Chest Research Articles

Chirurgie du cancer à petites cellules

Curative surgery for Small-Cell Lung Cancer (SCLCs) is rare, accounting for less than 5 % of surgeries for bronchopulmonary cancer. The rapid progression of SCLCs and their discovery at a metastatic or locally advanced stage generally exclude them from surgical strategy. Even in localized tumor forms, this surgery is rarely proposed. However, scientific societies (ASCO, ESMO, INCA) have established multimodal management recommendations including radical surgery for selected patients, despite very low levels of evidence. This primarily concerns stage I and sometimes stage II patients, if adjuvant chemotherapy is feasible. Including surgery, the median survival for stage I patients ranges from 28 to 54 months, and 5-year survival rates from 34 % to 65 %, values significantly higher than for non-operated patients. This surgery is not suitable for multi-site or “bulky” N2, but some N2 patients appear to benefit with 5-year survival rates exceeding 20 %. Salvage surgery after tumor re-evolution is possible under certain conditions. Lobectomy with lymph node dissection is the preferred intervention in this context, and the role of sub-lobar resection remains controversial. All these results justify medical combined to surgical discussions in Thoracic Oncology multidisciplinary tumor board for these SCLC patients. Thanks to screening programs and improved staging assessments, the more frequent diagnosis of less extensive forms will certainly highlight the role of surgery for SCLCs. 1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Regional Phase Angle As An Indicator Of Upper And Lower Body Strength Performance In Youth

Regional Phase Angle As An Indicator Of Upper And Lower Body Strength Performance In Youth

Effects Of Upper And Lower Body Blood Flow Restriction Training On Subjective Assessments

Effects Of Upper And Lower Body Blood Flow Restriction Training On Subjective Assessments

Abdominal Etching-A Novel Classification Method for Surgical Approach.

The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. Sixty-two patients (42 male) with an average age of 36years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

EP.05A.05 Brazilian Single-Center Experience in the Staging of Thoracic Neoplasms Using Endosonographic Methods (EUS/EBUS)

EP.05A.05 Brazilian Single-Center Experience in the Staging of Thoracic Neoplasms Using Endosonographic Methods (EUS/EBUS)

A Retrospective Analysis of 190 Patients With Scoliosis Referred to a Private Australian Clinical Advisory Service Between 2017 and 2020

ObjectiveThe aim of this study was to describe the demographic and clinical characteristics of patients with scoliosis from Australian primary care practices. MethodsA retrospective review of 190 patient records from August 2017 to April 2020 from a private Australian clinical advisory service database was performed. Deidentified demographic and clinical data were collated and analyzed, along with information regarding the referring practitioners and any accompanying clinical or paraclinical information. Numerical data were summarized with median and IQR, while categorical data were summarized with counts and percentages. Salient qualitative data from the advisory service records were also collated, coded, and summarized. ResultsPatients were aged between 3 and 87 years; the majority (71%) of patients were female, with a median age of 16 years (IQR, 13; range, 3-87 years). The most common type of spinal deformity seen in the sample was scoliosis (92%), with hyperkyphosis (7%) and other deformity (1%) making up the remaining cases. There was a wide variety of scoliosis presentations; however, curves were commonly (45%) located in the thoracic region of the spine. Observed scoliosis cases were of moderate severity with a median Cobb angle measuring 26.5° (IQR, 20°). Reports of pain were in the lower trunk/pelvis (46%), the middle trunk (16%), or throughout multiple bodily regions (27%). Alterations in normal spinal anatomy (eg, hemivertebrae) were common (55% of cases). The majority (86%) of patient cases came from chiropractors, whereas 9% were from osteopaths, 4% from physiotherapists, and 1% from other types of practitioners (eg, medical practitioners). ConclusionThe findings from this study suggest that patients presenting to practitioners in primary care settings in Australia present with a range of scoliosis and related spinal deformity presentations.

EP.11C.03 Anlotinib Combined with Immune Checkpoint Inhibitor May Benifit Advanced Smarca4-Deficient Thoracic Tumor Patients in First Line

EP.11C.03 Anlotinib Combined with Immune Checkpoint Inhibitor May Benifit Advanced Smarca4-Deficient Thoracic Tumor Patients in First Line

EP.06G.20 Advanced Squamous Cell Lung Carcinoma in Never Smokers: A Different Entity? Analysis from the Thoracic Tumor Registry in Spain (RTT)

EP.06G.20 Advanced Squamous Cell Lung Carcinoma in Never Smokers: A Different Entity? Analysis from the Thoracic Tumor Registry in Spain (RTT)

Quel bilan anatomo-pathologique ?

The WHO classification of lung tumours on which pathologists base their diagnosis was revised in 2015 on the basis of an international consensus established in 2011 between clinicians, radiologists and pathologists. This resulted in a histo-molecular and prognostic classification of adenocarcinomas. The use of immunohistochemistry for the classification of poorly differentiated non-small cell carcinomas and a new classification adapted to small specimens were defined. These concepts are still relevant today, as the management of small specimens is a key point in the collaboration between the sampling physician and the pathologist.This classification was revised in 2021 and remains broadly the same except for the appearance of new entities: SMARCA4-defident undifferentiated thoracic tumour; bron-chiolar adenoma / muconodular ciliated papillar tumour. Although rare, these lesions have histopathological, clinical and/or molecular appearances that merit their presence as new entities.For invasive adenocarcinomas, the 5 architectural patterns are maintained but the IASLC proposes a grading system which has shown a prognostic impact for early stages.Some clarifications regarding the diagnosis of neuroendocrine tumours/carcinomas were provided.Regarding pleural pathology, mesothelioma in situ is defined and characterised. 1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Certification system for multidisciplinary thoracic tumour boards.

In Spain, lung cancer (LC) is the fourth most common cancer. Managing LC involves different professionals, and cooperative and coordinated work is crucial. Therefore, important decisions are better made by Multidisciplinary Thoracic Tumour Boards (MTTBs). On the other hand, certification systems have proven to improve the structure of care, ultimately having a positive impact on patient survival. Herein, a multidisciplinary working group of 11 experts (a Radiologist, a Thoracic Surgeon, a Pulmonologist, a Radiotherapy Oncologist, four Medical Oncologists, a Hospital Managing Director, a Cytologist, and a Molecular Biologist specialist) proposed a standard to certify and evaluate MTTBs. The following components were suggested for the standard: minimum requirements for the MTTB, a mixed model developed in two stages (preparation and audit), a structure comprising three groups of indicators (Strategic and Management, Support, and Operational), three certification levels, and an audit process. In our opinion, certifying MTTBs is critical to improve the standard of care for LC patients.

OA18.06 Characteristics and Outcomes of Patients with SMARCA4-Deficient Undifferentiated Thoracic Tumors

OA18.06 Characteristics and Outcomes of Patients with SMARCA4-Deficient Undifferentiated Thoracic Tumors

EP.13D.09 Characteristics and Survival in Never-Smoking Small Cell Lung Cancer Cases an Analysis from the Thoracic Tumor Registry

EP.13D.09 Characteristics and Survival in Never-Smoking Small Cell Lung Cancer Cases an Analysis from the Thoracic Tumor Registry

Optimizing Accelerometer Placements For Detecting Upper Body Movement During Occupational Physical Activity Using Machine Learning

Optimizing Accelerometer Placements For Detecting Upper Body Movement During Occupational Physical Activity Using Machine Learning

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study.

Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation. Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation. Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement. Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Influence of the surrounding environment on the response of seated midsize male volunteers subjected to lateral sled accelerations

Predicting vehicle occupants’ posture during evasive manoeuvres is crucial for assessing their safety in the event of a collision. Volunteer experiments have been performed in the past under lateral accelerations, both within a vehicle cabin and on a seat mounted on a sled. However, discrepancies in the volunteer responses between both setups have been identified. This study hypothesizes that the response of the volunteers differs as a consequence of the proximity to the frame in the vehicle cabin, in comparison to the absence of such a structure on the sled.The present study conducted a novel sled experiment, on which five volunteers with anthropometry comparable to the 50th percentile male were subjected to 0.3 g lateral accelerations, with three different surrounding environments. In twelve pulses, an additional lateral structure was placed to the right or left side of the seated volunteers. The volunteers were asked to either brace or relax their muscles.The results show significant differences between the configurations with and without the structure placed on the right side. This effect was observed for both the lateral excursion of the upper body and the corresponding rotation when the volunteers were relaxed (p < 0.01). The average maximum lateral head rotation decreased from 27° to 14° with the structure on the right. No significant difference in head rotation was found for the braced muscle configuration.This study supports the hypothesis that the proximity to a surrounding environment influences human responses during dynamic loading. Nevertheless, there was no significant difference in maximum muscle activation between the configurations, but a faster reaction of the sternocleidomastoid muscle with the presence of the structure.

Effects of 8-weeks Surf Skateboard training on physical fitness in young people

BackgroundSurf skateboards have grown in popularity among young people in recent years. However, no research studies have analyzed the effect of surf skateboarding on physical fitness. ObjectiveThe purpose of this study was to determine the effects of 8-week surf skateboard training on physical fitness in young adults. MethodsTwenty-two young people, ages 18–24 years were randomly assigned into two groups: a control (CON; n = 11) and surf skateboarding (SSK; n = 11) group. The surf skateboard training group received an eight-week intervention consisting of three 60-minute (min) sessions per week, while the control group continued with their normal daily lives. Physical fitness was assessed before and after the intervention through a battery of tests that included body composition, cardiorespiratory fitness, muscular strength and endurance, flexibility, and balance. ResultsThe results showed that the SSK group demonstrated significant (p < 0.05) improvements in maximum voluntary ventilation, back and leg strength, lower body muscular endurance by the sit-to-stand tests, and balance in all direction compared with the pre-test and the CON group. In addition, the SSK group showed significantly (p < 0.05) decreased body weight, body mass index, percent body fat, and resting heart rate, while increased maximum oxygen consumption, pulmonary function, respiratory muscle strength, upper body muscular endurance by the sit-up test and flexibility compared with the pre-test. ConclusionThe findings suggest that surf skateboard training have an effective physical activity intervention to improve body composition, cardiorespiratory fitness, muscular strength and endurance, flexibility, and balance in young people.

Velocity-Based Training Induced Reductions In Upper Body Power Asymmetry In Persons’ With Parkinson’s Disease

Velocity-Based Training Induced Reductions In Upper Body Power Asymmetry In Persons’ With Parkinson’s Disease

Gastric dysplasia arising from a submucosal heterotopic gastric gland.

A submucosal heterotopic gastric gland (SHGG) is characterized by benign ectopic gastric tissue within the submucosa. Neoplasms arising from SHGGs are rare, and their definitive diagnosis via endoscopic biopsy is often challenging. We report the case of a 74-year-old man undergoing screening esophagogastroduodenoscopy, which revealed a subepithelial lesion with a central orifice in the upper body of the stomach. Endoscopic submucosal dissection (ESD) was performed because the endoscopic biopsy revealed a suspected pyloric gland adenoma. Pathological examination of the resected specimen confirmed SHGG with focal dysplasia. The patient recovered uneventfully and remained free of recurrence over a 5-year follow-up period. This case highlights the utility of ESD in both the treatment and accurate pathological diagnosis of neoplasms arising from SHGGs.

Methicillin-Resistant Staphylococcus aureus Secondary Infection as a Comorbid in Crusted Scabies Patient

Introduction: Crusted scabies (CS) is characterized by uncontrolled proliferation of mites up to thousands. Complications include glomerulonephritis, rheumatic fever, and secondary infection which can cause bacteremia and sepsis. This case report describes a case of CS that was hospitalized with secondary complications of MRSA infection. Case Presentation: A 44-year-old woman complained of thick scales and itching all over her body for 6 months. Complaints begin with reddish bumps between the fingers, toes, body, genitals, and scalp, accompanied by itching, especially at night. The patient took self-purchased corticosteroids for this complaint for 6 months. Dermatology status all over the body showed erythematous papules plaques with greenish-yellow scales, blackish crusts, hyperkeratosis, and excoriation, also erythematous base erosions and blackish crusts in the right thoracic region. Ectoparasite scrapping examination showed large amounts of Sarcoptes scabiei, eggs, and scybala, so the patient was diagnosed with Crusted scabies. A wound culture and nasal swab showed MRSA. The patient died of septic shock on day 12 of treatment. Discussion: Crusted scabies is a highly contagious form of scabies, characterized by thickening of the skin layer and crusts. Long-term corticosteroid consumption in this case caused a compromised immune response so that the number of mites multiplied rapidly and increased the risk of MRSA infection. MRSA mortality rates range from 5-60%. Conclusion: Ignored cases of scabies can develop into crusted scabies which have a high risk of secondary infection, such as MRSA which can cause serious morbidity and even mortality.

Clinical Application of Equivalent Uniform Dose in Intensity-Modulated Rotational Radiotherapy Based on Eclipse TPS

To investigate the application of equivalent uniform dose (EUD) in intensity-modulated rotational radiotherapy and to explore optimization methods for improving the quality of modulated treatment plans. The impact of the parameter a in the EUD formula on the characteristics of the EUD curve was analyzed using Python. Thirty cases of head and neck tumors, thoracic tumors, and pelvic tumors were randomly selected for treatment planning. Dose optimization for the target area and organs at risk were performed using a physics-based optimization approach or an optimization approach that combines physical constraints with the EUD function. The dose distribution and compliance with constraints of the two groups of plans were compared, while also observing the effect of different values of a on the planning outcomes. The impact of the value of a on the changes in EUD curve characteristics was consistent with its impact on the results of EUD plan optimization. When -15≤ a≤-5, the dose distribution in the target area was more uniform; when 1≤ a≤7, the effect on the uniform dose and low-dose regions in organs at risk was more noticeable; when 10≤ a≤30, the effect of constraining the high-dose regions in organs at risk was more pronounced, with the EUD for the target area and organs at risk exhibiting different expressions under different a values. The study also found that the target dose distribution and the protection of organs at risk in the EUD optimization group were better than those in the physical optimization group only. The a-value has a significant impact on the, the dose distribution in the target area and the organ at risk, providing a reference for the setting of a-value while using EUD to optimize the intensity modulation plan. The using of EUD optimization method can not only achieve excellent dose distribution in the target area, but also significantly reduce the normal tissue dose and the probability of complications, which has certain clinical application value.