Publications by authors named "Gabriel Marta"

37 Publications

Assessment of CO and aerosol (PM, PM, UFP) concentrations during the reopening of schools in the COVID-19 pandemic: The case of a metropolitan area in Central-Southern Spain.

Environ Res 2021 Mar 27;197:111092. Epub 2021 Mar 27.

INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Campus da FEUP, Rua Dr. Roberto Frias 400, 4200-465, Porto, Portugal. Electronic address:

Public health authorities have been paramount in guaranteeing that adequate fresh air ventilation is promoted in classrooms to avoid SARS-CoV-2 transmission in educational environments. In this work it was aimed to assess ventilation conditions (carbon dioxide, CO) and suspended particulate matter (PM, PM and UFP) levels in 19 classrooms - including preschool, primary and secondary education - located in the metropolitan area of Ciudad Real, Central-Southern Spain, during the school's reopening (from September 30th until October 27th, 2020) after about 7 months of lockdown due to COVID-19 pandemic. The classrooms that presented the worst indoor environmental conditions, according to the highest peak of concentration obtained, were particularly explored to identify the possible influencing factors and respective opportunities for improvement. Briefly, findings suggested that although ventilation promoted through opening windows and doors according to official recommendations is guaranteeing adequate ventilation conditions in most of the studied classrooms, thus minimizing the risk of SARS-CoV-2 airborne transmission, a total of 5 (26%) surveyed classrooms were found to exceed the recommended CO concentration limit value (700 ppm). In general, preschool rooms were the educational environments that registered better ventilation conditions, while secondary classrooms exhibited the highest peak and average CO concentrations. In turn, for PM, PM and UFP, the concentrations assessed in preschools were, on average about 2-fold greater than the levels obtained in both primary and secondary classrooms. In fact, the indoor PM and PM concentrations substantially exceeded the recommended limits of 8hr-exposure, established by WHO, in 63% and 32% of the surveyed classrooms, respectively. Overall, it is expected that the findings presented in this study will assist the establishment of evidence-based measures (namely based on ensuring proper ventilation rates and air filtration) to mitigate preventable environmental harm in public school buildings, mainly at local and national levels.
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http://dx.doi.org/10.1016/j.envres.2021.111092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003457PMC
March 2021

Evaluation of the occurrence of pathogenic free-living amoeba and bacteria in 20 public indoor swimming pool facilities.

Microbiologyopen 2021 01;10(1):e1159

Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain.

Recently, indoor swimming pool activities have increased to promote health-enhancing physical activities, which require establishing suitable protocols for disinfection and water quality control. Normally, the assessment of the microbial quality of the water in the pools only considers the presence of different bacteria. However, other less frequent but more resistant pathogens, such as free-living amoebas (FLA), are not contemplated in both existing recommendation and research activities. FLA represent a relevant human health risk, not only due to their pathogenicity but also due to the ability to act as vehicles of other pathogens, such as bacteria. Therefore, this work aimed to study the physicochemical characteristics and the occurrence of potentially pathogenic FLA and bacteria in water samples from 20 public indoor swimming facilities in Northern Portugal. Our results showed that some swimming pools presented levels of pH, free chlorine, and conductivity out of the recommended limits. Pathogenic FLA species were detected in two of the facilities under study, where we also report the presence of both, FLA and pathogenic bacteria. Our findings evidence the need to assess the occurrence of FLA and their existence in the same environmental niche as pathogenic bacteria in swimming pool facilities worldwide and to establish recommendations to safeguard the health of the users.
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http://dx.doi.org/10.1002/mbo3.1159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859502PMC
January 2021

Indoor environmental quality in households of families with infant twins under 1 year of age living in Porto.

Environ Res 2020 Nov 14:110477. Epub 2020 Nov 14.

Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal.

Exposure to air pollution in early years can exacerbate the risk of noncommunicable diseases throughout childhood and the entire life course. This study aimed to assess temperature, relative humidity (RH), carbon dioxide (CO) and monoxide (CO), particulate matter (PM, PM), ultrafine particles, nitrogen dioxide (NO), ozone (O), formaldehyde, acetaldehyde and volatile organic compounds (VOC) levels in the two rooms where infant twins spend more time at home (30 dwellings, Northern Portugal). Findings showed that, in general, the worst indoor environmental quality (IEQ) settings were found in bedrooms. In fact, although most of the bedrooms surveyed presented adequate comfort conditions in terms of temperature and RH, several children are sleeping in a bedroom with improper ventilation and/or with a significant degree of air pollution. In particular, mean concentrations higher than recommended limits were found for CO, PM, PM and total VOC. Additionally, terpenes and decamethylcyclopentasiloxane were identified as main components of emissions from indoor sources. Overall, findings revealed that factors related to behaviors of the occupants, namely related to a conscientious use of cleaning products, tobacco and other consumer products (air-fresheners, incenses/candles and insecticides) and promotion of ventilation are essential for the improvement of air quality in households and for the promotion of children's health.
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http://dx.doi.org/10.1016/j.envres.2020.110477DOI Listing
November 2020

Indoor air pollution, physical and comfort parameters related to schoolchildren's health: Data from the European SINPHONIE study.

Sci Total Environ 2020 Oct 6;739:139870. Epub 2020 Jun 6.

Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, F75012 Paris, France.

Substantial knowledge is available on the association of the indoor school environment and its effect among schoolchildren. In the same context, the SINPHONIE (School indoor pollution and health: Observatory network in Europe) conducted a study to collect data and determine the distribution of several indoor air pollutants (IAPs), physical and thermal parameters and their association with eye, skin, upper-, lower respiratory and systemic disorder symptoms during the previous three months. Finally, data from 115 schools in 54 European cities from 23 countries were collected and included 5175 schoolchildren using a harmonized and standardized protocol. The association between exposures and the health outcomes were examined using logistic regression models on the environmental stressors assessed in classroom while adjusting for several confounding factors; a VOC (volatile organic compound) score defined as the sum of the number of pollutants to which the children were highly exposed (concentration > median of the distribution) in classroom was also introduced to evaluate the multiexposure - outcome association. Schoolchildren while adjusting for several confounding factors. Schoolchildren exposed to above or equal median concentration of PM, benzene, limonene ozone and radon were at significantly higher odds of suffering from upper, lower airways, eye and systemic disorders. Increased odds were also observed for any symptom (sick school syndrome) among schoolchildren exposed to concentrations of limonene and ozone above median values. Furthermore, the risks for upper and lower airways and systemic disorders significantly increased with the VOCs score. Results also showed that increased ventilation rate was significantly associated with decreased odds of suffering from eye and skin disorders whereas similar association was observed between temperature and upper airways symptoms. The present study provides evidence that exposure to IAPs in schools is associated with various health problems in children. Further investigations are needed to confirm our findings.
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http://dx.doi.org/10.1016/j.scitotenv.2020.139870DOI Listing
October 2020

The expression of the long NEAT1_2 isoform is associated with human epidermal growth factor receptor 2-positive breast cancers.

Sci Rep 2020 Jan 28;10(1):1277. Epub 2020 Jan 28.

Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.

The long non-coding RNA NEAT1 locus is transcribed into two overlapping isoforms, NEAT1_1 and NEAT1_2, of which the latter is essential for the assembly of nuclear paraspeckles. NEAT1 is abnormally expressed in a wide variety of human cancers. Emerging evidence suggests that the two isoforms have distinct functions in gene expression regulation, and recently it was shown that NEAT1_2, but not NEAT1_1, expression predicts poor clinical outcome in cancer. Here, we report that NEAT1_2 expression correlates with HER2-positive breast cancers and high-grade disease. We provide evidence that NEAT1_1 and NEAT1_2 have distinct expression pattern among different intrinsic breast cancer subtypes. Finally, we show that NEAT1_2 expression and paraspeckle formation increase upon lactation in humans, confirming what has previously been demonstrated in mice.
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http://dx.doi.org/10.1038/s41598-020-57759-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987222PMC
January 2020

Comprehensive assessment of the indoor air quality in a chlorinated Olympic-size swimming pool.

Environ Int 2020 03 26;136:105401. Epub 2019 Dec 26.

Faculty of Engineering, University of Porto, Porto, Portugal.

Elite swimmers and swimming pool employees are likely to be at greater health risk due to their regular and intense exposure to air stressors in the indoor swimming pool environment. Since data on the real long-term exposure is limited, a long-term monitoring and sampling plan (22 non-consecutive days, from March to July 2017) was carried out in an indoor Olympic-size pool with a chlorine-based disinfection method to characterize indoor environments to which people involved in elite swimming and maintenance staff may be exposed to. A comprehensive set of parameters related with comfort and environmental conditions (temperature, relative humidity (RH), carbon dioxide (CO) and monoxide and ultrafine particles (UFP)) were monitored both indoors and outdoors in order to determine indoor-to-outdoor (I/O) ratios. Additionally, an analysis of volatile organic compounds (VOC) concentration and its dynamics was implemented in three 1-hr periods: early morning, evening elite swimmers training session and late evening. Samplings were simultaneously carried out in the air layer above the water surface and in the air surrounding the pool, selected to be representative of swimmers and coaches/employees' breathing zones, respectively. The results of this work showed that the indoor climate was very stable in terms of air temperature, RH and CO. In terms of the other measured parameters, mean indoor UFP number concentrations (5158 pt/cm) were about 50% of those measured outdoors whereas chloroform was the predominant substance detected in all samples collected indoors (13.0-369.3 µg/m), among a varied list of chemical compounds. An I/O non-trihalomethanes (THM) VOC concentration ratio of 2.7 was also found, suggesting that, beyond THM, other potentially hazardous VOC have also their source(s) indoors. THM and non-THM VOC concentration were found to increase consistently during the evening training session and exhibited a significant seasonal pattern. Compared to their coaches, elite swimmers seemed to be exposed via inhalation to significantly higher total THM levels, but to similar concentrations of non-THM VOC, during routine training activities. Regarding swimming employees, the exposure to THM and other VOC appeared to be significantly minimized during the early morning period. The air/water temperature ratio and RH were identified as important parameters that are likely to trigger the transfer processes of volatile substances from water to air and of their accumulation in the indoor environment of the swimming pool, respectively.
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http://dx.doi.org/10.1016/j.envint.2019.105401DOI Listing
March 2020

Assessment of indoor air conditions in households of Portuguese families with newborn children. Implementation of the HEALS IAQ checklist.

Environ Res 2020 03 28;182:108966. Epub 2019 Nov 28.

University of Porto, Porto, Portugal.

Conducting epidemiological and risk assessment research that considers the exposome concept, as in the case of HEALS project, requires the acquisition of higher dimension data sets of an increased complexity. In this context, new methods that provide accurate and interpretable data summary on relevant environmental factors are of major importance. In this work, a questionnaire was developed to collect harmonized data on potential pollutant sources to air in the indoor environment where children spend an important part of their early life. The questionnaire was designed in a user friendly checklist format to be filled out at the maternity in ten European cities. This paper presents and discusses the rationale for the selection of the questionnaire contents and the results obtained from its application in the households of 309 HEALS-enrolled families with babies recently born in Porto, Portugal. The tool was very effective in providing data on the putative air pollution sources in homes, with special focus on the bedroom of the newborns. The data collected is part of a wider effort to build the databases and risk assessment models of the HEALS project. The results of the analysis of the collected data suggest that, for the population under study, the main concerns on early life exposures at home can be related to emissions from the use of household solid fuels, indoor tobacco, household cleaning products, fragranced consumer products (e.g. air fresheners, incense and candles), moisture-related pathologies and traffic-related outdoor pollution. Furthermore, it is anticipated that the tool can be a valuable means to empower citizens to actively participate in the control of their own exposures at home. Within this context, the application of the checklist will also allow local stakeholders to identify buildings presenting most evident IAQ problems for sampling or intervention as well as to guide them in preparing evidence-based educational/awareness campaigns to promote public health through creating healthy households.
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http://dx.doi.org/10.1016/j.envres.2019.108966DOI Listing
March 2020

Assessment of the air quality in 20 public indoor swimming pools located in the Northern Region of Portugal.

Environ Int 2019 12 1;133(Pt B):105274. Epub 2019 Nov 1.

Faculty of Engineering, University of Porto, Porto, Portugal.

Air exposures occurring in indoor swimming pools are an important public health issue due to their popularity and regular use by the general population, including vulnerable groups such as children and elderly people. More comprehensive information on indoor air quality (IAQ) in swimming pools is thus needed in order to understand health risks, establish appropriate protective limits and provide evidence-based opportunities for improvement of IAQ in these facilities. In this context, twenty public indoor swimming pools located in the Northern Region of Portugal were examined in two sampling campaigns: January-March and May-July 2018. For each campaign, a comprehensive set of environmental parameters was monitored during the entire period of the facilities' operating hours of a weekday, both indoors and outdoors. In addition, four air (1-h samplings) and water samples were collected. Findings show that comfort conditions, ultrafine particles number concentrations and exposure to substances in the indoor air (concentration and composition) is likely to vary greatly from one public indoor swimming pool to another. Trihalomethanes (THM) and dichloroacetonitrile were the predominant disinfection by-products identified in the indoor air but other potentially hazardous volatile organic compounds, such as limonene, 1,2,4-trimethylbenzene, 2,2,4,4,6,8,8-heptamethylnonane, 2- and 3-methylbutanenitrile, acetophenone, benzonitrile, and isobutyronitrile were found to have relevant putative emission sources in the environment of the swimming pools analyzed. Furthermore, indicators of poor ventilation conditions (namely carbon dioxide, relative humidity and existence of signs of condensation in windows) and some water-related parameters (THM levels, conductivity and salinity) were found to be determining factors of the measured airborne THM concentrations that appeared to significantly potentiate the exposure. In summary, this work provides evidence for the need to establish adequate standards for the comprehensive evaluation of IAQ in public swimming pools, in order to guide further development of evidence-based prevention/remediation strategies for promoting healthy environments in swimming pools.
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http://dx.doi.org/10.1016/j.envint.2019.105274DOI Listing
December 2019

Predicting health risk from exposure to trihalomethanes in an Olympic-size indoor swimming pool among elite swimmers and coaches.

J Toxicol Environ Health A 2019 1;82(9):577-590. Epub 2019 Jul 1.

b Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal.

Disinfection by-products (DBP) such as trihalomethanes (THM) are formed when chlorine and bromine interact with natural organic materials in chlorine-treated swimming pools. Epidemiological evidence demonstrated an association between exposure to swimming pool environment and adverse health effects. Therefore, this study aimed to assess carcinogenic and non-carcinogenic risk of long-term exposure of elite swimmers and their coaches. In an Olympic-size indoor chlorinated swimming pool, THM levels were determined in water (21-69 µg/L), in the boundary layer above the water surface (59-397 µg/m), and in the air surrounding the pool (28-390 µg/m). These values were used to predict multi-pathway chronic daily intake (CDI), cancer risk (CR) and hazard index (HI). Oral and dermal CDI for swimmers were 2.4 × 10 and 2.0 × 10, respectively. The swimmers' inhalation CDI (1.9 × 10 mg/kg/day) was estimated to be sixfold higher than levels obtained for coaches (3.3 × 10 mg/kg/day). According to guidelines, the HI was acceptable, but CR exceeded the recommended limit for both, coaches (CR: 5.5 × 10-8.5 × 10; HI: 6.5 × 10-1 × 10) and swimmers (CR: 1.4 × 10-3.6 × 10 HI: 1.6 × 10-4.3 × 10). Our findings provide further support to the need to develop comprehensive guidelines to safeguard the health of individuals involved in elite swimming.
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http://dx.doi.org/10.1080/15287394.2019.1634383DOI Listing
May 2020

Loss of miR-198 and -206 during primary tumor progression enables metastatic dissemination in human osteosarcoma.

Oncotarget 2018 Nov 6;9(87):35726-35741. Epub 2018 Nov 6.

INSERM, UMR-S 1238, Nantes 44035, France.

The metastatic dissemination is a complex multistep process by which tumor cells from a primary site enter into the systemic circulation to finally spread at distant sites. Even if this mechanism is rare at the tumor level, it remains the major cause of Osteosarcoma-patients' relapse and mortality. MicroRNAs (miRNAs) have recently been described as novel epigenetics' genes' expression regulators actively implicated in cancer progression and dissemination. The understanding of their implication in the metastatic spreading could help clinicians to improve the outcome of osteosarcoma. We established the miRNA's expression-profile between primary bone-tumors (PTs), circulating tumor cells (CTCs) and lung metastatic (META) samples from mice xenograft models. Our results show that the expression level of the miR-198 and -206 was decreased in META samples, in which the expression of the metastasis-related receptor C-Met was up-regulated. Those expression variations were validated in osteosarcoma patient biopsies from matching primary tumors and lung metastasis. We validated the endogenous miRNAs inhibitory effects on both migration and invasion, as well as we confirmed by luciferase assays that the C-Met receptor is one of their targets. The anti-metastatic effect of these miRNAs was also validated , as their direct injections into the tumors reduce the number of lung-metastases and prolongs the overall survival of the treated animals. All together, our results suggest the absence of the miR-198 and -206 as powerful predictive biomarkers of the tumor cell dissemination and the rationale of their potential therapeutic use in the treatment of Osteosarcoma.
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http://dx.doi.org/10.18632/oncotarget.26284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254661PMC
November 2018

A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting.

J Thorac Cardiovasc Surg 2016 10 12;152(4):1008-17. Epub 2016 Aug 12.

Department of Thoracic Surgery, Medical University, Vienna, Austria.

Objectives: Repair of laryngotracheal stenosis with pronounced side-to-side narrowing and involvement of the glottis is challenging and usually requires laryngotracheal reconstruction with rib cartilage interpositions. This technique, as first described by Couraud, needs prolonged postoperative stabilization with Montgomery T-tubes, imposing significant morbidity and discomfort on patients. We describe our initial experience with a modified laryngotracheal reconstruction technique that avoids the need for prolonged postoperative stenting.

Methods: From November 2012 through May 2015, a series of 5 adult patients with glottosubglottic stenosis were operated in our institution. All patients had pronounced scar formation in combination with advanced side-to-side narrowing extending up to the level of the vocal folds. Operative technique consisted of a complete anterior and posterior laryngeal split followed by rib cartilage interposition in the cricoid plate posteriorly to enlarge the glottosubglottic diameter. The lateral edges of the rib graft were trimmed in such a way that lateral flanges were created, which allowed stable positioning of the graft. The distal trachea was then slid into the larynx, and the posterior defect was completely covered with a liberal membranous flap. The anterior part of the larynx was enlarged with a V-shaped segment of the anterior tracheal wall.

Results: This technique provided immediate stability without the need for temporary endoluminal stenting. The perioperative course was uneventful in all patients, and functional outcome was excellent.

Conclusions: We conclude that this modified technique of laryngotracheal reconstruction represents a valid treatment option for patients with complex glottosubglottic stenosis, avoiding the need for prolonged postoperative stenting.
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http://dx.doi.org/10.1016/j.jtcvs.2016.01.061DOI Listing
October 2016

The association between pro- and anti-inflammatory cytokine polymorphisms and periventricular leukomalacia in newborns with hypoxic-ischemic encephalopathy.

J Inflamm Res 2016 5;9:59-67. Epub 2016 May 5.

Radiology Department, São José do Rio Preto Medical School, FAMERP, São Paulo, Brazil.

Background: Periventricular leukomalacia (PVL) is a frequent consequence of hypoxic-ischemic injury. Functional cytokine gene variants that result in altered production of inflammatory (tumor necrosis factor-alpha [TNF-α] and interleukin-1beta [IL-1β]) or anti-inflammatory (interleukin-10 [IL-10]) cytokines may modify disease processes, including PVL.

Objective: The aim of this study was to evaluate if there is a relationship between the two proinflammatory polymorphisms (TNF-α-1031T/C and IL-1β-511C/T) and the anti-inflammatory polymorphism IL-10-1082G/A and PVL risk in Brazilian newborns with and without this injury.

Materials And Methods: A cross-sectional case-control study performed at the Neonatal Intensive Care Unit of the Children's Hospital and Maternity of the São José do Rio Preto Medical School (FAMERP). Fifty preterm and term newborns were examined as index cases and 50 term newborns as controls, of both sexes for both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed the three polymorphisms were amplified by polymerase chain reaction-restriction fragment length polymorphism.

Results: Gestational age ranged from 25 to 39 weeks, in the case group, and in the control group it ranged from 38 to 42.5 weeks (P<0.0001). Statistically significant association was found between TNF-α-1031T/C high expression genotype TC (odds ratio [OR], 2.495; 95% confidence interval [CI], 1.10-5.63; P=0.043) as well as between genotypes (TC + CC) (OR, 2.471; 95% CI, 1.10-5.55; P=0.044) and risk of PVL. Statistically significant association was found between IL-1β-511C/T high expression genotypes (CT + TT) (OR, 23.120; 95% CI, 1.31-409.4; P=0.003) and risk of PVL. Statistically significant association between IL-10-1082G/A high expression genotype GG (OR, 0.07407; 95% CI, 0.02-0.34; P<0.0001) as well as between IL-10-1082G high expression allele (OR, 0.5098; 95% CI, 0.29-0.91; P=0,030) and PVL reduced risk was observed. There was a statistically significant association between TC/CT/GA genotype combination and the risk of PVL (OR, 6.469; 95% CI, 2.00-20.92; P=0.001).

Conclusion: There is evidence of an association between the polymorphisms TNF-α-1031T/C, IL-1β-511C/T, and IL-10-1082G/A and PVL risk in this Brazilian newborn population studied.
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http://dx.doi.org/10.2147/JIR.S103697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862342PMC
May 2016

Circulating Tumor Cells: A Review of Non-EpCAM-Based Approaches for Cell Enrichment and Isolation.

Clin Chem 2016 Apr 19;62(4):571-81. Epub 2016 Feb 19.

INSERM, UMR 957, Equipe LIGUE Nationale Contre le Cancer 2012, Nantes, France; Université de Nantes, Nantes Atlantique Universités, Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, Nantes, France; CHU de Nantes, Nantes, France; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.

Background: Circulating tumor cells (CTCs) are biomarkers for noninvasively measuring the evolution of tumor genotypes during treatment and disease progression. Recent technical progress has made it possible to detect and characterize CTCs at the single-cell level in blood.

Content: Most current methods are based on epithelial cell adhesion molecule (EpCAM) detection, but numerous studies have demonstrated that EpCAM is not a universal marker for CTC detection because it fails to detect both carcinoma cells that undergo epithelial-mesenchymal transition (EMT) and CTCs of mesenchymal origin. Moreover, EpCAM expression has been found in patients with benign diseases. A large proportion of the current studies and reviews about CTCs describe EpCAM-based methods, but there is evidence that not all tumor cells can be detected using this marker. Here we describe the most recent EpCAM-independent methods for enriching, isolating, and characterizing CTCs on the basis of physical and biological characteristics and point out the main advantages and disadvantages of these methods.

Summary: CTCs offer an opportunity to obtain key biological information required for the development of personalized medicine. However, there is no universal marker of these cells. To strengthen the clinical utility of CTCs, it is important to improve existing technologies and develop new, non-EpCAM-based systems to enrich and isolate CTCs.
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http://dx.doi.org/10.1373/clinchem.2015.249706DOI Listing
April 2016

Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy.

Environ Int 2016 Apr-May;89-90:71-80. Epub 2016 Jan 28.

Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy and Laboratory of Parasitology and Allergy, Lascaray Research Centre, University of the Basque Country, Vitoria, Spain. Electronic address:

Alternaria alternata spores are considered a well-known biological contaminant and a very common potent aeroallergen source that is found in environmental samples. The most intense exposure to A. alternata allergens is likely to occur outdoors; however, Alternaria and other allergenic fungi can colonize in indoor environments and thereby increase the fungal aeroallergen exposure levels. A consequence of human exposure to fungal aeroallergens, sensitization to A. alternata, has been unequivocally associated with increased asthma severity. Among allergenic proteins described in this fungal specie, the major allergen, Alt a 1, has been reported as the main elicitor of airborne allergies in patients affected by a mold allergy and considered a marker of primary sensitization to A. alternata. Moreover, A. alternata sensitization seems to be a triggering factor in the development of poly-sensitization, most likely because of the capability of A. alternata to produce, in addition to Alt a 1, a broad and complex array of cross-reactive allergens that present homologs in several other allergenic sources. The study and understanding of A. alternata allergen information may be the key to explaining why sensitization to A. alternata is a risk factor for asthma and also why the severity of asthma is associated to this mold. Compared to other common environmental allergenic sources, such as pollens and dust mites, fungi are reported to be neglected and underestimated. The rise of the A. alternata allergy has enabled more research into the role of this fungal specie and its allergenic components in the induction of IgE-mediated respiratory diseases. Indeed, recent research on the identification and characterization of A. alternata allergens has allowed for the consideration of new perspectives in the categorization of allergenic molds, assessment of exposure and diagnosis of fungi-induced allergies.
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http://dx.doi.org/10.1016/j.envint.2016.01.003DOI Listing
November 2016

From respiratory sensitization to food allergy: Anaphylactic reaction after ingestion of mushrooms (Agaricus bisporus).

Med Mycol Case Rep 2015 Jun 24;8:14-6. Epub 2015 Feb 24.

Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy, Laboratory of Parasitology and Immunoallergy, Center for Research Laskaray, University of the Basque Country, Paseo Universidad, 6, 01006 Vitoria, Álava, Spain.

We report a case of a 38-year-old mold-allergic patient who developed episodes of generalized urticaria and systemic anaphylactic shock immediately after ingesting button mushrooms. A manganese-dependent superoxide dismutase (MnSOD) and a NADP-dependent mannitol dehydrogenase (MtDH) from Agaricus bisporus mushroom were identified as patient-specific IgE-binding proteins. Cross-reactivity between A. bisporus MnSOD and mold aeroallergens was confirmed. We conclude that prior sensitization to mold aeroallergens might explain severe food reactions to cross-reacting homologs mushroom proteins.
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http://dx.doi.org/10.1016/j.mmcr.2015.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348448PMC
June 2015

Characterisation of Alternaria alternata manganese-dependent superoxide dismutase, a cross-reactive allergen homologue to Asp f 6.

Immunobiology 2015 Jul 22;220(7):851-8. Epub 2015 Jan 22.

Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy and Laboratory of Parasitology and Allergy, Lascaray Research Centre, University of the Basque Country, Vitoria, Spain. Electronic address:

It is well known that Alternaria alternata presents a significant level of allergenic cross-reactivity with several other phylogenetically related and non-related allergenic moulds. To improve the molecular diagnosis, the identification and characterisation of all clinically relevant allergens, including both species-specific and cross-reacting proteins, is required. In this study we report the molecular and immunological characterisation of the A. alternata manganese-dependent superoxide dismutase (Alt a MnSOD) and its cross-reactivity with Asp f 6, a diagnostic marker allergen in allergic bronchopulmonary aspergillosis (ABPA). The cDNA coding for Alt a MnSOD sequence was isolated by RACE and PCR. Alt a MnSOD is a protein of 191 amino acids that presented significant homology and potential cross-reactive epitopes with Asp f 6. The recombinant protein was produced in Escherichia coli and the immunoreactivity was evaluated in patient sera. Immunoblotting analyses showed that seven of sixty-one A. alternata-sensitised patient sera and two ABPA patient sera reacted with the recombinant Alt a MnSOD. The native counterpart contained in both A. alternata and Aspergillus fumigatus extracts inhibited IgE binding to the recombinant molecule. The allergen was named Alt a 14 by the official Allergen nomenclature subcommittee. Thus, Alt a 14 is a relevant allergen in A. alternata sensitisation that may be used to improve diagnostic procedures. Evidence of cross-reactivity between Asp f 6 and Alt a 14-recognition by ABPA patient sera suggest the existence of an Alt a 14-mediated mechanism that, similar to Asp f 6, may be related to the pathogenesis of ABPA.
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http://dx.doi.org/10.1016/j.imbio.2015.01.006DOI Listing
July 2015

Surgical specimens, haemodynamics and long-term outcomes after pulmonary endarterectomy.

Thorax 2014 Feb 19;69(2):116-22. Epub 2013 Sep 19.

Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, , Vienna, Austria.

Background: Chronic thromboembolic pulmonary hypertension is surgically curable by pulmonary endarterectomy (PEA). It is unclear whether PEA impacts primarily steady state right ventricular afterload (ie, pulmonary vascular resistance (PVR)) or pulsatile right ventricular afterload (ie, pulmonary arterial compliance (C(PA))). Our objectives were to (1) quantify PEA specimens and measure the impact of PEA on PVR and C(PA) in a structure/function study and (2) analyse the effects of haemodynamic changes on long-term survival/freedom of lung transplantation in an outcome study.

Methods: Thrombi were laid out, weighed, photographed and measured. PVR, C(PA) and resistance times compliance (RC-time) were assessed at baseline, within 4 days after PEA ('immediately postoperative') and 1 year after PEA, in 110 consecutive patients who were followed for 34.5 (11.9; 78.3) months.

Results: Lengths and numbers of PEA specimen tails were inversely correlated with immediate postoperative PVR (p<0.0001, r=-0.566; p<0.0001, r=-0.580). PVR and C(PA) normalised immediately postoperatively while RC-time remained unchanged. Immediate postoperative PVR was the only predictor of long-term survival/freedom of lung transplantation (p<0.0001). Patients with immediate postoperative PVR<590 dynes.s.cm(-5) had better long-term outcomes than patients with PVR≥590 dynes.s.cm(-5) (p<0.0001, respectively).

Conclusions: PEA immediately decreased PVR and increased C(PA) under a constant RC-time. However, immediate postoperative PVR was the only predictor of long-term survival/freedom of lung transplantation. Our study confirms the importance of a complete, bilateral surgical endarterectomy. Low PVR measured immediately postoperative predicts excellent long-term outcome.
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http://dx.doi.org/10.1136/thoraxjnl-2013-203746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913220PMC
February 2014

A rare indication for video-assisted thoracoscopic surgery: headscarf needle aspiration.

Clin Respir J 2013 Jul;7(3):e15-7

Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.

Headscarf needle aspiration is a rare event, especially in Middle and Western European countries. Here, we report the case of a 37-year-old Austrian woman of Turkish origin who accidentally aspirated a turban pin. Repeated bronchoscopy was not successful in removing the aspirated foreign body, which extended past the right middle lobe to the interlobar fissure. The needle was finally removed by video-assisted thoracoscopic surgery.
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http://dx.doi.org/10.1111/crj.12022DOI Listing
July 2013

Cofilin, a hypoxia-regulated protein in murine lungs identified by 2DE: role of the cytoskeletal protein cofilin in pulmonary hypertension.

Proteomics 2013 Jan;13(1):75-88

Universities of Giessen and Marburg Lung Center, Giessen, Germany.

Chronic alveolar hypoxia induces vascular remodeling processes in the lung resulting in pulmonary hypertension (PH). However, the mechanisms underlying pulmonary remodeling processes are not fully resolved yet. To investigate functional changes occurring during hypoxia exposure we applied 2DE to compare protein expression in lungs from mice subjected to 3 h of alveolar hypoxia and those kept under normoxic conditions. Already after this short-time period several proteins were significantly regulated. Subsequent analysis by MALDI-MS identified cofilin as one of the most prominently upregulated proteins. The regulation was confirmed by western blotting and its cellular localization was determined by immunohisto- and immunocytochemistry. Interestingly, enhanced cofilin serine 3 phosphorylation was observed after short-term and after chronic hypoxia-induced PH in mice, in pulmonary arterial smooth muscle cells (PASMC) from monocrotaline-induced PH in rats, in lungs of idiopathic pulmonary arterial hypertension patients and in hypoxic or platelet-derived growth factor BB-treated human PASMC. Furthermore, elevated cofilin phosphorylation was attenuated by curative treatment of monocrotaline-induced PH in rats and hypoxia-induced PH in mice with the PDGF-BB receptor antagonist imatinib. In conclusion, short-term hypoxic exposure induced prominent changes in lung protein regulation. These very early changes allowed us to identify potential triggers of PH. Thus, respective 2DE analysis can lead to the identification of new target proteins for the possible treatment of PH.
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http://dx.doi.org/10.1002/pmic.201200206DOI Listing
January 2013

Right-sided approach for management of left-main-bronchial stump problems.

Eur J Cardiothorac Surg 2011 Oct 8;40(4):926-30. Epub 2011 Mar 8.

Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain.

Objective: Although the incidence of bronchopleural fistula (BPF) has decreased in the past decades, it remains a serious complication following pulmonary resection. The management of left-sided bronchial stump fistulas is difficult and depends on the choice of the approach. In contrast to several surgical procedures published in the past, herein we report our experience managing five left-main-bronchial stump (LMBS) problems through a right thoracotomy route.

Methods: Five women, who underwent left pneumonectomy and later developed BPF, were managed with this novel procedure at our Institution. BPF appeared between 12 days and 24 years after pneumonectomy. Diagnosis of BPF or bronchoesophageal fistula (BEF) was made by computed tomography (CT) scan and fiberoptic bronchoscopy. Through a right posterolateral thoracotomy incision, the LMBS was re-stapled and covered with pedicled flaps in all cases. In patient #4, carinal resection was performed also, with temporary extracorporeal membrane oxygenation (ECMO) application.

Results: The main results are depicted in the table. In all cases, encircling of the LMBS and stapling at the level of the carina was performed without difficulties. In patients #1, #2 and #3, resection of the bronchial stump remnant was also done and, in patient #4, carinal resection was also performed. All patients are doing well, with no evidence of recurrence of fistula.

Conclusions: We advocate the right posterolateral thoracotomy route for the management of left-sided BPFs as an alternative to transternal transpericardial and transthoracic closures. It is a safe, feasible and time-efficient approach that provides control of central structures and avoids previously manipulated or infected operative fields.
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http://dx.doi.org/10.1016/j.ejcts.2010.10.044DOI Listing
October 2011

Efficacy and safety of TachoSil® versus standard treatment of air leakage after pulmonary lobectomy.

Eur J Cardiothorac Surg 2010 Dec 11;38(6):683-9. Epub 2010 Jun 11.

Vienna University Hospital, Vienna, Austria.

Objectives: Alveolar air leakage remains a serious problem in lung surgery, being associated with increased postoperative morbidity, prolonged hospital stay and greater health-care costs. The aim of this study was to evaluate the sealing efficacy and safety of the surgical patch, TachoSil®, in lung surgery.

Methods: Patients undergoing elective pulmonary lobectomy who had grade 1 or 2 air leakage (evaluated by the water submersion test) after primary stapling and limited suturing were randomised at 12 European centres to open-label treatment with TachoSil® or standard surgical treatment (resuturing, stapling or no further treatment at the surgeons' discretion). Randomisation was performed during surgery using a centralised interactive voice response system. Duration of postoperative air leakage (primary end point), reduction of intra-operative air leakage intensity (secondary end point) and adverse events (AEs), including postoperative complications, were assessed.

Results: A total of 486 patients were screened and 299 received trial treatment (intent-to-treat (ITT) population: TachoSil®, n=148; standard treatment, n=151). TachoSil® resulted in a reduction in the duration of postoperative air leakage (p=0.030). Patients in the TachoSil® group also experienced a greater reduction in intra-operative air leakage intensity (p=0.042). Median time until chest drain removal was 4 days with TachoSil® and 5 days in the standard group (p=0.054). There was no difference between groups in hospital length of stay. AEs were generally similar in both groups, including postoperative complications.

Conclusions: TachoSil® was superior to standard surgical treatment in reducing both postoperative air leakage duration and intra-operative air leakage intensity in patients undergoing elective pulmonary lobectomy.
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http://dx.doi.org/10.1016/j.ejcts.2010.03.061DOI Listing
December 2010

Considerations on infectious complications using a drowned lung for transplantation.

Transpl Int 2010 Jul 5;23(7):e32-4. Epub 2010 May 5.

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Recently, the applicability of lungs from drowned victims for transplantation has been anecdotically described in literature. However, no data exist about hazards or limitations. Herein, we describe a case of lung transplantation from a submersion victim and the subsequent development of an Aeromonas hydrophila infection in the implanted organ. Based on this case we propose standard procedures, which should be followed when considering drowned donor lungs, in order to minimize risks for infectious complications.
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http://dx.doi.org/10.1111/j.1432-2277.2010.01099.xDOI Listing
July 2010

Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma.

Eur J Cardiothorac Surg 2008 Jul 14;34(1):204-7. Epub 2008 Apr 14.

Department of Cardio-Thoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: Malignant pleural mesothelioma is a mainly asbestos-related neoplasm that occurs with increasing frequency and is associated with a poor prognosis. Extrapleural pneumonectomy which was initially performed as a stand-alone treatment in patients with resectable disease is now currently almost uniformly applied as part of a multi-modal approach. Its value and advantage over other therapeutic strategies remain points of discussion. We therefore analysed our experience with extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.

Methods: We retrospectively reviewed our institutional experience with all consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma from 1994 to 2005. Patients were analysed with regard to hospital mortality and morbidity and long-term outcome.

Results: Forty-nine patients (10 female/39 male, mean age 58+12 years) underwent extrapleural pneumonectomy during the observation period. Median ICU stay was 1 day, median postoperative length of hospital stay was 13 days. After a mean follow-up of 2573 days, median survival was 376 days (mean 672+121 days, range 9-3384). One-year survival was 53%, 3-year survival 27% and 5-year survival 19%.

Conclusion: Extrapleural pneumonectomy as part of a multi-modality treatment regimen is a good treatment option for selected patients with malignant pleural mesothelioma. The long-term results of this limited series compare favourably to non-surgical treatment regimens. Larger randomised prospective multi-centre trials are warranted to establish clear guidelines.
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http://dx.doi.org/10.1016/j.ejcts.2008.03.003DOI Listing
July 2008

Haemodynamic complications after pneumonectomy: atrial inflow obstruction and reopening of the foramen ovale.

Eur J Cardiothorac Surg 2008 Feb 3;33(2):268-71. Epub 2007 Dec 3.

Department of Cardio-Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Background: Haemodynamic impairments after pneumonectomy are rare complications and present in different forms. Due to a low awareness of these potential complications their diagnosis is difficult and often established late. The most important forms are: firstly reopening of a previously closed foramen ovale (PFO) caused by a combination of changed anatomic position of the left atrium and elevated pulmonary artery pressure leading to a significant right-left shunt; secondly diaphragmatic relaxation can lead to a dislocation of the liver into the right hemithorax, compressing the right atrium with subsequent inflow obstruction.

Methods: We retrospectively analysed our patient cohort from 1997 to 2006 for occurrence of haemodynamic complications requiring surgical intervention after pneumonectomy.

Results: Five hundred and forty-six pneumonectomies were performed in our centre during the observation period. Five patients (1 female, 4 male, age 59+/-9 years) with haemodynamic complications were identified. Two of those patients were referred with haemodynamic complications after pneumonectomy was performed in a peripheral centre. All patients had undergone right pneumonectomy for NSCLC (n=4) or atypical carcinoid (n=1). Two patients were readmitted 3 months and 2 years postoperatively due to increasing platypnoea and orthodeoxia. After closure of the reopened foramen ovale, which was found as the underlying pathological mechanism, respiratory symptoms were resolved. One patient required reintubation 2h postoperatively; after surgical closure of a PFO the respiratory situation significantly improved. One patient was readmitted due to right atrial inflow obstruction 17 months after right pneumonectomy. Underlying cause was a severe diaphragmatic relaxation with compression of the atrium by the liver. After diaphragmatic plication all symptoms resolved. However 1 year thereafter reoperation for recurrence of diaphragmatic elevation was required. One patient was readmitted 3 months after pneumonectomy and partial atrial resection for cyanosis and dyspnoea. Diagnostics revealed a PFO and a massive raise of the right diaphragm with compression of the right atrium. After surgical correction of the contorted foramen ovale and diaphragmatic plication, symptoms vanished.

Conclusion: Haemodynamic alterations due to a reopened foramen ovale or right atrial inflow obstruction are rare, however they are severe complications after pneumonectomy. They occur at variable points in time after pneumonectomy. Diagnostic efforts are often made at a late stage due to a low awareness of the problem. Closure of the PFO either surgical or interventional and/or plication of the elevated diaphragm are mandatory. In our experience these complications occur only after right pneumonectomy.
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http://dx.doi.org/10.1016/j.ejcts.2007.10.020DOI Listing
February 2008

Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections.

Ann Thorac Surg 2007 May;83(5):1635-9

Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.

Background: The performance of endovascular stent-graft placement in patients suffering from aneurysms involving the descending aorta originating from chronic type B dissections is unclear.

Methods: Within a 2-year period, we treated 6 patients with this pathology. Four patients required extension of the proximal landing zone (autologous double transposition, n = 2; subclavian-to-carotid artery transposition, n = 2) before stent-graft placement.

Results: Supra-aortic rerouting procedures and endovascular stent-graft placement were performed successfully in all patients. Closure of the primary entry tear, full expansion of the stent-graft, and eventually, thrombosis of the false lumen was achieved in 5 patients. In 1 patient with a short proximal landing zone, a persisting type Ia endoleak was observed. In all patients with successful primary entry closure, a reduction in aneurysm diameter occurred. Mean follow-up is 16 months (range, 4 to 25).

Conclusions: Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections may serve as a valuable treatment option in this complex pathology. The chronic dissection membrane can be successfully compressed against large areas of the native aortic wall. A sufficient proximal landing zone is mandatory for early and late success.
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http://dx.doi.org/10.1016/j.athoracsur.2006.12.041DOI Listing
May 2007

Donor total lung capacity predicts recipient total lung capacity after size-reduced lung transplantation.

J Heart Lung Transplant 2005 Dec 6;24(12):2098-102. Epub 2005 Sep 6.

Department of Cardiothoracic Surgery, Vienna Medical University, Vienna, Austria.

Background: Size-reduced lung transplantation has only recently undergone widespread use, especially in highly urgent cases. However, it is still not considered standard procedure at most centers. It has the potential to alleviate the donor organ shortage by allowing the use of oversized grafts for small and pediatric recipients. Limited data exist on pre-operative parameters predicting functional outcome after lung transplantation in general, especially after size-reduced lung transplantation.

Methods: All 98 patients undergoing primary lung transplantation during a 2-year period, including 27 size-reduced lung transplantations, were analyzed retrospectively. Pre-operative functional parameters were-after correction of estimated values according to the amount of size reduction-correlated with post-operative functional assessment. Actual and predicted total lung capacity (TLC) of transplant recipients and predicted TLC of donors was compared with the best post-operative TLC achieved within 12 months after transplantation.

Results: Size-reduced lung transplantation was performed in 27 cases. Downsizing was achieved by lobar transplantation (n = 9), split-lung transplantation (n = 2) or peripheral segmental resection (n = 16). There was a statistically highly significant (p < 0.01) correlation between donor TLC and best recipient TLC achieved after transplantation (Pearson's correlation coefficient = 0.675). No statistically significant correlation was seen between pre-operative recipient actual TLC and best post-operative TLC (p = 0.87; Pearson's correlation coefficient = 0.415). In standard lung transplant recipients post-operative TLC was correlated with both donor predicted TLC (p < 0.01; Pearson's correlation coefficient = 0.509) and actual pre-operative recipient TLC (p < 0.01; Pearson's correlation coefficient = 0.667).

Conclusions: Post-operative recipient TLC in size-reduced lung transplantation can be predicted by donor TLC rather than pre-operative recipient TLC.
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http://dx.doi.org/10.1016/j.healun.2005.04.018DOI Listing
December 2005

Initial experience with oral valganciclovir for pre-emptive cytomegalovirus therapy after lung transplantation.

Wien Klin Wochenschr 2005 Jul;117(13-14):480-4

Department of Cardiothoracic Surgery, Vienna General Hospital, Vienna Medical University, Vienna, Austria.

Background: The most common opportunistic viral pathogen after lung transplantation is cytomegalovirus (CMV). Oral valganciclovir, a prodrug of ganciclovir, has been introduced as a potential drug for prophylaxis and treatment of CMV infection and disease in lung transplantation. The goal of this study was to describe our initial experience with oral valganciclovir for pre-emptive treatment of CMV infections after lung transplantation.

Methods And Patients: We summarize our experience with 19 patients who underwent lung transplantation and received pre-emptive oral valganciclovir therapy in the situation of positive CMV polymerase chain reaction (PCR) in either plasma or bronchoalveolar lavage. None of the patients presented with manifest CMV disease. Treatment dosage of valganciclovir was 450 mg to 1800 mg daily, depending on renal function and white blood count. Treatment was continued until the CMV PCR became negative, in any case for a period of at least 14 days.

Results: Three patients received two courses of pre-emptive oral valganciclovir; 16 patients were treated once. Eleven patients (57.9%) were treated because of a positive plasma CMV PCR; in eight patients (42.1%) the PCR was positive only in bronchoalveolar lavage. Therapy was initiated 896 +/- 1186 days (range, 108-3911) after transplantation with a mean CMV PCR of 45,536 +/- 149,294 copies (range, 426-706,000). In all cases the PCR fell below detectability (<400 copies) after a period of 22 +/- 10 days of treatment (range, 7-50 days). Mild to moderate leucopenia was observed in seven patients (36.8%) during treatment. None of the patients developed new onset of other potentially drug-related disorders such as neutropenia, anemia, deterioration of renal function or gastrointestinal disorder.

Conclusions: Pre-emptive therapy with oral valganciclovir for CMV infections detected by PCR in either plasma or bronchoalveolar lavage after lung transplantation seems to be efficacious and safe. However, regular blood counts should be performed to detect developing leucopenia.
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http://dx.doi.org/10.1007/s00508-005-0413-0DOI Listing
July 2005

Inverse T incision provides improved accessibility to the upper mediastinum.

J Thorac Cardiovasc Surg 2005 Jan;129(1):221-3

Department of Cardio-Thoracic Surgery, University Hospital of Vienna, Austria.

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http://dx.doi.org/10.1016/j.jtcvs.2004.04.036DOI Listing
January 2005

Split lung transplantation with intraoperative extracorporeal membrane oxygenation (ECMO) support.

Multimed Man Cardiothorac Surg 2005 Jan;2005(809):mmcts.2004.000984

Medical University of Vienna, Department of Cardio-Thoracic Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Pulmonary bipartitioning or split lung transplantation, which was first described in 1997, presently represents the most efficient use of donor lungs. With this technique, a left donor lung can be separated into an upper and lower lobe and used for bilateral transplantation in a smaller recipient. The right donor lung remains for use as a single lung graft in another patient. In 2001, a similar technique for splitting a right lung was described. The technique of harvesting and procurement of the donor organ for split lung transplantation is identical to the standard lung transplantation technique. The final separation of the donor lung is performed at the level of the interlobar fissure immediately prior to implantation. The lower lobe is implanted in the left recipient hemithorax, whereas the upper lobe, after closing of the central end of the left main pulmonary artery, and a 180° rotation along the vertical axis, is grafted into the right hilus. The use of extracorporeal membrane oxygenation (ECMO) provides intraoperative hemodynamic stability and protects the first implanted lobe from overflow and resulting reperfusion injury. This report discusses the technique developed at the department of cardiothoracic surgery of the Medical University of Vienna.
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http://dx.doi.org/10.1510/mmcts.2004.000984DOI Listing
January 2005

Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula.

Ann Thorac Surg 2005 Jan;79(1):284-8

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: Bronchopleural fistula is a serious complication after pneumonectomy. The aim of this retrospective study was to investigate the efficacy of bronchial stump reinforcement with a pedicled flap of whole pericardium.

Methods: The bronchial stump of 93 consecutive patients who underwent pneumonectomy between July 1988 and March 2003 was covered with a pedicled pericardial flap. Pneumonectomy was performed for primary lung cancer in 89.2% of patients. The study patients received concomitant extensive mediastinal lymphadenectomy, resection of adjacent structures (aorta, vena cava, thoracic wall), and neoadjuvant or planned adjuvant chemotherapy or radiotherapy, or both. Operative and perioperative complications were recorded, and patients were followed up for a mean of 15 +/- 21.2 months (range, 9 to 126).

Results: Perioperative mortality was 4.3% (n = 4; pulmonary embolism, sepsis, cardiac arrest, and sudden death in 1 patient each). Perioperative complications occurred in 2 patients: renal failure and hemiplegia in 1 patient and cardiac tamponade in 1 patient. The latter complication, caused by tight reconstruction of the pericardium, was directly related to the applied method and required reoperation. No evidence of postpneumonectomy bronchopleural fistula was observed perioperatively and during the whole follow-up. One-year and 2-year survival was 65.7% and 44.8%, respectively.

Conclusions: Bronchial stump reinforcement with a pericardial flap is a highly effective method for preventing postpneumonectomy bronchopleural fistula in selected patients.
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http://dx.doi.org/10.1016/j.athoracsur.2004.06.108DOI Listing
January 2005