility with a mean NPRS score of 1.13.

Conclusions

In undetermined ILD patients, surgical lung biopsy with a non-intubated VATS approach and spontaneous ventilation anesthesia appears to be both a practical and safe technique with an excellent diagnostic yield and high level of patient satisfaction.

Proximal long saphenous vein valves in primary venous insufficiency

OBJECTIVE

To verify some of the previous findings of venous valves described in the literature, their pathophysiological significance and clinical implications.

MATERIALS AND METHODS

The elementary components of 65 proximal valves of the long saphenous vein and their interrelationships were subjected to histopathological examination. Valves were taken from patients subjected to long saphenous vein surgical removal for varicose veins of the lower limbs. Measurements and morphological evaluations were performed by optical microscopy.

RESULTS

The valvular sinus, agger and proximal portion of the cusp underwent parallel variations of thickness. Thickening of the proximal portion of cusp was related to increase in smooth muscle cells in the agger and to elastic layer dissociation. Thickening of the distal portion of cusp depended on the collagen component; sometimes it was shortened, crumpled and led to the formation of a thickened border. The vein wall in a commissural aneurysm was usually thinner than in the valvular sinus. Alterations in the intima, in the elastic membrane and in the media were found in the 98% of the valvular annulus. Ectasis and asymmetry of the venous wall were mainly related to the muscular hypoplasia of the media.

CONCLUSIONS

The development of primary venous insufficiency seems to be due to the following tissue alterations: dilatation of the valvular annulus and hypotrophy of the cusp. The hemodynamic mechanical injury increases the tissue damages of both annulus and cusps. This pathophysiologic interpretation of venous insufficiency suggests the need for detailed diagnostic procedures before reparative surgery of valves.

Exploring the role of diet in modifying the effect of known disease determinants: application to risk factors of liver cirrhosis

The analysis of the combined effects of nutritional factors with other putative disease determinants in log-linear or logistic models is methodologically complicated by the strong multicollinearity between nutritional factors, resulting in poor precision in estimating the parameters. Furthermore, the generally used multiplicative structure is not always the most appropriate for describing the resulting joint effect of two or more factors on the disease risk. The authors addressed such problems in a case-control study assessing the interactions between alcohol intake, chronic hepatitis C virus (HCV) infection, and nutrient intake on the risk of liver cirrhosis. During the period from November 1989 to May 1990, 282 patients admitted to the medical departments of the hospitals of the Province of L'Aquila (central Italy) were enrolled: 115 cirrhotic patients aged 24-82 years (78 of whom were males) hospitalized because of liver decompensation, and 167 control patients aged 25-84 years (100 of whom were males) admitted to the same hospitals for acute diseases unrelated to alcohol intake, infection with hepatotropic viruses, and nutrition. No dose-effect relation was found between the intake of any nutrient and the risk of cirrhosis using classical methods. The analysis of principal components showed, however, that a pattern of higher lipid but lower protein and carbohydrate intakes was significantly associated with the risk of cirrhosis. The Breslow and Storer parametric family of relative risk functions showed that a multiplicative structure was the most adequate to describe the joint effect of nutritional pattern with alcohol intake and/or chronic HCV infection, whereas an additive structure best described the joint effect of chronic HCV infection and alcohol intake. In conclusion, the analysis of principal components and the Breslow and Storer family are useful tools to explore the role of diet on disease risk when precise pathogenic knowledge is not available. As an original finding, the authors suggest that a higher lipid intake, combined with lower protein and carbohydrate intakes, modifies multiplicatively the risk of cirrhosis associated with alcohol intake and/or chronic HCV infection.

A multicenter double-blind study of sulglycotide versus sucralfate in nonulcer dyspepsia

Nonulcer dyspepsia remains to this date a clinical disease entity that is diagnosed and treated empirically by considering such patients potential ulcer carriers and treating them accordingly with H2 antagonists. The purpose of this study was to assess the therapeutic effectiveness of sulglycotide in patients with nonulcer dyspepsia in a random double-blind trial vs sucralfate. One hundred and eighty-seven consecutive patients with nonulcer dyspepsia were treated with sulglycotide (oral, 200 mg t.i.d. for 6 weeks, n = 93) or with sucralfate (oral, 1 g t.i.d. for the same length of time, n = 94). Drug effectiveness was evaluated in terms of apparent clinical symptom modifications, fiberoptic endoscopy findings and histological aspects of biopsy specimens. Both treatments resulted in prompt abatement of the clinical complaints of nonulcer dyspepsia and the improvement of macroscopic gastritis at endoscopy. These results confirm the usefulness of cytoprotective drugs in nonulcer dyspepsia characterized by gastroduodenal inflammation.

[Epidemiological analysis of the incidence of varicose pathology in pregnancy]

One thousand and fourteen women who were delivered in the Obst. Gynec. Clinic "L. Mangiagalli" were investigated to evaluate the real incidence of varicose disease, its correlation with some factors and the development of complication. The observation period was comprised between the 1st and the 4th day of puerperium in which women were investigated by obstetricians through a detailed questionnaire and underwent an angiological visit. The mean age of the puerperae was 29.6 years (range 15-47 yrs); 587 women were primiparas (57.9%). The prevalence of varicose disease's different aspects resulted 57.9%, while the incidence related to pregnancy was 26.1%. The prevalence and the incidence resulted to be respectively 26.8% and 14.4% for varicosities, 5.6% and 3.1% for saphenous varicosis. Complications were observed in 10 patients (0.99%). 45.3% of patients reported family positivity for varicose disease; this group has shown a statistically significant difference (p less than 0.01) for the onset of different aspects of varicose syndrome.

[A multicenter study of defibrotide in the prevention of deep venous thrombosis. Final results]

In an open multicenter comparative study aimed at the evaluation of the efficacy of defibrotide and calcium heparin in the prophylaxis of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) an evaluation has been made on 4810 patients. 2810 patients received defibrotide (800 mg/die: 400 mg b.i.d. or 200 mg q.i.d. by IV route); 2000 patients received calcium heparin (500 IU b.i.d. or t.i.d. by SC route) till the 7th post-operative day. The diagnosis of DVT or pulmonary embolism (PE) was made according to clinical routine criteria. The incidence of DVT has been 33/2810 (1.17%) in the defibrotide group and 47/2000 (2.35%) in the heparin group (chi 2 p = 0.002), while the cases of suspected or ascertained PE have been respectively 15/2810 (0.53%) and 23/2000 (1.15%) (p = 0.025). The post-operative course was totally normal in both groups; no significant adverse reactions were noticed. The obtained results suggest the effectiveness of defibrotide as an alternative to heparin in the prevention of post-operative DVT.

[Defibrotide in the prevention of deep venous thrombosis in general surgery. Preliminary results of a multicenter study]

In an open multicenter comparative study aimed at the evaluation of the efficacy of defibrotide in the prophylaxis of postsurgical deep vein thromboses (DVT) an ad interim evaluation has been made on 2626 patients thus far enrolled. 1323 had received defibrotide (200 mg q.i.d. by IV route from day -1 to day +7th postoperative), 941 calcium heparin (5000 IU b.i.d. or t.i.d. by SC route from day 0 to day +7 postoperative) and 362 other treatments (antiaggregating agents, placebo or no therapy). This group has not been included in the final evaluation, due to its limited size. The diagnosis of DVT or pulmonary embolism (PE) was made according to clinical routinary criteria. The incidence of DTV has been 15/1323 (1.13%) in the defibrotide group and 21/941 (2.23%) in the heparin group (chi-square, p = 0.056) while the cases of suspected or ascertained PE have been respectively 3/1323 (0.22%) and 10/941 (1.06%) (p = 0.02). The incidence of adverse effects with defibrotide was less than 1%; occasional cases of increased serum transaminase levels were seen with heparin. These preliminary results supports the effectiveness of defibrotide in the prevention of post-surgery DVT, its effects being similar or more prominent than those of calcium heparin, currently regarded as the standard medication.

Development of the iris in the chicken embryo. I. A study of growth and histodifferentiation utilizing immunocytochemistry for muscle differentiation

The development of the iris was studied in chicken embryos from 4 days of incubation through hatching and in chicks up to 17 days posthatching. Serial sections of the eye were stained routinely or by immunocytochemical methods using myosin antiserum to enhance detection of differentiating muscle by light microscopy. Eyes from embryos at each stage were also examined by scanning electron microscopy. Outgrowth of the iris occurs in a sequential pattern around the eye, beginning at 6 1/2 days of incubation in the region temporal to the choroid fissure and proceeding around the eye. Since differentiation of the iris follows the same pattern, similar areas of the iris were compared at each stage of development. At 6 1/2 days of incubation, pigment granules can be seen in the anterior epithelium at the root of the iris, but it is not until 8 days of incubation that pigment is identified in the same area of the posterior epithelium. As development proceeds, the pigmentation of both epithelial layers progresses from the root of the iris to the pupillary margin. Early features of the development of the sphincter muscle can first be recognized in the 7-day embryo, when epithelial buds form from the anterior epithelium adjacent to the pupillary margin. Cells from these buds detach from the epithelium and populate the entire irideal stroma; these cells are the precursors of the sphincter muscle. The epithelial buds increase in size and distribution, and coalesce into a continuous ridge of cells around the iris by 10 days of incubation. The first muscle cells differentiate at 11 days of incubation when striated fibres can be identified by immunocytochemistry. The first striated fibres of the dilator muscle are seen in the 13-day embryo. Differentiation of the dilator muscle begins near the root of the iris and proceeds toward the pupillary margin, ultimately arising from the entire anterior epithelium except near the pupillary margin. Further differentiation of the sphincter and dilator muscles continues throughout incubation and for several weeks beyond hatching.

Development of the iris in the chicken embryo. II. Differentiation of the irideal muscles in vitro

The developmental capabilities of the iris rudiment in the chicken embryo, as well as the role of tissue interactions in the differentiation of the iris, were investigated in vitro. Sectors of the intact iris from 7 1/2- through 9-day embryos (stages 32 through 35) lost their morphological organization in vitro, but were capable of normal histodifferentiation. The pigmentation of the epithelium increased, and muscle differentiation occurred. Developing muscle was identified using immunocytochemistry with antiserum against chicken muscle myosin; this procedure permitted positive identification of myoblasts, myotubes, and muscle fibres in cultures in which histological features alone were equivocal. The proportion of irideal explants which developed muscle increased with the age of the embryo, and correlated with the incidence of epithelial buds and epithelial cells in the stroma. Irideal mesenchyme from stage-32 through stage-35 embryos was already populated with stromal epithelial cells when isolated, but growth and muscle differentiation in these cultures compared poorly with that in the intact iris in vitro. Isolated irideal epithelium (stages 32 through 37) demonstrated even more limited muscle differentiation in vitro, suggesting reciprocal interaction between irideal epithelium and mesenchyme during development. Irideal epithelium was also cultured in direct association with non-irideal mesenchyme from various embryonic organ rudiments, but muscle differentiation was not enhanced.