Search Results (11)

Objectives: Residual postoperative pleural space (RPPS) is a common event after pulmonary lobectomy. Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has been associated with a higher incidence of RPPS. This study aims to evaluate the incidence, the predictors, and potential clinical implications of RPPS following Uniportal VATS lobectomy. Methods: Patients who underwent Uniportal VATS lobectomy, without any previous neoadjuvant treatment, from June 2016 to March 2020, were retrospectively analyzed. RPPS was assessed using the last chest X-Ray prior to discharge and measured by Collins method (%). Results: Among 492 patients who underwent Uniportal VATS lobectomy, 325 (66.1%) developed RPPS. The mean RPPS volume measured by the Collins method was 15.46 ± 8.59% (vs. Collins = 4.2% in no-PRPS). An RPPS > 10.5% of Collins was significantly associated with a higher risk of postoperative air leak (AUC: 0.69, sensitivity: 69%, specificity: 54%, p < 0.001). Multivariable analysis identified the following predictors of RPPS > 10.5%: right-sided surgery (p < 0.001), upper lobectomy (p = 0.01), and prolonged air leak (p = 0.003). Patients with RPPS had a higher risk of only radiologically visible postoperative subcutaneous emphysema on the final chest X-ray (p = 0.041) and were more frequently discharged with a chest tube connected to a Heimlich valve (p < 0.001). Within 90 days post-discharge, 24 (4.9%) patients were readmitted due to increased RPPS (1.4%, requiring drainage in 5 cases [1%]), progression of subcutaneous emphysema (1.6%), and pleural effusion (1.8%, requiring drainage in 6 cases [1.2%]). However, RPPS was not associated with an increased overall risk of postoperative complications (p = 0.31) or 90-day readmission (p = 0.43). Conclusions: RPPS is a common occurrence following Uniportal VATS lobectomy but is not associated with clinically significant complications. The current study findings identified BMI, active smoking, right-sided surgery, and prolonged air leak as significant predictors of RPPS. Full article

Background: Next-day discharge post-robotic-assisted thoracic surgery (RATS) anatomical lung resections are shown to be achieved in young and fit patients. This study aims to compare next-day discharge RATS anatomical lung resection patients matched with patients who stayed longer. Methods: A retrospective analysis of patients who underwent RATS anatomical lung resection by a single surgeon was conducted. Based on the variables found to be different, two propensity-matched groups were created: a next-day discharge group and a group of patients with longer stays. Results: This study included 202 patients, 49 (24.3%) of whom were discharged the next day. The mean age was 68.3 ± 9.8 years, and 114 (56.4%) patients were females. Based on the variables found different, two matched groups with 46 patients for age, gender, performance score, American Society of Anesthesiologists score, number of co-morbidities and Forced Expiratory Volume in 1 sec were created. Re-admissions, complications, and death rates were similar, but next-day discharge patients had more sublobar resections (65.2% vs. 37%, p = 0.029), shorter procedures (132 vs. 179 min, p = 0.048), and morning theater slots (71.7% vs. 32.6, p = 0.018). These were shown to be independent predictors of next-day discharge. Major air leak issues also kept patients in the hospital longer (23.9% vs. 6.5%, p = 0.024). Conclusions: Next-day discharge following RATS anatomical lung resection appeared to have no increased risk of re-admissions or complications, irrespective of fitness, age, or other patient characteristics. Patients receiving short-duration surgery and morning sublobar resections without major air leak issues have higher chances of achieving next-day discharge. Full article

Uranium plays an important role in the modern nuclear industry. However, such a radioactive element can also cause severe damage to the environment once leaked or discharged into water or air, having a huge impact on the safety of the biosphere. In this work, we pioneered the use of fluorescent monomers as imprinted units, which promoted fluorescence emission of the material. A novel porous aromatic framework was obtained with uranyl ion chelating sites, namely MIPAF-15. The unique N-O chelating pockets on the 4-bromo-1-H-indole-7-carboxylic acid gave rise to high coordination affinity toward uranyl ions, which enabled the fast adsorption rate of uranyl ions and a uranyl ion adsorption capacity of 44.88 mg·g⁻¹ at 298 K with an initial pH value of 6.0 and the uranyl concentration of 10 ppm. At the same time, the fluorescence quenching effect of MIPAF-15 was observed upon its adsorption of uranyl ions, which allowed the selective detection of uranyl ions with a detection limit of 5.04 × 10⁻⁸ M, lower than the maximum concentration of uranyl ions in drinking water specified by the World Health Organization (6.30 × 10⁻⁸ M) and United States Environmental Protection Agency (1.11 × 10⁻⁷ M). This kind of multifunctional porous material produces a favorable pathway for the detection, removal and degeneration of highly pollutive ions, promoting the overall sustainable development of the natural environment. Full article

Hazardous substances such as hydrogen and chlorine are used in semiconductor manufacturing. When these gasses are discharged, they are mixed with outside air and are connected to a treatment facility through a duct inside a gas box. This study investigated an optimal exhaust design to prevent fire explosions and toxic exposure by optimizing the exhaust volume when hazardous substances leak from the gas box of semiconductor manufacturing equipment. In this study, carbon monoxide was used for modeling. A 75 mm duct was used, and the tracer gas was released into the gas box at 15.4 LPM. The concentrations were measured at nine points inside and outside the gas box. According to the test results, in an experiment designed with 0% air intake, the internal leakage concentration was measured to be more than 25% of the LEL (lower explosive limit) for 10 min when leakage occurred due to stagnant flow, and the outside toxicity concentration was also measured to be more than 50% of the TWA (time-weighted average) value. When the air intake ratio was designed to be 100%, there was a point on the outside that exceeded 50% of the TWA, confirming that excessive air intake could also cause gas to leak outside. Finally, when the intake ratio was designed to be 50% in both directions, it was confirmed that the airflow was maintained smoothly, and the hazardous gasses were safely diluted and discharged through the duct. This study was conducted to improve the safety of workers in the field in the event of leakage of flammable and toxic gasses by testing the location and area of the air intake hole in the gas box exhaust port. Through this effort, the aim is to present specific standards for gas box design and to assist in establishing a legal framework or standardized guidelines. Full article

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0–2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol. Full article

Bronchial-subarachnoid fistulas are rare occurrences, which are not well defined in the literature. This uncommon clinical phenomenon may result in symptomatic pneumorrhachis and presents unique clinical challenges. This report details a case of a 53-year-old female whose treatment for recurrent chondrosarcoma of the thoracic spine included multiple surgeries and radiotherapy. Two weeks after her most recent debulking surgery, she experienced a rapid onset of unusual symptoms, including headache, back and neck spasms, bladder incontinence, and confusion. The source of her symptoms was found to be secondary to pneumorrhachis from a pre-existing bronchial-pleural fistula that had fistulized to the subarachnoid space discovered on computed tomography (CT) and confirmed intraoperatively. The patient was treated successfully with high-flow oxygen therapy and bed rest, followed by surgical correction of both a pleural air leak and a dural defect with muscular flaps. The patient was discharged home in stable condition and remained clinically free of recurrent bronchial-subarachnoid fistula six months after surgical repair. This case contributes to the existing literature by providing detailed clinical insights into the diagnosis and successful management of a bronchial-subarachnoid fistula leading to pneumorrhachis, thereby highlighting the importance of early recognition and intervention and underscoring the need for further research in this area. Full article

This work presents the synthesis of tungsten nanoparticles (W NPs) using a cluster source based on magnetron sputtering combined with gas aggregation (MSGA), operated with up to 81% H₂ in the hydrogen/argon mixture used as a working gas. The results show that, with up to 41% H₂ in discharge, the synthesis rate increases by more than 60 times, rapidly decreasing for over 50% H₂ in discharge. The W dust is still produced for H₂-dominated discharges (81%), and its deposition rate is small but not negligible (0.02 mg/h). The obtained W NPs are isolated, with the diameter decreasing from 50 nm to 15 nm when the amount of H₂ in discharge is smaller than 41%. Over this value, the particles tend to agglomerate, forming structures similar to film-like deposits. Also, the diameter of the dust spots deposited on substrates depends on the H₂ content of the discharge. This allows the efficient coating of substrates up to 26 mm wide by translating them in front of the MSGA cluster source exit aperture. Additionally, for 41% H₂ in discharge, the influence of synthetic air leaks (0%–8.2%) in discharge was investigated. The deposition rate decreases rapidly (ceasing for around 6% air in discharge), and the obtained nanoparticles tend to agglomerate on the substrate (at 3.3% air content, the dust deposit has the aspect of a near-continuous film). Chemical composition investigations show a pronounced tendency for oxidation, nitridation, and oxynitride formation in the presence of air leaks. Full article

COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ventilation or extracorporeal membrane oxygenation (ECMO). We present a series of patients requiring veno-venous ECMO for COVID-19 ARDS who underwent endobronchial valve (EBV) management of PAL. This is a single-centre retrospective observational study. Data were collated from electronic health records. Patients treated with EBV met the following criteria: ECMO for COVID-19 ARDS; the presence of BPF causing PAL; air leak refractory to conventional management preventing ECMO and ventilator weaning. Between March 2020 and March 2022, 10 out of 152 patients requiring ECMO for COVID-19 developed refractory PALs, which were successfully treated with bronchoscopic EBV placement. The mean age was 38.3 years, 60% were male, and half had no prior co-morbidities. The average duration of air leaks prior to EBV deployment was 18 days. EBV placement resulted in the immediate cessation of air leaks in all patients with no peri-procedural complications. Weaning of ECMO, successful ventilator recruitment and removal of pleural drains were subsequently possible. A total of 80% of patients survived to hospital discharge and follow-up. Two patients died from multi-organ failure unrelated to EBV use. This case series presents the feasibility of EBV placement in severe parenchymal lung disease with PAL in patients requiring ECMO for COVID-19 ARDS and its potential to expedite weaning from both ECMO and mechanical ventilation, recovery from respiratory failure and ICU/hospital discharge. Full article

A compressed air system (CAS) is one of the most common and energy-consuming systems in manufacturing. To practice more economically and environmentally sustainable manufacturing, manufacturers need ways to reduce the energy costs and carbon footprint, resulting from a CAS in their production systems. While preliminary energy studies on a CAS and on machining processes are available separately, existing research studies rarely analyze energy costs using a tool that considers both a CAS and production systems. Therefore, in this study, we propose an energy simulation tool that combines a CAS and a production system to evaluate the effects of a CAS and production parameters on energy consumption and costs at a factory level. In particular, we develop a time-discretized algorithm for simulating a CAS to accurately consider the dynamics of CAS parameters such as pressure and flow rate. From 48 simulation case studies, we show that changes in a CAS such as proper HP sizing, a reduction in compressed air leaks, and a decrease in the discharge pressure can increase productivity and reduce energy costs by up to 11%. The simulation analysis from this study suggests a way to help manufacturers and researchers find more sustainable ways to achieve energy-efficient configurations for production systems including a CAS. Full article

The traditional orifice discharge formula used to estimate the flow rate through a leak opening at a pipe wall often produces inaccurate results. This paper reports an original experimental study in which the influence of orifice-to-pipe diameter ratio on leakage flow rate was investigated for several internal/external flow conditions and orifice holes with different shapes. The results revealed that orifice-to-pipe diameter ratio (or pipe wall curvature) indeed influenced the leakage flow, with the discharge coefficient ( $C_d$ ) presenting a wide variation (0.60–0.85). As the orifice-to-pipe diameter ratio decreased, the values of $C_d$ systematically decreased from about 12% to 3%. Overall, the values of $C_d$ also decreased with β (ratio of pressure head differential at the orifice to wall thickness), as observed in previous studies. On the other hand, orifice shape, main pipe flow velocity, and external medium (water or air) all had a secondary effect on $C_d$ . The results obtained in the present study not only demonstrated that orifice-to-pipe diameter ratio affects the outflow, but also that real scale pipes may exhibit a relevant deviation of $C_d$ from the classical range (0.61–0.67) reported in the literature. Full article

Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum, which almost invariably originates from the alveolar space or the conducting airways. It is rare in pediatric patients; however, occasional cases are reported to result from forced Valsalva’s maneuver due to cough, emesis, a first attack of wheeze, or asthma exacerbations. We report the case of a 7-year-old previously healthy girl, with a history of persistent dry cough one day before, who was brought to our unit with face, neck and chest swelling. The chest X-ray and computed tomography (CT) scan showed subcutaneous emphysema with pneumomediastinum and pneumopericardium without evidence of the origin of this air leak. Laboratory tests and the bronchoscopy were normal. The patient was admitted in the pediatric critical care and received noninvasive monitoring, analgesia, oxygen, and omeprazole as a prophylaxis for a gastric ulcer. The patient improved, subcutaneous emphysema resolved, and she was discharged on the third day. Full article