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Respiratory diseases are common cause of disability in the elderly and are often concomitant with other non-respiratory medical conditions. Interventional pulmonology includes advanced diagnostic and therapeutic techniques, successfully employed for benign and malignant pulmonary diseases with a good safety profile. A few studies are available on the efficacy and the safety of these procedures (both bronchoscopic and pleural techniques) in the elderly. Paucity of data in these patients may support reluctant clinicians. We carried out a non-systematic review aimed at describing the scientific literature on interventional pulmonology techniques in elderly patients with comorbidities. We summarized indications, performance characteristics, and safety profile of bronchoscopic techniques in the elderly, comparing outcomes between older and younger patients. We explored the role of age on anesthesia and sedation protocols during endoscopic procedures and assessed the influence of comorbidities on bronchoscopic outcomes. This review underlines that older age is not a barrier for implementing interventional pulmonology for diagnostic and therapeutic purposes.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading throughout Italy since February 2020. Limited data are available regarding indications, performance characteristics and safety of bronchoscopy (which is an aerosol generating procedure) in the context of SARS-CoV-2 outbreak. Methods: We performed a prospective, observational, multicentric study to describe the role of bronchoscopy during SARS-CoV-2 outbreak in Italy. Findings: 147 consecutive adult patients who underwent bronchoscopy between March 1st and April 15 th 2020 in five Italian hospitals were enrolled. 78/147 (53·1%) bronchoscopies were performed to detect SARS-CoV-2 in patients with negative nasopharyngeal swabs. SARS-CoV-2 was detected in 43/78 (55·1%) patients, without no difference in diagnostic yield between bronchoalveolar lavage (BAL) and bronchial washing (BW) (35/61, 57·4% and 8/17, 47·1%; p-value: 0·45). Suspected co-infections and management of obstructive atelectasis were the main indications for bronchoscopy in 31/147 (21·1%) patients with COVID-19 (respectively 11/31 (35·5%) and 7/31 (16·1%)). Suspected non-COVID-19 lower respiratory tract infections (18/38 (47·4%) and malignancy (7/38 (18·4%)) were the main indications in 38/147 (25·8%) patients without COVID-19. Overall, bronchoscopy was successfully performed for diagnostic and therapeutic purposes in 111/147 (75·5%) cases. 8/147 (5·4%) patients had mild complications related to the procedure.No procedure-related infections for patients and healthcare workers were recorded. Interpretation: bronchoscopy is a useful technique in the diagnosis of SARS-CoV-2 pneumonia in patients with negative swab. Endoscopic techniques may be safely and successfully performed for diagnostic and therapeutic purposes in the vast majority of the patients with or without SARS-CoV-2 illness. Funding: University of Milan Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the ethical committees of all the participating hospitals. Written informed consent was signed by recruited patients

Background: Since December 2019, COVID-19 has widely spread throughout the world, causing thousands of deaths. Clinical characteristics of COVID-19 patients have been widely reported, but significative disease-associated biomarkers are needed. We aimed to evaluate the prognostic power of circulating sphingosine-1-phosphate (S1P) in COVID-19, to propose S1P as a novel prognostic and predictive biomarker. Methods: Clinical and blood parameters were investigated in 111 COVID-19 patients (COV) and 47 healthy subject (HLT), with a particular focus on patients who required intensive care unit (ICU) admission. We measured serum levels of S1P and its main transporter apolipoprotein M (apoM) by ELISA assay. Correlation with clinical and blood parameters were performed by Pearson correlations. Univariable and multivariable regression analysis were performed to assess the interaction between clinically significant factors and ICU admission. Further, Cox regression was used to evaluate the prognostic power of S1P for ICU admission and mortality. Findings: We reported statistically significant alterations of several blood parameters in COV, as an increase of white blood cells, neutrophil-to-lymphocyte ratio, ferritin, D-dimer and fibrinogen, and a decrease in hemoglobin, lymphocyte count and total proteins. Our major finding is the drop of serum S1P level in COV, strongly associated with the decrease of red blood cells, the major source of plasmatic S1P, and both apoM and albumin, the most important transporters of circulating S1P. The multivariable regression analysis revealed that S1P is the most important predictor for ICU admission (OR:39·45, [95%CI:1·51-1031·60]; p=0·027), and Cox proportional-hazards model demonstrated a high power of S1P in predicting patient’s outcome. Interpretation: COVID-19 patients showed a drastic decrease of serum S1P, suggesting that circulating S1P levels may be clinically used as negative biomarkers to predict severity/mortality of COVID-19. Taken together, our results suggest that restoring S1P at physiological level may represent a novel therapeutic strategy. Funding: Italian Ministry of Health. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement:This prospective, case-control study was approved by the Ethic Committee of Ospedale San Paolo in Milan, Lombardy, Italy (COST Action n.2020/ST/057).

Pleural effusion is a frequent complication of acute pulmonary infection and can affect its morbidity and mortality. The possible evolution of a parapneumonic pleural effusion includes 3 stages: exudative (simple accumulation of pleural fluid), fibropurulent (bacterial invasion of the pleural cavity), and organized stage (scar tissue formation). Such a progression is favored by inadequate treatment or imbalance between microbial virulence and immune defenses. Biochemical features of a fibrinopurulent collection include a low pH (7.20), low glucose level (60 mg/dl), and high lactate dehydrogenase (LDH). A parapneumonic effusion in the fibropurulent stage is usually defined "complicated" since antibiotic therapy alone is not enough for its resolution and an invasive procedure (pleural drainage or surgery) is required. Chest ultrasound is one of the most useful imaging tests to assess the presence of a complicated pleural effusion. Simple parapneumonic effusions are usually anechoic, whereas complicated effusions often have a complex appearance (non-anechoic, loculated, or septated). When simple chest tube placement fails and/or patients are not suitable for more invasive techniques (i.e. surgery), intra-pleural instillation of fibrinolytic/enzymatic therapy (IPET) might represent a valuable treatment option to obtain the lysis of fibrin septa. IPET can be used as either initial or subsequent therapy. Further studies are ongoing or are required to help fill some gaps on the optimal management of parapneumonic pleural effusion. These include the duration of antibiotic therapy, the risk/benefit ratio of medical thoracoscopy and surgery, and new intrapleural treatments such as antibiotic-eluting chest tubes and pleural irrigation with antiseptic agents.

Many studies have investigated the possible impact of climate change on the distributions of plant species. In the present study, we test whether the concept of potential distribution is able to effectively predict the impact of climate warming on plant species. Using spatial simulation models, we related the actual (current species distribution), potential (modelled distribution assuming unlimited dispersal) and predicted (modelled distribution accounting for wind-limited seed dispersal) distributions of two plant species under several warming scenarios in the Sagarmatha National Park (Nepal). We found that the two predicted distributions were, respectively, seven and nine times smaller than the potential ones. Under a +3 °C scenario, both species would likely lose their actual and predicted distributions, while their potential distributions would remain partially safe. Our results emphasize that the predicted distributions of plant species may diverge to a great extent from their potential distributions, particularly in mountain areas, and predictions of species preservation in the face of climate warming based on the potential distributions of plant species are at risk of producing overoptimistic projections. We conclude that the concept of potential distribution is likely to lead to limited or inefficacious conservation of plant species due to its excessively optimistic projections of species preservation. More robust strategies should utilize concepts such as “optimal reintroduction”, which maximizes the benefit–cost ratio of conservation activities by limiting reintroduction efforts to suitable areas that could not otherwise be reached by a species; moreover, such strategies maximize the probability of species establishment by excluding areas that will be endangered under future climate scenarios.

The warming-induced increase in nutrient mineralization and the further increase in atmospheric nitrogen depositions raise the topic of whether and how alpine plants will react to enhanced nutrient availability. Despite several studies have shown the effects of fertilization on primary production of alpine plants, only few studies have considered the influences of nutrients on reproduction. Here, we investigated the effects of nitrogen (N) and phosphorus (P) amendments on cover, number of ramets, flowering effort and phenological timing of Gnaphalium supinum , an arctic-alpine widespread snowbed species. We set up an experimental design with four fertilization treatments (low N, P without additional N, low N + P, and high N + P) and an unfertilized control for three years (2003–2005), within a late snowbed located in the Italian Alps (Gavia Pass, 2700 m a.s.l.). The cover of Gnaphalium supinum was recorded at the peak of the aboveground biomass development in the three years, while the temporal dynamic of ramet density and reproductive phenophases were monitored during the 2005 growing season. The clonal growth of G. supinum resulted to be co-limited by N and P, while the flowering effort was stimulated by P. Flowering date was advanced by P supply, while N alone did not show any significant effect on phenology. In a warming scenario, with a predicted increase in N and P availability by nutrient mineralization and atmospheric deposition, this species should probably experience some benefits for its growth and reproduction if not limited by other factors such as the length of the growing season or interspecific competition.

Farmers and growers are constantly looking for high quality seeds able to ensure uniform field establishment and increased production. Seed priming is used to induce pre-germinative metabolism and then enhance germination efficiency and crop yields. It has been hypothesized that priming treatments might also improve stress tolerance in germinating seeds, leaving a sort of 'stress memory'. However, the molecular bases of priming still need to be clarified and the identification of molecular indicators of seed vigor is nowadays a relevant goal for the basic and applied research in seed biology. It is generally acknowledged that enhanced seed vigor and successful priming depend on DNA repair mechanisms, activated during imbibition. The complexity of the networks of DNA damage control/repair functions has been only partially elucidated in plants and the specific literature that address seeds remains scanty. The DNA repair pathways hereby described (Nucleotide and Base Excision Repair, Non-Homologous End Joining, Homologous Recombination) play specific roles, all of them being critical to ensure genome stability. This review also focuses on some novel regulatory mechanisms of DNA repair (chromatin remodeling and small RNAs) while the possible use of telomere sequences as markers of aging in seed banks is discussed. The significant contribution provided by Electron Paramagnetic Resonance in elucidating the kinetics of seed aging, in terms of free radical profiles and membrane integrity is reported.

New insights into the cycloaddition reaction between alkyl isocyanides and benzyliden-1,3-diketones are reported. 5-Hydroxy-N-substituted-2H-pyrrol-2-ones and not substituted furans, as previously reported, are formed. The proof of the structure relies on a thorough analytical investigation and X-ray crystallography.