Background: A tracheoesophageal fistula (TEF) represents a condition characterized by abnormal communication between the gastrointestinal tract and the airways. Although the current gold-standard treatment is surgery, pre-existing clinical conditions may represent contraindications. We therefore propose a bronchoscopic approach through rigid bronchoscopy without tracheostomy for total repair in patients suffering from benign tracheoesophageal fistulas. Methods: Fistula suture through rigid bronchoscopy with either absorbable (Vycryl 3.0, Ethicon, Inc.) or non-absorbable (Prolene, Ethicon US, LLC. 2022.) sutures was performed using a long needle holder as an alternative resolutive procedure to surgery. From 2015 to 2022, we retrospectively reviewed 10 consecutive patients affected by TEFs in our Endoscopic Unit at San Camillo-Forlanini Hospital (Rome, Italy) who underwent this bronchoscopic procedure. The coprimary outcomes were the proportion of fistulas successfully treated with the innovative treatment proposed and the rate of procedure-related complications. Results: The complete healing of the fistula was achieved in nine of the ten patients after 1 year. Follow-up with flexible bronchoscopy was scheduled and carried out at 1, 3, and 12 months following rigid bronchoscopy. Overall, seventeen endoscopic repair procedures were performed. Five of these patients required more than one endoscopic treatment to reach complete fistula closure. Fistula closure was not achieved post-procedure in one patient. No complications during procedures or in the follow-up period were reported. Conclusions: Despite the small cohort, our preliminary study has demonstrated that the endoscopic approach through rigid bronchoscopy, without tracheostomy, represents a safe and satisfactory alternative for patients affected by TEFs who are not suitable for surgery.

Background: The impact of cigarette smoking on cardiopulmonary function in elite athletes remains poorly characterised. This study aimed to evaluate the prevalence of smoking and its effects on pulmonary and exercise performance parameters among top-level competitors across different sport disciplines. Methods: 1005 Olympic-level athletes participating underwent comprehensive pre-participation screening, including spirometry and cardiopulmonary exercise testing (CPET). Smoking status was determined according to WHO definitions. Results: Among the 1005 athletes (53.4% males; mean age 26 ± 8.8 years), 117 (11.6%) were current smokers, predominantly males (70.9%). No smokers were identified among endurance athletes. Compared to non-smokers (n = 679), smokers were older (28 ± 5.8 vs. 25.5 ± 10.4 years, p = 0.026) and more frequently involved in mixed and skill disciplines (p = 0.043 and p = 0.006, respectively). In male smokers, spirometry revealed lower FVC (97.2 ± 10.3% vs. 101.1 ± 11.7%, p = 0.006), FEV₁ (97.3 ± 12.4% vs. 101.4 ± 10.3%, p = 0.002), and MVV (p = 0.010). CPET showed reduced functional capacity (W/kg, p < 0.0001), lower VO₂max (38.5 ± 7.8 vs. 42.2 ± 6.8 mL/min/kg, p < 0.0001), decreased O₂ pulse (p = 0.007) and lower first and second ventilatory thresholds (respectively p = 0.025; and p = 0.004), Similar but less pronounced reductions in VO₂max were found in female smokers (p = 0.003). Conclusions: Chronic smoking is associated with early spirometric and ventilatory impairments in elite athletes associated with lower aerobic capacity, despite their high levels of fitness. These effects are more marked in males, while females may exhibit partial protection. These findings highlight the importance of integrating smoking cessation and respiratory monitoring into athlete health programs.

Common variable immunodeficiency (CVID) is a form of primary immunodeficiency characterized by a low serum level of immunoglobulins and recurrent infections. Approximately 8-22% of patients with CVID develop lymphocytic granulomatous interstitial lung disease (GLILD). The confirmation of diagnosis is histological and mostly performed on surgical lung biopsy (SLB). According to new guidelines, transbronchial lung cryobiopsy (TBLC) in ILDs offers important diagnostic information with a shorter hospital stays and less major adverse events in comparison with SLB. The aim of our retrospective observational study is to evaluate the role of TBLC in the diagnostic work-up of a cohort of GLILD patients.The patients who received a multidisciplinary diagnosis of GLILD owing to a histological diagnosis obtained by TBLC in the period from September 2011 to July 2022 were retrospectively identified from our database. Data on clinical, laboratory and broncho-alveolar lavage fluid parameters, pulmonary function tests, radiological and pathological findings were retrieved from the registries. Samples obtained by TBLC were all considered adequate and histological features characteristic for GLILD were found in all nine patients. Pneumothorax was documented in two patient (22%), but none of them required chest drainage. Minor bleeding was reported in one patient (11%) during the procedure. This study demonstrates that transbronchial cryobiopsy is a safe and minimally invasive approach for characterizing GLILD in CVID patients, providing a high diagnostic confidence and low rate of complications.

Background: It has been postulated that COVID-19 lung injury may share some features with those observed in HALI. Thus, a correct target PaO₂ during oxygen supplementation may be crucial to protect the lung from further tissue damage. Aims and objectives: 1) to evaluate the effects of conservative oxygen supplementation during Helmet CPAP therapy on mortality and ICU admission in patients with COVID-19 and respiratory failure; 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections. Methods: This was a single-center, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during Helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target PaO₂ < 100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation. Results: Seventy-one patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% vs 62.7%, p<0.001). Rates of ICU admission and new-onset rate organ failure were lower in conservative cohort (14.1% vs 37.3%, p=0.001, and 9.9% vs 45.3% p<0.001, respectively). Conclusions: In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during Helmet CPAP was associated to improved survival, lower ICU admission rate and less new-onset organ failure.