Silviu Gabriel Vlasceanu

Background/Objectives: Sleeve lobectomy serves as a parenchyma-sparing alternative to pneumonectomy for central non-small cell lung cancer (NSCLC). This study describes and compares early postoperative outcomes and overall survival between sleeve lobectomy and pneumonectomy and explores factors associated with survival. Methods: A retrospective cohort analysis was conducted on 97 consecutive patients with central NSCLC operated at the Marius Nasta National Institute of Pneumophthisiology between September 2021 and December 2022, with follow-up through 1 March 2025. Patients were divided into two groups: sleeve lobectomy (n = 41) and pneumonectomy (n = 56). Early morbidity, mortality, and overall survival were evaluated using univariate analysis and multivariable Cox proportional hazards regression. Results: After multivariable adjustment, surgical procedure was not significantly associated with overall survival. A low rate of major anastomotic complications was observed in the sleeve lobectomy group, with one case of early partial anastomotic leak (2.44%) requiring surgical reinforcement. In an exploratory multivariable model, pathological nodal involvement and the number of involved lymph nodes were associated with mortality. Conclusions: In appropriately selected patients where an R0 parenchyma-sparing resection is technically feasible, sleeve lobectomy is associated with acceptable morbidity and survival. After adjustment, the surgical procedure was not significantly associated with overall survival. Nodal disease burden was the factor most strongly associated with survival in this cohort.

Background: Romania continues to experience one of the highest tuberculosis (TB) burdens in the European Union/European Economic Area. During the COVID-19 pandemic, reduced inpatient capacity accelerated the use of ambulatory care for patients with drug-susceptible tuberculosis (DS-TB). This study evaluated treatment outcomes, outcome ascertainment, hospitalization requirements, and factors associated with unfavorable outcomes among patients managed through ambulatory TB services. Methods: We conducted a retrospective observational cohort study of adults with pulmonary or extrapulmonary DS-TB managed through ambulatory tuberculosis dispensaries affiliated with the “Marius Nasta” Institute of Pneumophthisiology, Bucharest, Romania, between January 2020 and December 2022. Treatment outcomes were defined according to World Health Organization criteria. Factors associated with unfavorable outcome were assessed using Firth penalized-likelihood logistic regression. Hospitalization during treatment was analyzed as a secondary outcome. Results: The final cohort comprised 545 patients with DS-TB, with a mean age of 44.8 years and 56.1% being male. Overall, 281 of 545 patients achieved treatment success, corresponding to a WHO-defined treatment-success rate of 51.6%. Twenty-seven patients (5.0%) experienced an unfavorable outcome, while 237 (43.5%) were classified as not evaluated. Among the 308 patients for whom a determinate end-of-treatment outcome was available, 281 (91.2%) achieved treatment success; however, this conditional proportion does not represent the programmatic treatment-success rate for the entire cohort. Conclusions: Structured ambulatory DS-TB care was operationally feasible within this tertiary-care-linked dispensary network during the COVID-19 pandemic. However, the WHO-defined treatment-success rate for the entire cohort was 51.6%, largely reflecting the substantial proportion of patients without an evaluable final outcome. The high proportion of not-evaluated patients represents an important programmatic weakness and limits conclusions regarding the effectiveness of the ambulatory model. Improved outcome ascertainment and continuity of follow-up are essential components of decentralized TB care.

Background: Malignant tracheal stenosis (MTS) is a rare, life-threatening condition caused by primary tracheal tumor, mainly adenoid cystic carcinoma (ACC) and squamous cell carcinoma (SCC), and more rarely other primary neoplasms such as lymphomas, or local extension/metastasis from adjacent malignancies (thyroid, esophageal, lung, or mediastinal cancers). Accounting for <0.1% of respiratory tumors, MTS presents with progressive respiratory failure, requiring urgent multidisciplinary care involving thoracic surgery, interventional pulmonology, oncology, and intensive care. Diagnosis relies on clinical evaluation, advanced imaging and endoscopy. Bronchoscopy (BC) remains the best investigation for direct visualization and biopsy or performing therapeutic maneuvers. Prognosis depends on histology, local extent, and achieving R0 resection. Tracheal resection with primary anastomosis remains the curative standard for resectable cases. Interventional procedures (debulking, laser, cryotherapy, stenting) are essential for palliative management and acute stabilization. Methods: A structured (non-systematic) search of PubMed/MEDLINE, Embase, Scopus, and Web of Science (1965–2025) was performed using MeSH/Emtree terms and free-text keywords. Studies were included if they evaluated adult patients with malignant central airway stenosis, primary tracheal tumors, or secondary invasion undergoing surgical, bronchoscopic, or multimodal interventions, including ECMO support. Results: Malignant tracheal stenosis (MTS)—predominantly adenoid cystic and squamous cell carcinomas—imposes a critical clinical burden despite its low incidence. Complete surgical resection with negative margins remains the curative treatment for resectable disease. In unresectable cases, multimodal palliative interventions (stenting, laser/electrocautery ablation, and mechanical debulking) provide rapid airway restoration and quality-of-life improvements, whereas ECMO is an established rescue or adjunctive support strategy in selected critical airway procedures performed in experienced centers. Three-dimensional bioprinting and tissue-engineered reconstruction remain experimental or early clinical, and bioresorbable stents and artificial intelligence (AI)-based tools remain investigational; none is currently part of routine MTS management. Conclusions: R0 resection for appropriately selected resectable disease and interventional airway management for unresectable symptomatic disease are the best-supported strategies, although the evidence derives mainly from retrospective series from specialized centers. Emerging technologies require prospective validation before clinical adoption. Management should be individualized, multidisciplinary and centralized in experienced airway centers.

Background: Romania continues to experience one of the highest tuberculosis (TB) burdens in the European Union/European Economic Area. During the COVID-19 pandemic, reduced inpatient capacity accelerated the use of ambulatory care for patients with drug-susceptible tuberculosis (DS-TB). This study evaluated treatment outcomes, outcome ascertainment, hospitalization requirements, and factors associated with unfavorable outcomes among patients managed through ambulatory TB services. Methods: We conducted a retrospective observational cohort study of adults with pulmonary or extrapulmonary DS-TB managed through ambulatory tuberculosis dispensaries affiliated with the “Marius Nasta” Institute of Pneumophthisiology, Bucharest, Romania, between January 2020 and December 2022. Treatment outcomes were defined according to World Health Organization criteria. Treatment success was calculated among patients with a determinate outcome and complemented by best-case/worst-case sensitivity analyses for patients classified as not evaluated. Factors associated with unfavorable outcome were assessed using Firth penalized-likelihood logistic regression. Hospitalization during treatment was analyzed as a secondary outcome. Results: The final cohort comprised 545 patients with DS-TB, with a mean age of 44.8 years and 56.1% being male. Among 308 patients with a determinate end-of-treatment outcome, 281 achieved treatment success and 27 experienced an unfavorable outcome, corresponding to a treatment-success rate of 91.2% (95% CI 87.5–94.1). However, 237 patients (43.5%) were classified as not evaluated; sensitivity analyses yielded treatment-success estimates ranging from 51.6% to 95.0%. Male sex was associated with unfavorable outcome in univariable analysis (OR 2.43, 95% CI 1.03–6.54; p = 0.042), but the association was no longer statistically significant after adjustment (aOR 2.70, 95% CI 0.90–10.67; p = 0.079). No other baseline factor was significantly associated with unfavorable outcome. Documented non-compliance was markedly more frequent among patients with unfavorable outcomes and was interpreted as a treatment-process indicator rather than a baseline prognostic factor. Hospitalization was required in 24 of 483 patients (5.0%), and adverse drug reactions were strongly associated with hospitalization (OR 5.95, 95% CI 2.55–13.72; p < 0.001). Conclusions: Structured ambulatory DS-TB care was feasible during the COVID-19 pandemic within a tertiary-care-linked dispensary network, with high treatment success among patients with known outcomes and a low requirement for hospitalization. However, the substantial proportion of patients without an evaluable final outcome limits interpretation of the overall success estimate. The findings emphasize the importance of complete outcome ascertainment, adherence support, adverse-event surveillance, and clear referral pathways in ambulatory TB programs. Prospective multicenter studies with comparator groups are needed to establish the long-term effectiveness, safety, and scalability of this model.

Background and Clinical Significance: Solitary fibrous tumor (SFT), historically termed hemangiopericytoma (HPC), is a rare fibroblastic mesenchymal neoplasm with variable biological behavior. Pulmonary involvement is uncommon and may represent either a primary thoracic tumor or metastatic disease from an extrapulmonary site. Its clinical course ranges from indolent, surgically curable disease to aggressive malignancy with local recurrence and distant dissemination. In this retrospective case, confirmatory STAT6 immunohistochemistry was unavailable; therefore, the tumor is described as a hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Case Presentation: We report the case of a 33-year-old woman who presented with sudden-onset hemoptysis and was found to have two large, well-defined bilateral pulmonary masses. Initial clinical and radiological evaluation raised suspicion of primary pulmonary tumors or other benign lesions. Because both lesions were considered resectable, staged pulmonary resections were performed. Subsequent reassessment of the patient’s medical history revealed previous surgeries for a poorly documented recurrent thigh tumor, later confirmed to represent the primary malignant hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Despite staged pulmonary resections, systemic chemotherapy, and further oncologic management, the disease progressed rapidly, with cerebral, bilateral pulmonary, mediastinal, and subcutaneous metastases. The patient died within 18 months of the initial pulmonary diagnosis. Conclusions: This case highlights the diagnostic difficulty of metastatic pulmonary hemangiopericytoma, particularly when the primary soft tissue tumor is inadequately documented. It emphasizes the importance of detailed clinical history, retrieval of previous histopathological reports, and long-term surveillance in patients with soft tissue tumors, even when initially considered benign.

Background: Endobronchial tumors represent a heterogeneous spectrum of benign and malignant histopathological types. Selecting the optimal surgical strategy remains a multidisciplinary challenge. This study evaluates how the integration of spirometry, DLCO, and CPET can objectively stratify cardiorespiratory risk and guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality. Methods: A single-center, retrospective study was conducted between 2020 and 2025, evaluating an initial screening cohort of 93 patients with endobronchial masses. Following multidisciplinary tumor board review based on functional and anatomical criteria, 36 patients were excluded from major resection due to extensive disease or prohibitive functional risk, while 57 underwent tailored surgical interventions, including sleeve resections, lobectomies, bilobectomies, and pneumonectomies. Preoperative evaluation included spirometry, DLCO, cardiological assessment, CT, and autofluorescence bronchoscopy (AFB). Results: Spearman correlation analysis demonstrated that advanced age and higher ASA scores significantly correlated with reduced preoperative DLCO (p < 0.0001). The overall postoperative morbidity rate was 36.84% (n = 21) and perioperative mortality was 5.26% (n = 3). Stratified analysis by surgical magnitude demonstrated a significant escalation in overall complication rates from parenchymal-sparing sleeve resections (17.6%, 95% CI: 3.8% to 43.4%) to standard lobectomies (40.7%, 95% CI: 22.4% to 61.2%), bilobectomies (50.0%, 95% CI: 15.7% to 84.3%), and radical pneumonectomies (60.0%, 95% CI: 14.7% to 94.7%; p = 0.042). Severe morbidity (Clavien–Dindo Grade III–IV) was significantly lower in the sleeve resection subgroup (5.8%) compared to pneumonectomies (40.0%, p = 0.015). Fatal outcomes occurred exclusively following major resections and were attributable to ARDS and acute cardiovascular events. Conclusions: A multi-parametric preoperative protocol provides an informative framework for risk stratification in endobronchial tumor surgery, helping to describe baseline reserves and explore post-resection trends. However, the anatomical and hemodynamic magnitude of radical pneumonectomy constitutes an independent risk modifier that cannot be fully captured by preoperative functional testing alone, highlighting the exploratory nature of these single-center retrospective observations rather than a definitive algorithmic validation.

(TB) induces a pronounced thromboinflammatory state during active disease, characterized by elevated fibrinogen, D-dimer, and thrombin-related activity, reduced levels of endogenous anticoagulants, impaired fibrinolysis, platelet activation, and endothelial dysfunction. Although many of these abnormalities improve after treatment initiation, accumulating evidence suggests that microbiological cure may not fully restore vascular, immune, and hemostatic homeostasis. This raises the possibility that TB leaves a persistent thromboinflammatory imprint after cure. This narrative synthesizes current evidence on tuberculosis-associated hypercoagulability during active disease and after treatment, and proposes a conceptual framework for post-tuberculosis thromboinflammatory memory grounded in cellular persistence, tissue remodeling, and extracellular vesicle-mediated signaling. Candidate storage compartments include hematopoietic stem and progenitor cells, monocyte/macrophage lineages, alveolar macrophages, remodeled pulmonary endothelium, and fibrotic post-TB lung tissue. EVs may function as mobile vectors that transfer procoagulant phospholipids, tissue factor, inflammatory proteins, and regulatory microRNAs between these compartments, thereby linking local post-TB remodeling to systemic vascular and coagulation pathways. A mechanistic evidence ladder is proposed, encompassing phenotypic persistence, EV cell-of-origin attribution, molecular persistence, paired longitudinal validation, functional transfer, and clinical outcome linkage. Current data support the biological plausibility of this framework but remain insufficient to establish post-TB thromboinflammatory memory as a defined clinical entity. Direct evidence in long-term TB survivors is still lacking, particularly with respect to persistent EV signatures, cell-specific reservoirs, and the functional transfer of procoagulant phenotypes. Longitudinal, cell-resolved, multi-omic, and functionally validated studies are required to determine whether TB leaves a durable thromboinflammatory memory, where it is stored, and whether it contributes to long-term thrombotic and cardiovascular risk. This article should be interpreted as a narrative review with a conceptual framework rather than as evidence that post-tuberculosis thromboinflammatory memory is already a formally established clinical entity.

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses.

Preserved ratio impaired spirometry (PRISm) is increasingly recognized as a clinically important non-obstructive spirometric phenotype associated with excess all-cause, respiratory, and cardiovascular mortality. PRISm is variably defined across studies and should be distinguished from pre-COPD and restrictive spirometric pattern, particularly in LMIC settings where diagnostic context may differ. Although most evidence has been generated in high-income settings, PRISm may be especially relevant in low- and middle-income countries (LMICs), where the phenotype appears to arise within a markedly different exposure environment. Rather than reflecting predominantly the smoking–obesity–metabolic profile commonly described in wealthier populations, PRISm in LMICs may more often emerge from the cumulative effects of tuberculosis, household biomass smoke, ambient particulate air pollution, poverty-related undernutrition, impaired lung growth, and other adverse life-course exposures. These factors may contribute both to low-volume lung-function impairment and to increased cardiovascular risk through shared pathways of chronic low-grade inflammation, immune activation, oxidative stress, endothelial dysfunction, and metabolic dysregulation. In this context, PRISm may represent a measurable interface between environmental and infectious lung injury, social disadvantage, and systemic vascular vulnerability. The emerging literature further suggests that PRISm in LMICs may include distinct leaner, poverty-related, and infection-linked phenotypes that differ from the obesity-associated patterns more often described in high-income cohorts. This perspective has important clinical implications, as PRISm may identify individuals at elevated risk of cardiometabolic comorbidity, heart failure, stroke, and cardiovascular death who may otherwise remain unrecognized within current respiratory care pathways. Although direct causal evidence remains limited, the convergence of epidemiological, mechanistic, and clinical data supports the view that PRISm in LMICs should be considered a meaningful cardiopulmonary risk state rather than a benign spirometric abnormality. Further LMIC-focused longitudinal, mechanistic, and implementation research is needed to refine phenotyping, clarify causal pathways, and inform integrated prevention strategies.

Tuberculosis–diabetes mellitus (TB-DM) is increasingly recognized as a syndemic in which chronic metabolic dysregulation amplifies tuberculosis severity, delays treatment response, and increases relapse and mortality. However, conventional systemic correlates soluble cytokines and bulk whole-blood transcriptomic signatures often appear broadly similar between TB and TB-DM. This highlights a key gap: clinically meaningful immune dysfunction in TB-DM likely resides in specific lung and blood cell states that are poorly resolved by bulk assays. Small extracellular vesicles (EVs) in plasma and bronchoalveolar lavage (BAL) provide a tractable “liquid biopsy” layer because their RNA and protein cargo can integrate information from infected macrophages, neutrophils, and epithelial/endothelial compartments, and may also include pathogen-derived components. Yet most EV studies remain bulk and cell-agnostic, and interpretation is constrained by heterogeneous vesicle mixtures, selective cargo packaging, and co-isolated non-vesicular contaminants, issues that are especially problematic for nucleic-acid claims without rigorous controls. In this targeted narrative review (2010–2026), we argue that single-cell and multimodal immune reference atlases, including scRNA-seq/CITE-seq, provide a needed scaffold to link EV cargo patterns to specific immune cell states, pathways, and anatomic compartments in TB-DM, enabling prioritized candidates and testable hypotheses. We outline three complementary frameworks: reference-atlas anchoring to project EV cargo modules onto atlas-defined immune states; orthogonal triangulation combining computational inference with immunoaffinity enrichment, targeted validation, and functional assays; and cautious use of “droplet-era” extracellular signals as hypothesis-generating priors for EV-producing states. Implemented in longitudinal, clinically annotated cohorts with standardized EV workflows, atlas-guided EV profiling could yield cell-of-origin–resolved biomarkers of TB-DM immunopathology and treatment response, while prioritizing mechanistically plausible targets for host-directed intervention.