Rib Cage Research Articles

Numerical analysis on heat transfer, flow structure and exergy loss of combined truncated and circular ribs in a square duct

The heat transfer, friction and exergy loss of a square duct with combined circular and trun-cated rectangular ribs are analyzed using computational fluid dynamics. The study is focused on the effect of rib arrangements on the flow and heat transfer performance. The analysis is carried out with six truncated rib angles varying between 15° and 90° and Re range of 12000 – 43000. The heat transfer is maximum in the middle part of the duct for 30° and 45° rib angles along span wise direction. The position of wake region is highly dependent on separation point over the circular rib as wake moves away radially from the axis of the duct for rib angles of 60°, 75° and 90°. The turbulent flow structures in large scale originates from side wall have marked effect on the heat transfer for the rib angles of 60°, 75° and 90° and with nearly with equal intensity for 15°, 30° and 45° rib angles. The exergy loss associated with friction is higher for 60° rib angle. While the normalized friction factor obtained with Fanning’s equation varied between 1.8 and 4.2 and thermal hydraulic performance varied between 0.2 and 1.3 for the range of reexamined.

Experimental and numerical investigation on the film-cooling a gas turbine vane pressure side with various internal rib angles

To study the effects of the internal rib angles on the film cooling performance of turbine vane, a single row of film cooling holes on the pressure side was investigated using pressure sensitive paint (PSP) technology and numerical approaches. For the four internal ribbed cooling channels (smooth channel, 30°, 60° and 90° ribs), the distributions of film cooling effectiveness at three blowing ratios (0.3, 0.5, 0.8) and two density ratios (1.0, 1.5) were studied. Experimental results showed that the 30° rib is the most effective for most working conditions, followed by the smooth channel. When the blowing ratio (M) increases from 0.3 to 0.8, the film cooling effectiveness improvement of the 30° rib increases from 32.2% to 96.4% compared with the smooth channel. With the exception of slight variations at the local level, the area-average film cooling effectiveness for various angled ribs decreases as the blowing ratio increases within the scope of the experiment. The adherence of the cooling jet improves as the density ratio increases. For different angled ribs, the spanwise coverage of the film expands, the area with high cooling effectiveness expands, and the spanwise average film cooling effectiveness increases at the downstream regions of the film holes. With the increase of blowing ratio, the increment of density ratio on film cooling effectiveness is increased. The increment ratio for the smooth channel is the largest as the density ratio increased from 1.0 to 1.5 and it reaches 135 % when blowing ratio is 0.8. The film cooling effectiveness of film discharge for a turbine vane is systematically investigated with different rib configurations. The current study is useful for designing the pressure side of turbine vanes.

Investigation of the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in unilateral breast cancer surgery survivors: a cross-sectional study.

Despite the research on structural and functional changes that may occur in breast cancer survivors, no study has investigated the relationship between spinal characteristics and the respiratory system. Therefore, we aimed to investigate the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in breast cancer patients who have completed their treatment METHODS: This cross-sectional study included 38 female breast cancer surgery survivors. Participants underwent the following evaluations: Chest wall mobility with a tapeline; postural assessments (spinal curvature, spinal mobility, and spinal inclination) with a non-invasive, computer-assisted electromechanical device; and pulmonary function test and respiratory muscle strength with a portable digital spirometer device. The relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions was analyzed by the bivariate correlation analysis. Increased thoracic curvature angle was associated with decreased FEV1 (r=-0.360, p=0.026) and decreased subcostal mobility (r=-0.385, p=0.017), and the increase in thoracic frontal mobility was associated with decrease in PEF (r=-0.342, p=0.036). Increased lumbar mobility was associated with increased FVC (r=0.324, p=0.047), and increased total spinal inclination mobility was associated with decreased MIP (r=-0.396, p=0.017). Chest wall mobility was associated with postural assessments at varying rates (the r value ranged from -0.357 to 0.661, p<0.05). The changes in spinal posture and mobility of women who have undergone unilateral breast cancer surgery were associated with respiratory parameters and thoracic cage mobility. These patients' spinal posture and mobility should be taken into account in conjunction with respiratory functions for a comprehensive assessment.

Segmental Rib Index and Spinal Deformity: Scoliogenic Implications.

The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistically significant relationship between these parameters would be very important for biomechanical relations in rib cage (RC) deformity presented as rib hump deformity (RHD) and deformity in the spine, and would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA was documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as rib hump deformity (RHD) in all IS patients, and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of thoracic asymmetry in relation to the spinal deformity, mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics was 14 years, which is when the RI shows a stronger correlation with spinal deformity, namely when thoracic deformity is decisively effective in the development of thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study may provide scoliogenic implications for IS, as far as the role of the thorax is concerned.

Early Onset Scoliosis and Adolescent Idiopathic Scoliosis: A Review of the Literature and Correlations With Pulmonary Dysfunction.

In the managementof early onset scoliosis (EOS) and adolescent idiopathic scoliosis (AIS), orthopedic surgeons are tasked with considering the effects that curves and their treatment can have on the respiratory system, possibly the most relevant being pulmonary dysfunction due to thoracic cage changes. The pulmonary impairment that occurs as a result of scoliosis varies widely and requires a multimodal response, includingphysiologic testing, such as pulmonary function tests (PFTs) and consistent psychosocial monitoring of the patient. This forces healthcare providers to consider all factors affecting the patient's quality of life (QOL) and not just the primary pathology they are treating. One method that could be utilized to ensure a more holistic approach to treatment is the use of patient-reported outcome measures (PROMs) to assess the QOL domains. Thus, this review serves to highlight the importance of addressing and correcting pulmonary dysfunction in the care of children with EOS and AISin a holistic manner.

An extended focused assessment with sonography in trauma ultrasound tissue-mimicking phantom for developing automated diagnostic technologies.

Introduction: Medical imaging-based triage is critical for ensuring medical treatment is timely and prioritized. However, without proper image collection and interpretation, triage decisions can be hard to make. While automation approaches can enhance these triage applications, tissue phantoms must be developed to train and mature these novel technologies. Here, we have developed a tissue phantom modeling the ultrasound views imaged during the enhanced focused assessment with sonography in trauma exam (eFAST). Methods: The tissue phantom utilized synthetic clear ballistic gel with carveouts in the abdomen and rib cage corresponding to the various eFAST scan points. Various approaches were taken to simulate proper physiology without injuries present or to mimic pneumothorax, hemothorax, or abdominal hemorrhage at multiple locations in the torso. Multiple ultrasound imaging systems were used to acquire ultrasound scans with or without injury present and were used to train deep learning image classification predictive models. Results: Performance of the artificial intelligent (AI) models trained in this study achieved over 97% accuracy for each eFAST scan site. We used a previously trained AI model for pneumothorax which achieved 74% accuracy in blind predictions for images collected with the novel eFAST tissue phantom. Grad-CAM heat map overlays for the predictions identified that the AI models were tracking the area of interest for each scan point in the tissue phantom. Discussion: Overall, the eFAST tissue phantom ultrasound scans resembled human images and were successful in training AI models. Tissue phantoms are critical first steps in troubleshooting and developing medical imaging automation technologies for this application that can accelerate the widespread use of ultrasound imaging for emergency triage.

Effect of chest wall mobilization on respiratory muscle function in patients with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial

BackgroundClinical trials have demonstrated positive correlation between pulmonary function and chest wall expansion in COPD. Decrease in chest wall expansion in patients with COPD compromises rib cage mobility and functional length of respiratory muscles that ultimately jeopardize the efficacy and function of respiratory system. MethodThirty male adults (mean age: 74.97 ± 6.29) suffered with severe COPD were randomly allocated to either experimental group (chest wall mobilizations) or control group. Both groups received standardized education and walking exercise (twice/week) for 6 weeks. Patients in experimental group received additional chest wall mobilizations that include stretching and joints mobilization. Pulmonary function, respiratory muscle strength, thoracic excursion, cervical and thoracic range of movement were evaluated at baseline, post-program and at 3-month follow-up. ResultsThere were significantly greater improvements in respiratory muscle strength, thoracic excursion and thoracic range of movement (p < 0.01) except thoracic flexion. Lower thoracic excursion is strongly associated with increase in maximum inspiratory pressure (β = 13.64, p < 0.001) and maximum expiratory pressure (β = 16.23, p < 0.001). Thoracic range of movement especially extension (p < 0.001) and bilateral rotation (p < 0.01) exhibit a strong relationship with increase in lower thoracic excursion (adjusted R2 = 0.876) as shown in multiple regression analysis. ConclusionAdditional chest wall mobilization in the rehabilitation of patients with COPD is likely to enhance thoracic extension and rotation which increase lower thoracic excursion. This significant improvement in chest expansion capacity allows respiratory muscles to work at an optimal functional length which result in greater respiratory muscle strength in patients with severe COPD.

Outside the Cage Subcostal RATS Lobectomy: Technical Aspects and Results of the First Series of a Novel Approach to Pulmonary Lobectomy.

The goal of minimally invasive surgery is to reduce trauma to patients and improve their postoperative outcomes. In this context, the utilization of robot-assisted thoracic surgery (RATS) in the treatment of lung cancer has increased worldwide. The feasibility of single-incision major pulmonary resections by RATS was recently reported, with the objective of minimizing the surgical trauma of the traditional multiportal RATS approach. However, both techniques require intercostal incisions, potentially causing immediate and chronic pain resulting from intercostal nerve injury. To reduce postoperative pain resulting from intercostal approaches, we developed a nonintercostal, outside the thoracic cage (OTC) approach for RATS lobectomy, avoiding intercostal instrumentation. This report aims to describe the results of the first reported series of OTC subcostal RATS lobectomies. Retrospective analysis of a series of the first consecutive patients operated on using the novel OTC subcostal RATS lobectomy technique. Between August and December 2022, a total of 10 consecutive cases were analyzed. The median age was 63 (55 to 84) years, the mean body mass index was 29 (24 to 45) kg/m2, and the median American Society of Anesthesiologists score was III (II to IV). No serious adverse events were observed, and there was no conversion of the surgical technique. The mean operative time was 132.6 (98 to 223) min. The median length of stay was 2 days. No pain-related complications, readmissions, or 30-day mortality were observed. This series demonstrates that OTC RATS lobectomy is feasible and safe. A phase I clinical trial is currently underway to prospectively assess the safety of the technique as well as its clinical relevance.

225 The Effect of Different Analytical Methods on Assessment of Bone Mineralization of Various Rib Bones in Response to Dietary P, Phytase, and Vitamin D in Nursery Pigs

Abstract Pigs (n = 350; initial body weight = 11.9 ± 0.56 kg) were used to evaluate the effects of different bones and analytical methods on the assessment of rib bone mineralization response to dietary P and vitamin D in nursery pigs. Currently, there is little information available describing the effect of rib location (2nd through 10th) on measures of bone mineralization including density and ash. Pens of pigs (5 pigs/pen) were randomized to 6 dietary treatments in a randomized complete block design with 10 pens/treatment. Pens of pigs were assigned dietary treatments consisting of: 1) P at 0.19% STTD P (deficient); 2) P at 0.33% STTD P (NRC requirement) using monocalcium phosphate; 3) P at 0.33% STTD P using monocalcium phosphate and phytase; 4) P at 0.44% STTD P (industry level) using monocalcium phosphate, phytase, no vitamin D; 5) diet 4 with vitamin D (1,653 IU/kg), and 6) diet 5 with additional 2,000 IU/kg 25(OH)D3 (HyD). After feeding diets for 28-days, eight pigs/treatment were harvested for bone analysis. The 2nd, 3rd, 5th, 7th, and 10th ribs were collected from each pig and analyzed for bone density and non-defatted bone ash. All bones were cleaned of tissue and then dried at 105°C for 7 d and then ashed in a muffle furnace at 600°C for 24 h. Bone density was measured on each bone based on Archimedes principle. There was no interaction between bone and dietary treatment for bone density and non-defatted bone ash (P &amp;gt; 0.05; Table). Therefore, interpretation of results will focus on the effect of bone and treatment on measures of mineralization. Pigs fed deficient P (0.19%) had less bone density and ash percent compared with treatments fed NRC and industry levels of P. For bone density, there was a significant main effect of bone (P = 0.001), with the 10th rib having greater bone density than all other treatments and the 3rd rib having greater bone density than the 5th rib. Bone density of the 2nd and 7th ribs did not differ (P &amp;gt;0.05) from either the 3rd or 5th ribs. For non-defat bone ash, 10th rib had the greatest (P &amp;lt; 0.05) bone ash, followed by the 2nd rib which was greater (P &amp;lt; 0.05) than the 3rd rib, with the 5th and 7th ribs having the least non-defat bone ash percent. In summary, bone density and ash responses varied depending on the bone being measured. When measuring all of the bones, the 10th rib has the greatest value for bone density and bone ash percent, while the 5th rib has the least value for both bone density and bone ash percent compared with the rest of the bones analyzed. These results can help guide diagnostic investigations and aid in comparing results across different bones used to measure bone mineralization.

Marwah's Confluence Point, Evaluating Safety of Insertion of Veress Needle Just below the Rib Cage at the Confluence of the 8th to 10th Ribs

Marwah's Confluence Point, Evaluating Safety of Insertion of Veress Needle Just below the Rib Cage at the Confluence of the 8th to 10th Ribs

The macroscopical anatomy of the lungs and thorax of the African lion (Panthera leo)

AbstractThe left and right lungs extend from the second rib to the 13th, while only a small portion is present cranial to the 4th rib. The basal border of the left lung extends horizontally from the second costochondral junction (CCJ) to just ventral to the seventh CCJ, and then dorso‐caudally to the angle of the 13th rib. The right lung has a similar configuration except for the basal border, which is located above the fifth to the sixth CCJ. The cardiac incisure is more prominent in the right lung and is formed by the notched space between the ventral margins of the cranial and middle lobes. The lungs are well‐lobated, with complete fissures laterally but none medially. The trachea and primary bronchi are large and have a wide, thin membranous part. The muscular front limbs could limit cranial thoracic expansion, with the result that the bulk of the functional lung capacity is present caudal to the tricipital line. Recommended sites for intracardiac injections are on either side of the fifth CCJ, and for thoracocentesis, just dorsal to the seventh or eighth CCJ. Care is needed while intubating a lion's trachea because of the delicate membranous part.

THE TREATMENT RESULTS OF HEMOTHORAX IN BLUNT CHEST TRAUMA

Background: Blunt chest trauma is a life-threatening emergency that has a variety of injuries, from chest wall contusions and rib fractures to lung and pleural injuries, from trachea and esophagus to heart and large vessels trauma, of which hemothorax is a common complication of blunt chest trauma. Diagnosis is based on signs and symptoms, including blood loss, pleural effusion syndrome, and imaging findings. Conservative treatment and thoracostomy are the most common treatments and succeed in almost all cases, while the rest require thoracotomy. Follow-up care is necessary to perform strategy changes immediately for the best overall results. Objectives: To study the clinical, imaging features, and treatment results of hemothorax in blunt chest trauma. Materials and methods: A prospective descriptive study of 41 patients with hemothorax was conducted at the Department of Thoracic Surgery, Can Tho General Hospital, from April 2022 to December 2022. Results: The mean age was 53.24 ± 8.97; 70.73% were male; traffic accident was the most common cause (73.17%); chest pain and dyspnea were the two most frequent symptoms, accounting for 97.56% and 48.78%, respectively; the syndrome of decreased breath sounds, dullness to percussion and decreased tactile fremitus was found in 78.05%. The mean number of rib fractures was 4.24 + 2.29; the most common ribs fractured were the 4th through 10th ribs (53.66%); hemothorax and hemopneumothorax accounted for 75.61% and 24.39%, respectively; 28 patients (68.29%) received conservative treatment, in which three patients (10.71%) worsing then received pleural drainage, as a whole, 16 patients in total received pleural drainage treatment; the overall treatment success rate was 97.56%, and 1 case (2.44%) had a complication of empyema; the length of hospital stay was 7.29  2.69 days and differed between the two groups of patients with minimal hemothorax and other hemothorax (p=0.049). Conclusions: Chest pain and dyspnea were the most common clinical symptoms; conservative treatment is common and follow-up is important; the overall treatment success rate was 97.56% and the length of hospital stay was 7.29  2.69 days.

Numerical Simulation and Application of a Channel Heat Sink with Diamond Ribs

This paper presents a channel radiator with ribbed ribs and primarily investigates the fluid flow and heat-transfer characteristics of the channel radiator. A three-dimensional numerical simulation of the radiator’s pressure-drop and heat-transfer process was conducted using the finite volume method. A comparison between the experimental data and the simulation results demonstrates that the simulation in this paper is accurate, with a maximum error not exceeding 5%. Furthermore, the radiator was further subjected to geometric parameter studies, principally including the height ratio between the fins and the channel, the fin angle, and the spacing between the fins. The thermal resistance, Nusselt number, friction factor, and heat-transfer enhancement factor were calculated. The results indicate that if the geometric parameters are selected appropriately, the heat sink will enhance heat-transfer performance within an acceptable pressure drop. When the Reynolds number is greater than 507.5, the height ratio of 25%, the rib angle of 135°, and the rib spacing of 2.5 mm can be given priority. This heat sink is used in PCR devices, and experimental results show that the novel channel heat sink can meet the heat dissipation requirements of the TEC during the PCR process.

Growth-preserving instrumentation for early onset scoliosis

Early onset scoliosis is defined as aspinal deformity originating in the first 10years of life. Growth-preserving spinal instrumentation has therefore been designed to preserve growth of spine and chest wall and lungs to avoid serious pulmonary complications after early spine fusion. Indications, surgical technique and results of the vertical expandable prosthetic titanium rib (VEPTR) technique, traditional growing rods (TGR), and magnetically controlled growing rods (MCGR) will be described. Indications for VEPTR are so-called mixed congenital deformities (type3) associated with vertebral malformations in association with chest wall deformities, especially fused ribs. There are also indications for neuromuscular or syndromic early onset scoliosis with bilateral rib-to-ilium constructs. However, most of those deformities are currently treated with either GR or MCGR in most centers. GR and MCGR are currently the treatment of choice for the majority of early onset scoliosis. There is no indication for growth-preserving strategies if the patients are mature or there is only little growth remaining. In these cases, final fusion should be performed. While the VEPTR technique involves an extensive approach with muscular dissections to the thoracic cage including rib osteotomies and thoracotomies, treatment with TGR or MCGR is minimally invasive, only exposing proximal and distal anchor points, leaving most of the spine including the apex undisturbed. Early mobilization is usually possible after 24-48 h. Braces may have to be prescribed for patients with osteopenia, noncompliance, or arisk to fall. Since 2005, more than 200patients were treated with the VEPTR technique, more than 200 patients with the MCGR technique, and about 30patients with the TGR technique in our department. Complication rates are high with all techniques including the law of diminishing returns, autofusion, bone anchor-related complications like loosening or migration of implants, failure to distract and proximal junctional kyphosis. In our own series of 13patients below age 3years, VEPTR proved to be effective for mixed deformities. In other studies, we were able to show that physiological growth with MCGR can be maintained for 2-3years but spinal growth declines after that period with acceptable complications. Complication rates in most studies are lower with MCGR compared to TGR and VEPTR. Therefore, it is currently the treatment of choice for most early onset scoliosis patients.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Deep Learning for Automated Triaging of Stable Chest Radiographs in a Follow-up Setting.

Background Most artificial intelligence algorithms that interpret chest radiographs are restricted to an image from a single time point. However, in clinical practice, multiple radiographs are used for longitudinal follow-up, especially in intensive care units (ICUs). Purpose To develop and validate a deep learning algorithm using thoracic cage registration and subtraction to triage pairs of chest radiographs showing no change by using longitudinal follow-up data. Materials and Methods A deep learning algorithm was retrospectively developed using baseline and follow-up chest radiographs in adults from January 2011 to December 2018 at a tertiary referral hospital. Two thoracic radiologists reviewed randomly selected pairs of "change" and "no change" images to establish the ground truth, including normal or abnormal status. Algorithm performance was evaluated using area under the receiver operating characteristic curve (AUC) analysis in a validation set and temporally separated internal test sets (January 2019 to August 2021) from the emergency department (ED) and ICU. Threshold calibration for the test sets was conducted, and performance with 40% and 60% triage thresholds was assessed. Results This study included 3 304 996 chest radiographs in 329 036 patients (mean age, 59 years ± 14 [SD]; 170 433 male patients). The training set included 550 779 pairs of radiographs. The validation set included 1620 pairs (810 no change, 810 change). The test sets included 533 pairs (ED; 265 no change, 268 change) and 600 pairs (ICU; 310 no change, 290 change). The algorithm had AUCs of 0.77 (validation), 0.80 (ED), and 0.80 (ICU). With a 40% triage threshold, specificity was 88.4% (237 of 268 pairs) and 90.0% (261 of 290 pairs) in the ED and ICU, respectively. With a 60% triage threshold, specificity was 79.9% (214 of 268 pairs) and 79.3% (230 of 290 pairs) in the ED and ICU, respectively. For urgent findings (consolidation, pleural effusion, pneumothorax), specificity was 78.6%-100% (ED) and 85.5%-93.9% (ICU) with a 40% triage threshold. Conclusion The deep learning algorithm could triage pairs of chest radiographs showing no change while detecting urgent interval changes during longitudinal follow-up. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Czum in this issue.

Ribcage sign: A novel morphology of congenital cataract with preexisting posterior capsular defect (PPCD)

We describe a new clinical characteristic noted in congenital cataract with a preexisting posterior capsular defect (PPCD). We describe this sign as a “ribcage sign” owing to its similarity to the human ribcage enclosing thoracic organs. The permeability changes in the posterior capsule and interaction of the cortex with the vitreous could be the probable cause of such a unique morphology.

OA04 Muscle weakness in chronic rheumatic diseases: the need for early diagnosis and tailored exercise programme

OA04 Muscle weakness in chronic rheumatic diseases: the need for early diagnosis and tailored exercise programme

Thoracal motion-based analysis of breathing patterns in individuals with a mild-moderate Covid-19 history using machine learning techniques: A single blinded multidisciplinary study on post-Covid

BackgroundCovid-19 led to deaths worldwide and left significant sequelae in a lot of people. Thoracic movements are important for the proper functioning of the respiratory system. However, there is no study on how the thoracic mobility of individuals who have recovered fully from Covid-19 is affected. MethodsIn this study, the differences between thorax movements of healthy individuals and individuals with Covid-19 were investigated from a multidisciplinary perspective for the first time. Spontaneous and deep breathing data under two (at sitting- at standing) different conditions were collected and analyzed. In terms of engineering, using the Boruta feature selection method and various machine learning algorithms, discriminative features that will benefit clinically were determined. Clinically, the effect of Covid-19 was examined statistically in terms of respiratory biomechanics with thoracal motion-based analysis of 22 individuals. ResultsThe use of Boruta in sitting and standing positions during deep breathing increased the classification performance. In spontaneous breathing, using Boruta only in the sitting position provided an increase in classification performance achieving an accuracy of 95.45 %. The results of the study showed that respiratory movements of the thoracic cage in the anteroposterior and craniocaudal directions were more restricted and had weaker respiratory acceleration skills in individuals with a Covid-19 history (p < 0.05). ConclusionFrom a clinical point of view, it was observed that the respiratory acceleration movements were restricted in individuals with a Covid-19 history even though full recovery. Also, it was revealed that machine learning models can classify with high performance in situations requiring effort.

Effect of thoracic cage width on surgery time and postoperative outcome in minimally invasive esophagectomy

IntroductionMinimally invasive esophagectomy (MIE) for esophageal cancer is a complex procedure that reduces postoperative morbidity in comparison to open approach. In this study, thoracic cage width as a factor to predict surgical difficulty in MIE was evaluated.MethodsAll patients of our institution receiving either total MIE or robotic-assisted MIE (RAMIE) with intrathoracic anastomosis between February 2016 and April 2021 for esophageal cancer were included in this study. Right unilateral thoracic cage width on the level of vena azygos crossing the esophagus was measured by the horizontal distance between the esophagus and parietal pleura on preoperative computer tomography. Patients’ data as well as operative and postoperative details were collected in a prospective database. Correlation between thoracic cage width with duration of the thoracic procedure and postoperative complication rates was analyzed.ResultsOverall, 313 patients were eligible for this study. Thoracic width on vena azygos level ranged from 85 to 149 mm with a mean of 116.5 mm. In univariate analysis, a small thoracic width significantly correlated with longer duration of the thoracic procedure (p = 0.014). In multivariate analysis, small thoracic width and neoadjuvant therapy were identified as independent factors for long duration of the thoracic procedure (p = 0.006). Regarding postoperative complications, thoracic cage width was a significant risk factor for occurrence of postoperative pneumonia in the multivariate analysis (p = 0.045). Dividing the cohort into two groups of patients with narrow (≤ 107 mm, 19.5%) and wide thoraces (≥ 108 mm, 80.5%), the thoracic procedure was significantly prolonged by 17 min (204 min vs. 221 min, p = 0.014).ConclusionA small thoracic cage width is significantly correlated with longer operation time during thoracic phase of a MIE in Europe, which suggests increased surgical difficulty. Patients with small thoracic cage width may preferably be operated by MIE-experienced surgeons.Graphical abstract