Department Of Thoracic Surgery Research Articles

The Effect of Gefitinib on Treatment Necessity and Prognosis of NSCLC Patients with Early EGFR Mutations.

Objective To investigate the need for and prognostic impact of gefitinib on the treatment of patients with early-stage epidermal growth factor receptor (EGFR) mutated non-small-cell lung cancer (NSCLC). Methods Clinical data of patients with stage IB-IIA non-squamous non-small-cell lung cancer admitted to our thoracic surgery department from January 2020 to January 2022 were collected, and a total of 94 cases were included, divided into 44 cases in the control group (EGFR mutation-negative) and 50 cases in the experimental group (EGFR mutation-positive (including those on medication (19 cases) and those not on medication (31 cases)) according to the outcome of EGFR mutation. To evaluate the necessity and prognostic effect of gefitinib in the treatment of NSCLC patients with early EGFR mutations. Results The lung cancer recurrence rate in the experimental group (66.00%) was higher than that in the control group (40.91%), and the difference was statistically significant (χ2 = 5.937, P=0.015); in the subgroup analysis of the experimental group samples, the pharmacological intervention of gefitinib had a significant effect on lung cancer recurrence (χ2 = 7.797, P=0.005), and the proportion of lung cancer recurrence in patients not taking the drug (80.65%) was significantly higher than in the drug-taking group (42.11%); the median survival time was 53.6 months using EGFR mutation type as the study factor, with a statistically significant difference in change in 5-year survival rate for EGFR mutation type (χ2 = 6.095, P=0.047) and the lowest 5-year survival rate for subjects with EGFR mutation type Exon 20 T790M. Conclusion Patients with early gene drive positive lung adenocarcinoma are significantly more likely to recur and metastasise and have shorter survival times in the absence of pharmacological intervention.

Effect of pleural adhesions on short- and long-term outcomes after minimally invasive esophagectomy: a propensity score matching analysis.

The extent to which the presence of pleural adhesions affects the surgical and oncological outcomes of patients undergoing McKeown minimally invasive esophagectomy (MIE) for esophageal cancer (EC) has not previously been studied. Data of consecutive EC patients undergoing McKeown MIE by a single surgeon in the Department of Thoracic Surgery at Daping Hospital from November 2015 to December 2020 were collected. Patients were grouped according to the presence or absence of pleural adhesions when entering the chest cavity. Propensity score matching (PSM) was used to reduce selection bias from confounding factors. Kaplan-Meier was used to assess the survival differences. A total of 617 consecutive EC patients underwent McKeown MIE were enrolled. There were 116 patients with pleural adhesions (Group A) and 501 patients without pleural adhesions (Group B). Patients in Group A were more likely to be older than those of patients in Group B: (66.26 vs. 63.27, P = 0.001). In addition, Group A had more patients with chronic obstructive pulmonary disease (COPD) (24.1% vs. 16.8%, P = 0.04). After propensity score matching (102 matched patients in Group A and 185 matched patients in Group B), these findings were no longer statistically significant. Postoperative pulmonary infection occurred in 57 patients in Group A and in 15 patients in Group B (53.9% vs. 13.0%, P < 0.001). In addition, the presence of pleural adhesions was significantly associated with the prolonged operation time (232min vs. 210min, P < .001), length of stay (12days vs. 10days, P = 0.001), and hydrothorax requiring drainage (12.7% vs. 5.4%, P = 0.04). However, the disease-specific survival and disease-free survival rates were comparable between the two groups (P = 0.40 and 0.13, respectively). The presence of pleural adhesions predicted an increased operation time, length of stay, postoperative pneumonia, and hydrothorax requiring drainage of EC patients undergoing McKeown MIE, but did not exert unfavourable effect on long-term survival.

Analysis of the Effect of Quality Nursing on Recovery after Thoracic Surgery.

Objective To observe the feasibility and safety of rapid rehabilitation nursing in the perioperative period of thoracoscopic treatment of lung cancer patients. Rapid rehabilitation nursing was compared with conventional perioperative nursing to explore its clinical efficacy, i.e., its advantages in improving postoperative comfort, postoperative rehabilitation efficiency, and hospitalization cost of patients undergoing thoracoscopic lung cancer resection. Methods We carried out a retrospective analysis of 337 lung cancer patients who underwent lobectomy in our thoracic surgery department from July 2019 to June 2021, of which 168 lung cancer patients whose perioperative care method was traditional rehabilitation care were classified as A and 169 lung cancer patients who started to implement the intelligent medical intervention method in the department in September were classified as intelligent medical B. By reviewing patient cases and departmental statistics, general information, length of stay, hospitalization cost, complication rate, pain score, bowel movement recovery time, and pulmonary function index of the two groups A and B were compared. Nursing satisfaction was investigated by using a questionnaire. All the data in the study were processed and analyzed using SPSS 17.0 software. Results There were no differences in preoperative general data, pathological findings, preoperative underlying diseases, lesion involvement sites, and postoperative TNM stages (P > 0.05), which were comparable; the incidence of postoperative pulmonary infection and atelectasis complications, postoperative hospitalization time, and hospitalization cost were lower in group B than in group A; the postoperative chest tube drain placement time was shorter in group B than in group A, and the difference between the two groups was statistically significant (P < 0.05). The incidence of postoperative pain and discomfort in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05); the incidence of postoperative chest pain, bleeding, pneumothorax, pulmonary infection, and atelectasis in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05). Conclusion Intelligent medical rehabilitation nursing has good application value in thoracoscopic lung cancer surgery. Applying the concept of intelligent medical rehabilitation nursing provides an important experimental basis and theoretical basis for improving the postoperative survival quality and clinical symptoms of patients undergoing thoracoscopic lung cancer resection, which helps to promote the postoperative recovery of patients with thoracoscopic lung cancer, improves the recovery efficiency of patients and their overall quality of life, and is superior to the conventional nursing group.

Comparison of complications and long-term survival after minimally invasive esophagectomy versus open esophagectomy in patients with esophageal cancer and chronic obstructive pulmonary disease

ObjectiveTo compare the complications and long-term survival of esophageal cancer patients with chronic obstructive pulmonary disease (COPD) after minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) using propensity score matching (PSM).MethodsEsophageal cancer patients who underwent esophagectomy at the Thoracic Surgery Department of the First Affiliated Hospital of Hebei North University from January 2010 to December 2018 were retrospectively enrolled. The incidence of postoperative complications and prognosis of the MIE (n = 132) and OE (n = 138) groups were compared. To reduce bias, 1:1 PSM was adopted for the analysis.ResultsThe median disease-free survival (DFS) of the MIE and OE groups were 24 months and 26 months, respectively, and neither group reached median survival. There was no significant difference between the two groups in terms of 3-year DFS and overall survival (OS). The stratification of the patients on the basis of the percentage of estimated forced expiratory volume in the first second (%FEV1) did not result in significant differences in the survival rates. A total of 42 patients (50%) in the MIE group and 55 patients (65.48%) in the OE group experienced complications, and the difference was statistically significant (OR=0.527, 95% CI: 0.283–0.981, P=0.042). The incidence of acute COPD exacerbation (OR=0.213, 95% OR, CI: 0.068–0.666, P=0.004) and pulmonary atelectasis requiring bronchoscopic aspiration (OR=0.232, 95% OR, CI: 0.082–0.659, P=0.004) were significantly higher in the OE versus the MIE group. In addition, the distribution of the various grades of complications also differed significantly between the two groups (P=0.016). While the incidence of minor complications (≤Grade II) was similar in both groups (P=0.503), that of severe complications (≥Grade III) was markedly higher in the OE group (P=0.002) and the Grade-IIIa complications were predominant (P=0.001). The severity of complications was correlated with the postoperative duration of hospital stay in both groups (r=0.187, P=0.015). No significant difference was observed in the incidence of minor complications (≤Grade II) between the two groups following stratification on the basis of %FEV1, whereas severe complications were more frequent in the OE group among patients with %FEV1 between 60% and 70% (P=0.001<0.05).ConclusionThere was no significant difference in the postoperative DFS and OS of esophageal cancer patients with COPD after undergoing MIE or OE. However, MIE significantly reduced the incidence of severe postoperative complications among patients with %FEV1 between 60% and 70%.

Retrospectively analyze and compare the efficacy and safety of thoracoscopic-assisted Nuss repair of pectus excavatum under intubation anesthesia and non-intubation anesthesia

Thoracoscopic-assisted Nuss repair is a commonly used method for treating pectus excavatum, which has always been performed under tracheal intubation and general anesthesia. However, general anesthesia with endotracheal intubation can produce intubation and anesthetic drug related complications. In non-intubation anesthesia, laryngeal mask is used instead of tracheal intubation without muscle relaxants and small doses of sedative and analgesic drugs. Therefore, non-intubation anesthesia can reduce complications and speed up postoperative recovery. This study retrospectively analyzed the clinical impact of these two anesthesia methods on thoracoscopic-assisted Nuss repair for the treatment of pectus excavatum. A total of 115 pectus excavatum patients who underwent thoracoscopic-assisted Nuss procedure repair in the Department of Thoracic Surgery of Yunnan First People's Hospital from January 2017 to January 2022 were included. All subjects in this study underwent thoracoscopic assisted Nuss repair in the same thoracic surgical team. According to different anesthesia methods, they were divided into non-intubation anesthesia group (n=62) and intubation anesthesia group (n=53). The intubation time, intraoperative mean heart rate, postoperative complications, postoperative first oral food intake, water intake, ambulation, defecation time, postoperative blood drawing results, postoperative hospital stay and total hospitalization cost were compared between the two groups. There were no significant differences in clinical characteristics and preoperative examination indexes between the two groups, which were comparable. Compared with the intubation anesthesia group, the non-intubation anesthesia group had less anesthesia intubation time, lower intraoperative mean heart rate, less postoperative complications, such as pneumothorax, pleural effusion, and lung infection. In the non-intubation anesthesia group, the first time to eat, drink, get out of bed, and defecate were all earlier. Routine blood results 24 h after surgery indicated that the non-intubation anesthesia group had lower white blood cell, neutrophil and lymphocyte, an earlier postoperative discharge time, and lower total hospitalization expenses. Non-intubation anesthesia in thoracoscopic-assisted Nuss procedure for the repair of pectus excavatum can make the postoperative recovery of patients faster and has better safety and efficacy.

Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up.

Although pneumonectomy is an important surgical treatment for tuberculosis-destroyed lung (TDL), few studies have investigated long-term postoperative TDL prognosis. Here, risk factors were determined for postoperative secondary respiratory failure and modified British Medical Research Council (mMRC ≥1) at discharge and at 1-year post-surgical follow-up. A two-way cohort study was conducted of 116 patients admitted to our thoracic surgery department for surgical TDL treatment from January 2001 to June 2020. General clinical data were collected then patient postoperative mMRC scores were monitored for 1 year. Dyspnea-associated factors (mMRC ≥1) were identified then risk factors for postoperative respiratory failure and compromised long-term respiratory function were identified using multivariate adjusted logistic regression analysis. Of 116 patients, 27.6% (32/116) developed respiratory failure secondary to surgery. Multifactorial logistic regression analysis revealed that preoperative serum albumin of <30 g/L [adjusted odds ratios (aOR) 6.613, 95% confidence intervals (CI): 1.064-41.086] and intraoperative bleeding of >1,000 mL (aOR 6.876, 95% CI: 1.236-38.243) were risk factors for subsequent respiratory failure only in patients experiencing postoperative secondary respiratory failure. Sorting of patient mMRC dyspnea index scores into two groups (mMRC =0, mMRC ≥1) followed by logistic regression analysis revealed that risk factors for 1-year postoperative dyspnea included mMRC score ≥1 at discharge (aOR 14.446, 95% CI: 1.102-189.361) and postoperative respiratory failure occurrence (aOR 9.946, 95% CI: 1.063-93.034). TDL patient preoperative hypoalbuminemia and extensive intraoperative bleeding were risk factors for postoperative secondary respiratory failure. Postoperative secondary respiratory failure and high mMRC (≥1) at discharge were associated with reduced postoperative long-term recovery of respiratory function.

Clinical Outcomes of Pulmonary Resections for Benign Lung Diseases in Adults

Benign lung diseases (BLD) are a spectrum of diseases that require medical and surgical attention. Surgical treatment in majority cases provides curative treatment in majority of the cases. Objective:  To assess the clinical outcome in patients who undergo pulmonary resection for various indications in BLD. Methods: A prospective study was conducted in The Department of Thoracic surgery at Jinnah Postgraduate Medical Center, Karachi from June 2021 to June 2022. All symptomatic patients above the age of 12 years with radiological evidence of resectable lung disease with good cardiopulmonary reserve were included. Results: Eighty-four patients were included; sixty-six (78.6%) were males. Most common indication for resection was bronchiectasis (n=32; 38.1%) and aspergilloma (n=22; 26.2%). Majority of the patients presented with productive cough (44; 52.3%), chest pain (41; 48.8%) and hemoptysis (28;33%). Eighteen (81.8%) out of 22 patients of aspergilloma were complex in nature. Lobectomy (67; 78.8%) was most commonly performed followed by wedge resection (10; 11.7%). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) both were significantly improved after lung resection (p˂0.001). The most common complications were post resection fluid (n=12; 14.2%), residual pleural space (n=10;11.9%). Three patients (3.6%) died; two (2.38%) due to respiratory failure and one (1.2%) after myocardial infraction. Conclusions: Despite limitations, lobectomy and lesser pulmonary resections are safe procedures when patients are carefully selected and prepared. Management in a dedicated Thoracic Surgical unit is essential to keep the complication rate under control and patients should be assessed for symptomatic (spirometric) and radiological improvement on follow up visits to document ongoing clinical improvement for an improved quality of life

Journal-related Activities and Other Special Activities at the 2022 American Society of Anesthesiologists Meeting

As in previous years, Anesthesiology will sponsor several sessions at the annual meeting of the American Society of Anesthesiologists (ASA; Schaumburg, Illinois), Anesthesiology 2022. The meeting is being held in New Orleans, Louisiana. Details about the format and meeting attendance can be found on the website, asahq.org/annualmeeting.Saturday October 22, 2022, 1:15pmto 3:15pmRoom 243Sachin Kheterpal, M.D., M.B.A., Editor, Anesthesiology, University of Michigan, Ann Arbor, Michigan.“Progress and Missteps in Perioperative Medicine Big Data Research” by Sachin Kheterpal, M.D., M.B.A., University of Michigan, Ann Arbor, Michigan.“Choosing Wisely in Big Data Analysis: Risk Adjustment, Prediction, or Causation” by Elizabeth L. Whitlock, M.D., M.A., M.Sc., University of California, San Francisco, California.“High-Stakes Epidemiology: Using Big Data to Estimate Causal Effects” by Brian T. Bateman, M.D., Stanford University School of Medicine, Stanford, California.“Exciting Developments in Big Data Analysis Methods” by Timothy T. Houle, Ph.D., Massachusetts General Hospital, Boston, Massachusetts.Research, quality improvement, clinical guideline, and policy-making efforts based upon “big data” are increasingly common in perioperative medicine. All anesthesiologists must be facile in understanding and communicating the strengths and weaknesses of these databases and projects. This session will arm every anesthesiologist with the skills necessary to consume or create the in vogue and ubiquitous “big data” study with a discerning eye.Saturday, October 22, 2022, 3:30pmto 4:30pmRoom 243Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief, Anesthesiology, Duke University Medical Center, Durham, North Carolina; Deborah J. Culley, M.D., Executive Editor, Anesthesiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.Anesthesiology is sponsoring its seventh Major Clinical Trials Session, a high-profile, large-audience forum for initial presentations of major randomized clinical trial results. It is designed for substantial trials, usually randomized and blinded, with a clinically important primary outcome.Sunday, October 23, 2022, 8:30amto 11:30amRoom 243Deborah J. Culley, M.D., Executive Editor, Anesthesiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Andrew Davidson, M.B.B.S., M.D., Executive Editor, Anesthesiology, Royal Children’s Hospital, Melbourne, Australia.Postoperative delirium affects a substantial portion of surgical patients and is associated with both short- and long-term complications and morbidity. The science behind delirium is rapidly evolving with better diagnostic tools, a greater understanding of the neurobiology, and greater understanding of the possible etiology. The symposium will feature both plenary lectures by experts in the field and presentations of eight featured top abstracts selected for their relevance to the mechanism and biology of postoperative delirium in both pediatric and geriatric patients. The full text for each abstract can be found at the ASA abstract website.“Removing the Confusion about Delirium” by Jamie W. Sleigh, M.D.The University of Auckland, Hamilton, New Zealand.“Pediatric Delirium: Do We Know What We Think We Know” by Andrew Davidson, M.B.B.S., M.D.Royal Children’s Hospital, Melbourne, Australia.“Postoperative Changes in the Cerebrospinal Fluid Proteome Suggest a Role of the Complement Pathway in Postoperative Delirium” by Jake Thomas, B.S., Matt Foster, Ph.D., Joseph Lucas, Ph.D., Mary Wright, M.S., Joseph Mathew, M.D., M.B.A., Miles Berger, M.D., Ph.D., Michael Devinney, M.D., Ph.D.Duke University School of Medicine, Durham, North Carolina (J.T.); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (M.F., M.W., J.M., M.B., M.D.); Vital Statistics, L.L.C., Chapel Hill, North Carolina (J.L.)“Emergence Delirium and Behavior at 3 Months after General Anesthesia in Preschool Children” by Amira Joseph, M.D., David O. Warner, M.D., Yu Shi, M.D.Mayo Clinic College of Medicine, Rochester, Minnesota“Demographic Characteristics as Predictors of Clinical Outcomes in Very Elderly Adults” by Guillermo Madrid, M.D., M.Sc., Laura Cristina Moyano, M.D., Jairo Ricardo Moyano, M.D., Ph.D., Maria Jose Pelaez Jaramillo, M.D.Anesthesiology, Fundacion Santa Fe de Bogota, Bogota, Colombia“A Proteomic-derived Predictive Model for Postoperative Delirium in Cardiac Surgical Patients” by Tanvi Khera, M.D., Maria Carolina-Bittercourt Gonçalves, Ph.D., Shilpa Narayanan, B.A., Simon T. Dillon, Ph.D., Yoojin Jung, Ph.D., Hasan H. Otu, Ph.D., Long H. Ngo, Ph.D., Edward R. Marcantonio, M.D., Towia A. Libermann, Ph.D., Balachundhar Subramaniam, M.D.Anesthesia Critical Care and Pain Medicine, and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (T.K., M.C-B.G., S.N., S.T.D., Y.J., L.H.N., E.R.M., T.A.L., B.S.); Electrical and Computer Engineering, University of Nebraska–Lincoln, Lincoln, Nebraska (H.H.O.)“Anesthesia/Surgery Induces Delirium-like Behavior in Aged Mice Via Cells–Mediated Increase of TAU-PT217 in Blood” by Jing Lu, M.D., Ph.D., Feng Liang, Ph.D., Ping Bai, Ph.D., Zhengwang Sun, Ph.D., Wenjie Tian, M.D., Ph.D., Changning Wang, Ph.D., Edward R. Marcantonio, M.D., M.S., Guang Yang, Ph.D., Zhongcong Xie, M.D., Ph.D.Anesthesiology, Critical Care and Pain Medicine, Cardiology, and Radiology, Massachusetts General Hospital, Boston, Massachusetts (J.L., F.L., Z.S., W.T., C.W.); Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (E.R.M.); Columbia University, New York, New York (G.Y.); Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts (P.B., Z.X.)“Postoperative Delirium and Altered Connectivity within the Default Mode Network and Hippocampus” by Heather Acuff, M.D., Ph.D., Laurel Zelnik, B.S., Joshua Siegel, M.D., Ph.D., Jacob Bolzenius, Ph.D., Mehdi Kafashan, Ph.D., Thomas Nguyen, B.S., Anhthi Luong, B.S., Michael S. Avidan, M.B., B.Ch., Tammie Benzinger, M.D., Ph.D., Ben Julian Palanca, M.D., Ph.D.Anesthesiology, and Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri (H.A., L.Z., J.B., M.K., T.N., A.L., M.S.A., T.B., B.J.P.); PeaceHealth Medical Group Anesthesiology, Longview, Washington (J.S.)“Association of Malnutrition and Frailty with Postoperative Delirium in Older Patients after Hip Fracture Surgery” by Benayas Dereje Begashaw, B.Sc., Esteban Franco-Garcia, M.D., Marilyn Heng, M.D., M.P.H., Oluwaseun Johnson-Akeju, M.D., M.Sc., John A. Reich, M.D., Sadeq A. Quraishi, M.D.Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts (B.D.B., J.A.R., S.A.Q.); Department of Medicine, Department of Orthopaedic Surgery, and Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.F-G., M.H., O.J-A.)“Postoperative Delirium and Blood Brain Barrier Breakdown in Older Noncardiac Surgical Patients” by Megan Wong, B.S., Mary Cooter Wright, M.S., Pallavi Avasarala, Ayesha Syed, B.A., Edward R. Marcantonio, M.D., Niccolo Terrando, Ph.D., Joseph P. Mathew, M.D., M.B.A., Miles Berger, M.D., Ph.D., Michael Devinney, M.D.Duke University School of Medicine, Durham, North Carolina (M.W.); Duke University Medical Center, Durham, North Carolina (M.C.W., P.A., A.S., N.T., J.P.M., M.B., M.D.); Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.)Anesthesiology is sponsoring two Best Abstract sessions: one in basic science and another in clinical science. The abstracts were chosen by a panel of editors who examined the highest scoring abstracts from the ASA subcommittees, choosing those with important scientific and clinical application and novelty. The following are summaries of the excellent abstracts that will be presented.Sunday, October 23, 2022, 1:00pmto 2:55pmRoom 243Michael J. Avram, Ph.D., Assistant Editor-in-Chief, Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Deborah J. Culley, M.D., Executive Editor, Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Martin J. London, M.D., Editor, Anesthesiology, University of California, San Francisco School of Medicine and the Veterans Affairs Medical Center, San Francisco, California.“Discovery of a Quinone Analog as a Novel Anesthetic Agent” by Richard Levy, M.D., Abhishek Srivastava, B.S., Keren Griffiths, M.D., Ph.D., Yash Somnay, M.D., Ph.D.Columbia University, New York, New YorkPropofol interferes with electron transfer at the level of coenzyme Q and induces excessive proton leak within mitochondria. Synthetic coenzyme Q analogs have similar biologic activity in vitro. The hypothesis that quinone analogs would induce propofol-like sedation and hypnosis was tested in mice using the short-chain coenzyme Q analog ubiquinone-5. Ubiquinone-5 immediately induced loss of righting reflex with an ED50 of 81 mg/kg, and latency to return of righting reflex was correlated with dose. Ubiquinone-5 induced excessive proton leak in isolated forebrain mitochondria, inhibited electron transport chain enzyme complex activities, and compromised mitochondrial membrane potential.“A Genetically Engineered Mouse that Improves TRPV1-mediated Insulin Release and Glucose Handling Is Protected from Cardiac Injury” by Eric Gross, M.D., Ph.D., Yang Bian, Ph.D., Shufang He, Ph.D.Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California (E.G., Y.B.); Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, and Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China (S.H.)Transient receptor potential vanilloid 1 (TRPV1) regulates myocardial reperfusion injury, but the region of TRPV1 important for limiting organ injury is unclear. Because TRPV1 activation antagonizes insulin release from pancreatic β cells, mice with a missense mutation in TRPV1 (K710N) were studied to determine whether a specific amino acid within the C terminus of TRPV1 causes resistance to cardiac injury by modifying insulin release and glucose handling. A discrete amino acid of TPRV1, K710, was found to regulate the response to a glucose challenge and insulin release, changes in which led to improved glycolytic handling and protection of cardiomyocytes from cellular stress.“β-Arrestin Recruitment Does Not Explain Respiratory Depression from Opioids of the Nitazene Family” by Barbara Palkovic, M.D., Daniel J. Sprague, M.D., Ph.D., John D. McCorvy, Ph.D., Maggie M. Calkins, B.S., Thomas M. Langer III, M.D., Ph.D., Jennifer J. Callison, B.S., Eckehard A. Stuth, M.D., Astrid G. Stucke, M.D.Faculty of Medicine Osijek, Osijek, Croatia (B.P.); Cell Biology, Neurobiology and Anatomy, and Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin (D.J.S., J.D.M., M.M.C., T.M.L., J.J.C., E.A.S., A.G.S)Opioid-induced respiratory depression has been attributed to recruitment of the β-arrestin scaffold rather than G protein activation, both of which result from binding of the agonist to the mu-opioid receptor. The hypothesis that respiratory depression strongly correlates with β-arrestin recruitment was tested by studying in vitro and in vivo effects of opioids of the nitazene family that are biased toward either mechanism. Although activation of G protein versus β-arrestin pathway by nitazene mu-opioid receptor agonists varied with their molecular structure, the degree of β-arrestin recruitment did not correlate with the magnitude of respiratory depression.“Effects of Low versus High Positive End-expiratory Pressure on Mechanical Power and Pulmonary Neutrophilic Inflammation in Experimental Acute Respiratory Distress Syndrome” by Nikola Anusic, M.D., Martin Scharffenberg, M.D., Robert Huhle, M.D., Jakob Wittenstein, M.D., Marcelo Gama De Abreu, M.D.Outcomes Research, Cleveland Clinic, Cleveland, Ohio (N.A.); Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany (M.S., R.H., J.W.); Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.G.D.A.)Mechanical ventilation may cause ventilator-induced lung injury. Mechanical power, which describes the energy transferred to the respiratory system per unit time, has been associated with surrogates of ventilator-induced lung injury. The hypothesis that protective mechanical ventilation strategies using different levels of positive end-expiratory pressure differ in their mechanical power and pulmonary neutrophilic inflammation was tested in a randomized study of 24 anesthetized pigs in which lung injury had been induced by saline lavage. Protective mechanical ventilation with low compared to high positive end-expiratory pressure increased mechanical power and worsened lung inflammation.“Altered Astrocytic Bioenergetics and Delayed Emergence from Propofol in a Rodent Model of Alcohol Intolerance” by Candida Goodnough, M.D., Ph.D., Ryan Ozawa, B.S., Rafaela Rodrigues Hell, Ph.D., Katie Chang, Eric R. Gross, M.D., Ph.D.Stanford University, Stanford, CaliforniaAlcohol intolerance is due to a genetic variant in the mitochondrial enzyme aldehyde dehydrogenase 2 (ALDH2*2), which limits the metabolism of acetaldehyde, a metabolite of ethanol. The hypothesis that the inactivating genetic variant ALDH2*2 will delay recovery from anesthesia due to an altered mitochondrial redox state was tested in wild-type ALDH2 and ALDH2*2 knock-in mice. There was no difference between groups in time to loss of righting reflex or duration of propofol-induced general anesthesia, but ALDH2*2 mice had delayed recovery from anesthesia as defined by behavioral tests. Bioenergetics were altered in mitochondria of ALDH2*2 astrocytes at baseline and in the presence of propofol.“Mitigation of Burn-induced Motor Neuron Apoptosis, Synaptic Denervation, and Muscle Wasting by Decreasing Spinal Microglia Inflammatory Responses” by Jingyuan Chen, M.D., Ph.D., Yoshinori Kitagawa, M.D., Ph.D., Yang Ren, M.D., Shingo Yasuhara, M.D., Ph.D., J.A. Jeevendra Martyn, M.D., F.R.C.A.Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (J.C.); Tottori University Hospital, Yonago, Japan (Y.K.); Shriners Hospital for Children and Harvard Medical School, Boston, Massachusetts (Y.R., S.Y., J.A.J.M.)The hypothesis that microglia-mediated cytokine release plays a pivotal role in motor neuron loss, distant synaptic disintegration, and muscle wasting after burn injury and that mitigation of microglia activation by α7AChR stimulation would attenuate these was tested in wild-type and α7AChR knock-out mice randomly divided into sham-burn or third degree 30% total body surface area burn injury groups. The selective α7AChR agonist GTS-21 or saline was administered after burn injury. GTS-21 ameliorated burn injury–induced microglia activation, as evidenced by decreased inflammatory cytokine release, and alleviated motor neuron loss, synaptic disintegration, and muscle wasting in wild-type but not knock-out mice.“Dysfunction of the Endogenous Opioid System in Descending Pain-modulating Circuits Is Involved in the Augmented Pain Response after Traumatic Brain Injury” by Qiliang Chen, M.D., Ph.D., David J. Clark, M.D., Ph.D.Department of Anesthesiology, Perioperative and Pain Medicine, Stanford–Anesthesia School of Medicine, Stanford, California (Q.C.); Stanford–Anesthesia School of Medicine, Palo Alto, California (D.J.C.)The hypothesis that traumatic brain injury exacerbates pain in response to a subsequent soft tissue injury by virtue of dysfunctional descending pain modulation was tested in a mouse model of mild traumatic brain injury. Animals with traumatic brain injury experienced a prolonged period of allodynia after a distal periphery injury. Their eventual recovery from allodynia was dependent on endogenous opioid tone on the pronociceptive neurons in the descending pain-modulation system. Loss of these pronociceptive neurons prevented the development of allodynia after traumatic brain injury.“Electroacupuncture Relieves Incision Pain by Regulating Inflammation and Immune System in Rats” by Lulin Ma, M.D., Ph.D., Daling Deng, M.D., Tianhao Zhang, M.D., Yuanyuan Ding, M.D., Wenjing Zhao, M.D., Xiangdong Chen, Ph.D.Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaTranscriptomic (messenger RNA [mRNA]) methods were used to detect the gene changes of dorsal root ganglia of male Sprague-Dawley rats randomly assigned to control, incision, and incision plus electroacupuncture groups. Pain behaviors were measured in the three groups the day before and 2, 4, and 24 h after surgery. Dorsal root ganglia were collected for mRNA sequencing 24 h after surgery. In the incision plus electroacupuncture group, the mechanical withdrawal threshold and thermal withdrawal latency increased, the cumulative pain score decreased, and there were 4 upregulated genes and 12 downregulated genes identified compared to the incision group.“The Biphasic Effects of Sevoflurane of Different Concentration on Airway Inflammation in Developing Asthmatic Rats” by Guangting Zhang, M.S., Fenglin Wang, M.S., Yin Ran, M.S., Yannan Zhou, M.S., Xiaoxi Zhang, M.S., Dexing Liu, M.D.Anesthesiology Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, ChinaThe effects of different concentrations of sevoflurane on airway inflammation were studied in a developing female Sprague-Dawley rat ovalbumin-induced allergic asthma model. Sevoflurane concentrations of 0.4%, 0.8%, 1.6%, or 3.2% were inhaled for 30 min. Sevoflurane had opposite, concentration-dependent effects on airway inflammation. At 0.4%, sevoflurane aggravated alveolar septal thickening and inflammatory infiltration and upregulated IL-4 and IgE but downregulated IFN-γ concentrations. In contrast, 3.2% sevoflurane alleviated alveolar septal thickening and inflammatory infiltration, and downregulated IL-4 and IgE but upregulated IFN-γ concentrations.“Volatile Anesthetic Loading of the Sonoparticles: A Preparation for Future Clinical Applications” by Siavash Sedghi, M.D., Amir Teimouri Dereshgi, M.D., Eric Young, B.S., Bruce A. Davidson, Ph.D., Hilliard Kutscher, Ph.D., Paul R. Knight, M.D., Ph.D., Nader D. Nader, M.D., Ph.D.Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New YorkAlthough use of volatile anesthetics for ischemic preconditioning is well established, airway compromise is a major drawback when they are given at high enough concentrations to have systemic effects. The objective of these in vitro experiments was to load sevoflurane in Food and Drug Administration–approved (for use as a contrast material during ultrasonic examination) lipid microsphere sonoparticles as a vehicle and evaluate its release in response to externally delivered sound shock waves compared to its release from intralipid 20% and from 0.9% normal saline. The sonoparticle preparation released sevoflurane most rapidly and at the highest concentration (3.5%) during the 30-min sonication period.“Intergenerational Effects of Surgery and Sevoflurane Anesthesia in Young Adult Rats with Traumatic Brain Injury” by Anatoly Martynyuk, D.Phil., Lingsha Ju, M.D., Jiepei Zhu, D.Phil., Nikolaus Gravenstein, M.D., Christoph N. Seubert, M.D., Terrie Vasilopoulos, D.Phil.Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FloridaThe effects of general anesthesia/surgery, traumatic brain injury, and subsequent repeated exposure to sevoflurane on neurobehavioral and neuroendocrine abnormalities in exposed young adult males (F0 generation) and their future offspring (generation F1) was tested in male Sprague-Dawley rats. Surgery, traumatic brain injury, and subsequent exposure to sevoflurane in young adult male rats led to proinflammatory, neuroendocrine, and neurobehavioral abnormalities in the exposed rats and in their future, primarily male, offspring.“MicroRNAs Involved in Dexmedetomidine Preconditioning-induced Neuroprotection” by Hyunyoung Seong, M.D., Daun Jeong, M.Sc., Jang Eun Cho, M.D., Ph.D.Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea (H.S., J.E.C.); Institute for Healthcare Service Innovation, Korea University, Seoul, Korea (D.J.)Dexmedetomidine has been reported to protect the brain from cerebral ischemia. MicroRNAs play important roles in ischemic tolerance induced by preconditioning. The association of microRNAs with the preconditioning effects of dexmedetomidine in neural ischemia was studied in mice administered dexmedetomidine before transient infarcts were induced by middle cerebral artery occlusion for 1 h. The infarct volume was reduced, expression of five microRNAs was increased, and expression of three microRNAs was decreased in mice preconditioned with dexmedetomidine. In vitro, microRNA-323 inhibition reduced cell apoptosis in an oxygen-glucose–deprived environment and had a neuroprotective effect.Sunday, October 23, 2022, 3:05pmto 5:00pmRoom 243Michael J. Avram, Ph.D., Assistant Editor-in-Chief, Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Deborah J. Culley, M.D., Executive Editor, Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Martin J. London, M.D., Editor, Anesthesiology, University of California, San Francisco School of Medicine and the Veterans Affairs Medical Center, San Francisco, California.“Artificial Intelligence-based Phenotyping of Thoracic Surgery to Anticipate Clinical Trajectory” by Pascal Laferriere-Langlois, M.D., Fergus Imrie, Ph.D., Maxime Cannesson, M.D.Anesthesiology, and Department of Electrical and Computer Engineering, University of California in Los Angeles, Los Angeles, CaliforniaClassifying a patient’s risk is important for clinical treatment, decision sharing, optimal resource distribution, and billing. Records of 1,933 surgical procedures performed by the thoracic surgery department since 2013 were extracted from the electronic medical record, 105 readily extractable features were extracted from each, and artificial intelligence, with clustering, was applied to identify phenotypes among these patients. Three phenotypes with distinct care trajectories and outcomes were identified among the records extracted. Patients with phenotype 3 (N = 424) experienced 66.7% of the deaths, 67.3% of prolonged intensive care unit stays, and 73.0% of prolonged hospital stays.“Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for Treating Pain Following Mastectomy” by Adam Schaar, M.D., Brian M. Ilfeld, M.D., John J. Finneran IV, M.D., Matthew W. Swisher, M.D., Engy Tadros Said, M.D., Rodney A. Gabriel, M.D., Jacklynn F. Sztain, M.D., Bahareh Khatibi, M.D., Andrea Trescot, M.D., Anne M. Wallace, M.D.Department of Anesthesiology, and Department of Surgery, University of California San Diego, San Diego, California (A.S., B.M.I., J.J.F., M.W.S., E.T.S., R.A.G., J.F.S, B.K.,A.M.W.); Florida Pain Relief Group, Tampa, Florida (A.T.)This randomized, observer- and participant-masked, sham-controlled pilot study evaluated preoperative ultrasound-guided percutaneous cryoneurolysis for the treatment of pain after mastectomy. On postoperative day 2, participants who had received active cryoneurolysis (n = 31) had a median [interquartile range] pain score, measured on a 0 to 10 numerical rating scale, of 0 [0 to 1.4] versus 3.0 [2.0 to 5.0] in patients given sham (n = 29). Cryoneurolysis decreased cumulative opioid use during the first 3 weeks by 98%. Chronic pain had developed after 1 yr in one (3%) active and five (17%) sham participants.“Perioperative Mortality of the COVID-19 Patient” by Michael Aziz, M.D., Katie J. Schenning, M.D., M.P.H., Vikas N. O’Reilly-Shah, M.D., Michael R. Mathis, M.D. Anesthesiology &amp; Perioperative Medicine, Oregon Health &amp; Science University, Portland, Oregon (M.A., K.J.S.); University of Washington, Seattle, Washington (V.N.O-S.); University of Michigan, Ann Arbor, Michigan (M.R.M.)The 30-day mortality of 3,721 elective surgical patients who had recovered from previous COVID-19 infection was compared to that of a propensity-matched cohort of 3,721 elective surgical patients without previous COVID-19 infection in a multicenter retrospective observational study of cases performed between April 2020 and April 2021. Among COVID-19–exposed patients, 160 (4.3%) expired within 30 days of surgery, whereas 63 (1.7%) of the propensity-matched control patients expired within 30 days of surgery.“Automated End-tidal Control Device Achieves and Maintains Concentration of Exhaled Agent and Oxygen Effectively” by Guy Dear, F.R.C.A., Matthew A. Klopman, M.D., Melissa D. McCabe, M.D., Melinda S. Seering, M.D.Anesthesiology, Duke University, Durham, North Carolina (G.D.); Emory University, Sandy Springs, Georgia (M.A.K.); Loma Linda University Medical Center, Loma Linda, California (M.D.M.); Anesthesia, University of Iowa, Iowa City, Iowa (M.S.S.)Automated gas control alters fresh gas flow and controls end-tidal anesthetic and oxygen concentrations using an end-tidal control device. A multicenter randomized controlled trial compared end-tidal control with standard anesthesia practice in 220 patients. End-tidal control achieved the desired end-tidal anesthetic and oxygen concentrations quickly and maintained the end-tidal concentration within a closer tolerance with minimal overshoot than standard anesthesia practice. End-tidal control reduced mean inhaled agent usage by 26% for desflurane, 30% for isoflurane, and 5% for sevoflurane.“Persistent Brain Connectivity Changes in Healthy Volunteers following Nitrous Oxide Inhalation” by Ben Palanca, M.D., Ph.D., Thomas A. Zeffiro, Ph.D., Britt M. Gott, M.S., Thomas Nguyen, B.S., Charles F. Zorumski, M.D., Charles R. Conway, M.D., Peter Nagele, M.D., M.S. Anesthesiology, and Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri (B.P., B.M.G., T.N., C.F.Z., C.R.C.); Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland (T.A.Z.); University of Chicago Medicine, Chicago, Illinois (P.N.)Nitrous oxide alleviates treatment-resistant depression. The effects of nitrous oxide on brain connectivity after inhalation were determined in a single-blinded crossover study of 16 healthy volunteers who underwent inhalation sessions of a 50% nitrous oxide/oxygen mixture for 1 h or an oxygen/air mixture for 1 h, in a randomized order. Functional magnetic resonance imaging identified increases in global connectivity to primary visual regions at 2 and 24 h after nitrous oxide inhalation that are consistent with reported changes in visual perception of the external world.“A Liberal Transfusion Strategy Leads to Higher Infection Rates, Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy (ORACL), A Prospective Randomized Study 30 Day Inpatient Complications” by Leilani Mullis, M.D., Brian Mullis, M.D., Walt Virkus, M.D., Laurence Kempton, M.D.Indiana University School of Medicine, Indianapolis, IndianaThere is ongoing debate about what level of anemia should be used as a transfusion trigger for asymptomatic trauma patients no longer in a resuscitative phase. To determine if a more conservative strategy is safe and decreases the risk of infection, 99 asymptomatic young orthopedic trauma patients no longer being resuscitated were randomly assigned to a conservative transfusion strategy of 5.5 g/dl or a liberal strategy of 7.0 g/dl in this multicenter pilot study. A conservative transfusion strategy of 5.5 g/dl led to a lower deep infection rate without an increase in adverse outcomes.“Signaling Cascades of Circulating Glycosaminoglycans Reflect Pulmonary Injury in COVID-19” by Melanie Borrmann, M.D., Florian Brandes, M.D., Benedikt Kirchner, M.Sc., Matthias Klein, M.D., Marlene Reithmair, M.Sc., Michael Pfaffl, M.Sc., Gustav Schelling, M.D., Markus Rehm, M.D., Agnes Meidert, M.D.Department of Anesthesiology, Ludwig Maximilian University of Munich, Munich, Germany (M.B., F.B., M.R., A.M.); Division of Animal Physiology and Immunology, Technical University of Munich, Weihenstephan, Germany (B.K., M.P.); Department of Neurology, Ludwig Maximilian University of Munich, Munich, Germany (M.K.); Institute of Human Genetics, Munich, Germany (M.R.); Ludwig Maximilian University of Munich, Munich, Germany (G.S.)The circulating glycosaminoglycans hyaluronan and heparan sulfate were measured in 20 patients with COVID-19 pneumonia, 20 patients with COVID-19 acute respiratory distress syndrome (ARDS), and 20 healthy controls, and molecular signaling networks targeted by these glycocalyx components were identified. Plasma hyaluronan and heparan sulfate concentrations increased with disease severity and were higher in COVID-19 ARDS than in COVID-19 pneumonia and in healthy volunteers. Plasma hyaluronan concentrations were also higher in pneumonia than in healthy controls. Hyaluronan, heparan sulfate, and their upregulated degradative enzymes HYAL1 and HPSE activated cytokine signaling in immune cells and aggravated vascular barrier dysfunction in COVID-19 ARDS.“2019 Multicenter Hypotension Prediction Index Clinical Study” by Xiaodong Bao, M.D., Ph.D., Kamal Maheshwari, M.D., Donald H. Penning, M.D., Sydney E. Rose, M.D., Gaurav Malhotra, M.D., David R. Drover, M.D., Nirav J. Shah, M.D., Karen B. Domino, M.D., Claudia F. Clavijo, M.D.Massachusetts General Hospital, Boston, Massachusetts (X.B.); Cleveland Clinic, Solon, Ohio (K.M.); Henry Ford Hospital–Residents, Detroit, Michigan (D.H.P.); Oregon Health and Science University, Portland, Oreg

Application of three-dimensional computed tomography bronchography and angiography in thoracoscopic anatomical segmentectomy of the right upper lobe: A cohort study.

ObjectiveThree-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide detailed imaging information for pulmonary segmentectomy. This study aimed to investigate the safety and effectiveness of 3D-CTBA guidance of anatomical segmentectomy of the right upper lobe (RUL).MethodsThis was a retrospective analysis of anatomical segmentectomy of the RUL at the Thoracic Surgery Department of the Fourth Hospital of Hebei Medical University from December 9, 2013, to June 2, 2021. Preoperatively, all patients underwent contrast-enhanced CT of the chest (to determine the size of the pulmonary nodule) and a lung function test. 3D-CTBA has been performed since 2018; patients with vs. without 3D-CTBA were compared. Segmentectomy was performed according to nodule location.ResultsOf 139 patients (46 males and 93 females, aged 21–81 years), 93 (66.9%) completed single segmentectomy, 3 (2.2%) completed single subsegmentectomy, 29 had combined subsegmentectomy, 7 had segmentectomy combined with subsegmentectomy, and 6 had combined resection of two segments. Eighty-five (61.2%) patients underwent 3D-CTBA. 3D-CTBA cases had decreased intraoperative blood loss (67.4 ± 17.6 vs. 73.1 ± 11.0, P = 0.021) and shorter operation time (143.0 ± 10.8 vs. 133.4 ± 20.9, P = 0.001). 3D-CTBA (Beta = −7.594, 95% CI: −12.877 to −2.311, P = 0.005) and surgical procedure (Beta = 9.352, 95% CI: 3.551–15.153, P = 0.002) were independently associated with intraoperative blood loss. 3D-CTBA (Beta = −13.027, 95% CI: −18.632 to 17.422, P < 0.001) and surgical procedure (Beta = 7.072, 95% CI: 0.864–13.280, P = 0.026) were also independent factors affecting the operation time.ConclusionPreoperative use of 3D-CTBA to evaluate the pulmonary vessels and bronchial branch patterns of the RUL decreased blood loss and procedure time and so would be expected to improve the safety and effectiveness of thoracoscopic segmentectomy.

Esophagocolonic OrVil Anastomosis After Minimally Invasive Esophagectomy.

Purpose: The classical colon substitution procedure is open surgery. Still, technological developments could allow a minimally invasive procedure that might improve patient outcomes. To present the efficacy and safety of esophagocolonic OrVil anastomosis after minimally invasive esophagectomy. Methods: This retrospective study included 10 patients with esophageal cancer treated with OrVil anastomosis (OA) between August 2017 and May 2021 at Department of Thoracic Surgery, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China and the Fourth Associated Hospital of Anhui Medical University. The patient's characteristic information and related perioperative indexes were collected from the hospital's electronic medical record system and the patients were followed up. Results: The mean operative time and median intraoperative blood loss were 530 ± 88 minutes and 200 (range: 100-300) mL, respectively. A median of 26 (range: 13-30) lymph nodes was dissected per patient. The median total duration of hospitalization and postoperative hospitalization was 32 (range: 24-64) and 15 (range: 12-42) days, respectively. Seven (70%) patients had postoperative pulmonary infections. Two (20%) patients had postoperative respiratory failure. No esophagocolonic anastomotic leakage was observed in all cases. One patient was complicated with postoperative colonicoduodenal anastomotic leakage after the operation and was cured. However, 1 (10%) of the remaining 9 patients died from colonicolonic anastomotic leakage during hospitalization. The living 9 cases were followed up, and the median overall survival time was 36 months. Conclusion: Colonic interposition for esophageal cancer is effective and safe using the minimally invasive OA technique.

Diagnostic and Therapeutic Characteristics in Patients with Pneumotorax Associated with COVID-19 versus Non-COVID-19 Pneumotorax.

Introduction: Pneumothorax is a condition that usually occurs in thin, young people, especially in smokers. It is an unusual complication of COVID-19 disease that can be associated with worse results. This disease can occur without pre-existing lung disease or without mechanical ventilation. Materials and Methods: We present a monocentric comparative retrospective study of diagnostic and treatment analysis of two groups of patients diagnosed with COVID-19 and non-COVID-19 pneumothorax. All patients included in this study underwent surgery in a thoracic surgery department. The study was conducted over a period of 18 months. It included 34 patients with COVID-19 pneumothorax and 42 patients with non-COVID-19 pneumothorax. Results: The clinical symptoms were more intense in patients with COVID-19 pneumothorax. We found that the patients with COVID-19 had significantly more respiratory comorbidities. Diagnostic procedures include chest CT exam for both groups. Laboratory findings showed that increasing values for the analyzed data were consistent with the deterioration of the general condition and the appearance of pneumothorax in the COVID-19 group. The therapeutic attitude regarding the non-COVID-19 group was to eliminate the air from the pleural cavity and surgical approach to the lesion that determined the occurrence of pneumothorax. The group of patients with COVID-19 pneumothorax received systemic treatment, and only minimal pleurotomy was performed. The surgical approach did not alter patients’ survival. Conclusions: Careful monitoring of the patient’s clinic and laboratory tests evaluating the degradation of the lung parenchyma, correlated with the imaging examination (chest CT) is mandatory and reduces COVID-19 complications. Early imaging examination starts an effective diagnosis and treatment management. In severe COVID-19 pneumothorax cases, the pneumothorax did not influence the evolution of COVID-19 disease. When we found that the general condition worsened with the rapid progression of dyspnea and the deterioration of the general condition, and we found that it represented the progression or recurrence of pneumothorax.

Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery.

Background and purposeWith the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients.MethodsThe clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed.ResultsThe incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072).ConclusionPostoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.

Key Factors Associated With Administration of Ventilator Support After Thymoma Resection.

In clinical practice, some patients undergoing surgery for thymoma require post-surgical ventilator support, although, factors associated with administration of ventilator support are unclear. This study aimed to explore factors associated with incidence of post-surgical severe respiratory failure requiring ventilator support after thymoma resection. Clinical data of patients who underwent thymoma re-section in our thoracic surgery department between January 2001 and February 2020 was retrospectively analyzed. Multiple logistic regression analysis was used to identify factors associated with patient need for post-surgical ventilator support after thymoma resection. Among 157 patients who underwent thymoma resection, 17.8% (28/157) required post-surgical ventilator support. Results of univariate analysis revealed that gender, myasthenia gravis (MG) grade, anti-MG medication use (neostigmine or prednisone), Masaoka thymoma stage, pulmonary function test index values, surgical approach, and intraoperative blood loss were associated with increased incidence of severe respiratory failure requiring post-operative ventilator support (P<0.05). Results of multivariable logistic regression analysis revealed that median sternotomy, MG grade three status, and patient use of anti-MG drug treatments before thymoma resection surgery were associated with greater need for post-surgical ventilator support. Our data suggest that median sternotomy, MG grade three status, and preoperative use of anti-MG drugs are associated with greater incidence of severe respiratory failure requiring respiratory support after thymoma surgery. Therefore, patients with these risk factors should be closely monitored to reduce the incidence of severe postoperative respiratory failure.

Adjuvant chemotherapy can benefit the survival of stage I lung adenocarcinoma patients with tumour spread through air spaces after resection: Propensity-score matched analysis.

BackgroundIt is still unclear whether stage I lung adenocarcinoma patients with tumour spread through air spaces (STAS) can benefit from postoperative adjuvant chemotherapy (ACT) after lobectomy. This study investigated the effect of ACT on the postoperative survival of patients with stage I (STAS+) lung adenocarcinoma.MethodsWe retrospectively analysed the clinical data of stage I (STAS+) invasive lung adenocarcinoma patients who underwent lobectomy in the Department of Thoracic Surgery of our hospital from January 1, 2013 to January 1, 2016. Propensity score matching (PSM) was performed to group patients to investigate whether ACT could lead to better prognosis of patients.ResultsA total of 593 patients with stage I (STAS+) lung adenocarcinoma were enrolled. The study after PSM included 406 patients. Kaplan–Meier survival analysis showed the experimental group had a better 3-year recurrence-free survival (RFS) rate (p = 0.037) and the 5-year RFS rate (p = 0.022) than the control group. It also had higher 5-year overall survival (p = 0.017). The multivariate analysis by Cox proportional hazard regression model showed that stage I STAS+ lung adenocarcinoma patients with lymphatic vessel invasion (HR: 1.711, 95% CI: 1.052-2.784; p = 0.045), vascular invasion (HR: 5.014, 95% CI: 3.154-7.969; p < 0.001), and visceral pleural invasion (HR: 2.086, 95% CI: 1.162-3.743; p = 0.014), and without ACT (HR: 1.675, 95% CI: 1.043-2.689; p = 0.033) had a significant survival disadvantage.ConclusionACT can boost the postoperative survival of patients with stage I (STAS+) lung adenocarcinoma.

The comparison of Lobe-Specific or Systematic Mediastinal Lymph Node Dissection for Early-Stage Lung Adenocarcinoma With Consolidation Tumor Ratio Over 0.5

IntroductionSurgery is the most effective treatment for early-stage lung cancer. This study will propose a personalized plan for mediastinal lymph node dissection in early-stage lung adenocarcinoma to reduce the risk of surgery and improve the quality of life. MethodsThis study retrospectively analyzed the patients underwent lobectomy and lymph node dissection in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical stage I lung adenocarcinoma patients with solid component ratio (CTR) between 0.5 and 1 were included. Patients were divided into systematic (S-MLND) and lobe-specific (L-MLND) mediastinal lymph node dissection groups. The days of hospitalization, the presence or absence of complications, the recurrence-free survival rate, and the overall survival rate were calculated to evaluate the postoperative quality and operation risk of the patients. Results210 patients (138 L-MLND and 72 S-MLND) were included. 2 lymph node metastases appeared in the S-MLND group while none in the L-MLND group (P = .049). No differences were shown in age, tumor site, size, solid component, degree of tumor invasion, and stage. The proportion of patients with severe postoperative cough and the length of hospital stay in the L-MLND group decreased. The 5-year OS of the entire cohort was 98.1%, 98.6% in L-MLND, compared with 97.2% in S-MLND; RFS was 94.8%, 95.7% in L-MLND, compared with 93.0% in S-MLND. ConclusionFor cIA lung adenocarcinoma, according to the Thin-slice CT within 1 month before the operation, if the main lesion was less than 3 cm and CTR over 0.5, L-MLND is as effective as S-MLND.

The prognostic influence of histological subtypes of micropapillary tumors on patients with lung adenocarcinoma ≤ 2 cm.

ObjectiveThis study aimed to explore the value of micropapillary histological subtypes in predicting the specific surgical specificity and lymph node metastasis prognosis of early lung adenocarcinoma.MethodsA total of 390 patients with lung adenocarcinoma were included who underwent surgery in the Department of Thoracic Surgery of the Affiliated Provincial Hospital of Anhui Medical University from January 2016 to December 2017. The data were analysed with SPSS 26.0 statistical software, and the clinicopathological data of the two groups were compared with the chi-square test. The survival rate was calculated by the Kaplan-Meier method, and the difference in survival rate between groups was analysed by the log-rank test. Multivariate survival analysis was performed using the Cox model.ResultsUnivariate analysis of the clinicopathological data of the patients showed that the micropapillary histological subtype was significantly associated with the survival rate of patients (p=0.007). The clinicopathological data of the patients were substituted into the Cox model for multivariate analysis, and the results showed that the micropapillary histological subtype was an independent prognostic factor affecting the survival rate of the patients (p=0.009).The average survival time of Group A (micronipple composition > 5%) was 66.7 months; the 1-year, 3-year, and 5-year survival rates were 98.8%, 93.0%, and 80.9%, respectively.The survival of the lobectomy group was better than that of the sublobectomy group and the survival of patients with systematic dissection was better than that of patients with limited lymph node dissection. The average survival time of Group B (micronipple composition ≤ 5%) was 70.5 months; the 1-year, 3-year, and 5-year survival rates were 99.3%, 95.4%, and 90.6%, respectively. There was no difference in the survival rate between the lobectomy group and sublobectomy group, and there was also no difference in survival between systematic lymph node dissection and limited lymph node dissection, The survival rate of Group B was significantly better than that of Group A.ConclusionThe micropapillary histological component is an independent risk factor after surgery in patients with ≤2 cm lung adenocarcinoma. When the proportion of micropapillary components is different, the prognosis of patients is different when different surgical methods and lymph node dissections are performed. Lobectomy and systematic lymph node dissection are recommended for patients with a micropapillary histological composition >5%; sublobar resection and limited lymph node dissection are recommended for patients with a micropapillary histological composition ≤5%.

Construction of Pulmonary Embolism Prediction, Early Warning, and Precontrol MDT Collaborative Nursing Model Based on the Smith Model.

The purpose of this study was to construct a multidisciplinary collaborative nursing model for pulmonary embolism risk prediction, early warning, and precontrol based on the Smith model and evaluate the application effect and hospitalization satisfaction. 2,037 patients hospitalized in the thoracic surgery department from June 1, 2019, to May 31, 2021, were selected as the research subjects. The control group received routine pulmonary embolism prevention management, while the experimental group received safe, case-based, and programmatic multidisciplinary intervention management based on the Smith policy management model. The data were analyzed statistically. The experimental group's extubation and hospitalization time, D-dimer value, incidence of deep vein thrombosis, and pulmonary embolism on the seventh day after surgery were lower than those in the control group, and the satisfaction of hospitalization in the experimental group was higher than that in the control group. The implementation of the multidisciplinary collaborative nursing model of pulmonary embolism risk prediction, early warning, and precontrol based on the Smith model can promote the preventive effect of pulmonary embolism risk of surgical patients in our department and effectively improve the satisfaction of hospitalization, which is worthy for further promotion.

Management peculiarities of costovertebral hydatidosis.

Costovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified. The aim of our study was to specify the management peculiarities of costovertebral hydatidosis. Between January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department. The mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications. Costovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.

The Effect of Birth Month on the Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery.

Cardiovascular diseases remain one of the leading causes of morbidity and mortality worldwide, however its surgical treatment remains risky with possible complications. There is increasing evidence that the month of birth (MOB) has been related to different health problems during life. The aim of this study was to identify the effect of MOB on the risk of deep sternal wound infections (DSWI) in patients after open-heart surgery. The follow-up retrospective research was performed at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. We analyzed the MOB of 201 patients, who underwent open-heart surgery between January 2017 and December 2018. The case group consisted of 46 patients, who suffered from DSWI. Multivariate logistic regression for the association between MOB and risk of DSWI was used. The results showed that the risk of DSWI was by four times higher for patients born in June-September months. The risk of developing DSWI in the case group was even higher for women, patients aged 70 years and younger, those overweight or obese, and patients who underwent only CABG surgery. Due to the growing evidence that the month of birth affects the onset of diseases, it is important to assess MOB as the potential risk factor for developing DSWI.

The Fear of Surgery and Coronavirus in Patients Who Will Undergo a Surgical Intervention

PurposeThe aim of this study was to determine the fear of surgery and Coronavirus in patients who will undergo a surgical intervention.DesignA descriptive cross-sectional study.MethodsThis study was carried out with 103 patients who were hospitalized in the thoracic and cardiovascular surgery departments of a university hospital between July and December 2021 and underwent elective cardiac/thoracic surgery for various indications. The Patient Information Form, Surgical Fear Questionnaire, and Coronavirus (COVID-19) Fear Scale were used to collect data. One hundred three patients were reached within the scope of the study. Data were analyzed with the Mann Whitney U and Kruskal Wallis tests and Spearman's correlation analysis in IBM SPSS (V.22.0) program.FindingsThe mean age of the participants was 57.8 ± 14.0 years (19-82), 68.0% (n = 70) were male, and 78.7% (n = 81) underwent thoracic surgery. The total mean score of the patients on the Surgical Fear Scale was 26.9 ± 20.5 while the total mean score on the Coronavirus Fear Scale was 18.2 ± 7.5. A weak positive correlation was identified between the patients' total score averages on the Surgical Fear Scale and the Coronavirus Fear Scale (COVID-19) (P < .001).ConclusionsPatients undergoing cardiothoracic surgery had a low fear of surgery and a close to moderate fear of Coronavirus. Patients' fears of surgery and Coronavirus should be determined before surgery, and psychological support should be provided to patients with high levels of fear.