DONA ORA
Pubblicazioni recenti - cardiac surgery
-
Echocardiography Aided by Computed Tomography to Diagnose Obstructive Masses in Patients with Prosthetic Heart Valves.
Tex Heart Inst J2020 Aug;47(4):342. doi: 10.14503/THIJ-20-7376.
Kalcik Macit, Guner Ahmet, Gunduz Sabahattin, Ozkan Mehmet,
Guarda su PubMed
-
A History of Cardiac Surgery: An Adventurous Voyage from Antiquity to the Artificial Heart.
Tex Heart Inst J -
En Bloc AngioVac Removal of Thoracic Aortic Mass.
Tex Heart Inst J2020 Aug;47(4):315-318. doi: 10.14503/THIJ-18-6917.
Kang Jeanney, Fleischman Fernando, Saremi Farhood, Shavelle David M,
Abstract
The AngioVac system, designed for suction during extracorporeal bypass, is used to aspirate masses, thrombi, and other undesirable material from the cardiovascular system. To date, it has been used extensively in the venous system and right side of the heart; however, its use in the arterial system has been limited because of smaller vessel sizes and the requirement for a 26F sheath. We report the case of a 45-year-old woman with a history of angiosarcoma who presented with acute embolic events that affected her spleen and lower extremities. We removed a large mobile mass en bloc from her distal thoracic aorta by using the AngioVac system as an alternative to surgical resection. The patient recovered with no recurrence. We discuss the benefits and challenges of using the AngioVac within small vessels of the arterial system.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Ten-Year Survival With a Continuous-Flow Left Ventricular Assist Device and Aortic Valve Closure.
Tex Heart Inst J2020 Aug;47(4):325-328. doi: 10.14503/THIJ-19-7193.
Letsou George V, Musfee Fadi I, Lee Andrew D, Cheema Faisal, Delgado Reynolds M, Frazier O H,
Abstract
We report the long-term survival of a 46-year-old man supported with a HeartMate II continuous-flow left ventricular assist device after complex repair of a bicuspid aortic valve, anomalous left main coronary artery, and dilated aorta. He has been maintained on an anticoagulation regimen of warfarin and low-dose aspirin without problems for 10 years, during which he has worked continuously and productively. Device flow has been kept at 10,000 rpm. Possible contributors to this long-term success include proper alignment of the device inflow cannula, pericardial patch closure of the left ventricular outflow tract, and, notably, the remarkable freedom from mechanical failure of the continuous-flow left ventricular assist device. Whether the higher flow rate produced by the pericardial patch closure contributes to pump longevity is unknown and merits further investigation.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Simple Felt-Plug Closure Technique for Minimally Invasive Removal of a Centrifugal-Flow Left Ventricular Assist Device.
Tex Heart Inst J2020 Aug;47(4):322-324. doi: 10.14503/THIJ-19-7097.
Schutz Alexander, Mattar Aladdein, Loor Gabriel, Cohn William E, Shafii Alexis,
Abstract
As the indications for implanting left ventricular assist devices have expanded, some patients are qualifying for device removal after myocardial recovery. Whereas explantation has been described for previous generations of devices, no standard procedures have been developed. Removal of centrifugal-flow devices has created the need for a plug to seal the apical ventriculotomy after pump removal. However, no commercially available products are available in the United States. We used a novel technique to fashion a plug from Teflon felt and a Dacron graft to enable minimally invasive explantation of a current-generation centrifugal-flow device in a 33-year-old woman.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Late Bacterial Endocarditis in an Intravenous Drug User With an Amplatzer Septal Occluder.
Tex Heart Inst J2020 Aug;47(4):311-314. doi: 10.14503/THIJ-18-6903.
La Sala Michael S, Zohourian Hajir, McKeown Joseph, Snyder Samuel,
Abstract
Infective endocarditis of a fully endothelialized cardiac prosthesis, and especially the late presentation of endocarditis, challenges our current understanding of device-related complications. Late bacterial endocarditis associated with the Amplatzer Septal Occluder, a device frequently used to close atrial septal defects, has been documented only rarely. We report the case of an intravenous drug user who had late infective endocarditis associated with his Amplatzer Septal Occluder, secondary to methicillin-sensitive Staphylococcus aureus bacteremia nearly 14 years after device insertion. The patient recovered after surgical excision and débridement of the vegetative mass, which may be the first time that a surgical approach has been taken to treat this condition. This report corroborates the need for late screening of high-risk patients who have septal occluder devices.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Interventricular Septal Rupture in a 62-Year-Old Man With Familial Amyloid Polyneuropathy.
Tex Heart Inst J2020 Aug;47(4):302-305. doi: 10.14503/THIJ-18-6799.
Pidello Stefano, Simonato Erika, Orzan Fulvio, Frea Simone, Barreca Antonella, Rinaldi Mauro, Boffini Massimo,
Abstract
Cardiac involvement in familial amyloid polyneuropathy consists of arrhythmias, conduction disturbances, and heart failure. To our knowledge, heart rupture has never been described in association with this condition. We report the case of a 62-year-old man with a 6-year history of refractory familial amyloid polyneuropathy who underwent liver transplantation. The operation was complicated by severe hypotension because the neuropathy involved the autonomic system. Perioperatively, the patient had a myocardial infarction, and during the next 10 days, a complete interventricular septal rupture developed, resulting in a systemic-to-pulmonary shunt. Coronary angiographic findings were normal. However, the shunt caused unstable hemodynamics, resulting in cardiogenic shock. An attempt to close the rupture percutaneously failed. The patient underwent successful heart transplantation 50 days later. Macroscopic examination of the explanted heart showed thickening of both ventricles, septal rupture, and a gray scar in the interventricular septum around the cavity. Histopathologic examination revealed intramural amyloid angiopathy. Our case shows that heart rupture can occur in patients with familial amyloid polyneuropathy who have no history of obstructive coronary artery disease, perhaps as a result of tissue fragility caused by amyloid angiopathy. Therefore, autonomic disturbances should be regarded with concern and promptly treated in the perioperative period.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Transcatheter Mitral Valve Replacement for Treating Native Mitral Valve Disease: Current Status.
Tex Heart Inst J2020 Aug;47(4):271-279. doi: 10.14503/THIJ-18-6650.
Chen Yan, Hu Junjie, Wu Shunqiang, Zhang San, Wu Kaiqin, Wang Wenli, Zhou Yongxin,
Abstract
Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Open Repair of Acute Type A Intramural Hematoma in 3 Patients.
Tex Heart Inst J2020 Aug;47(4):290-297. doi: 10.14503/THIJ-20-7242.
Frankel William C, Weldon Scott A, Green Susan Y, Amarasekara Hiruni S, LeMaire Scott A, Coselli Joseph S,
Abstract
Acute aortic syndrome encompasses classic aortic dissection and less common aortic phenomena, including intramural hematoma (IMH), a hemorrhage within the aortic media that occurs without a discrete intimal tear. We reviewed our experience with treating acute type A IMH to better understand this acute aortic syndrome. A review of our clinical database identified 1,902 proximal aortic repairs that were performed from January 2006 through December 2018; of these, 266 were for acute aortic syndrome, including 3 (1.1%) for acute type A IMH. Operative technique varied considerably. All IMH repairs involved hemiarch or total arch replacement. In all 3 patients, the IMH extended distally into the descending thoracic aorta. There were no operative deaths or major adverse events (stroke, paraplegia, paraparesis, or renal failure necessitating dialysis) that persisted to hospital discharge. Length of hospitalization ranged from 5 to 20 days. All 3 patients were alive at follow-up (range, 2-6 yr) and needed no aortic reintervention after their index or staged repairs. In our experience, repair of acute type A IMH was infrequent and could be either simple or complex. Despite our limited experience with this disease, we found that it can be repaired successfully in urgent and emergency cases. Following treatment guidelines for aortic dissection appears to be a reasonable strategy for treating IMH.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
Mechanical Prosthetic Valve Sparing for Aortic Root Abscess Complicated by Infective Endocarditis.
Tex Heart Inst J2020 Aug;47(4):280-283. doi: 10.14503/THIJ-19-7059.
Ahmed Ahmed, Ammar Ayman, Elnahas Yasser, Abd Al Jawad Mohammed,
Abstract
Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (?30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicemia, and multisystem organ failure. At 1-year follow-up, the 18 surviving patients (90%) were symptom free and had a well-functioning mechanical aortic valve with no paravalvular leak. We conclude that, in certain patients, our technique for managing aortic root abscess and sparing the mechanical aortic valve is a safe and less time-consuming approach with relatively low mortality and encouraging midterm follow-up outcomes.
© 2020 by the Texas Heart® Institute, Houston.
Guarda su PubMed
-
The therapeutic significance of the novel photodynamic material TPE-IQ-2O in tumors.
Aging (Albany NY)2020 Dec;13(1):1383-1409. doi: 10.18632/aging.202355.
Wang Liyu, Liu Yu, Liu Hengchang, Tian He, Wang Yalong, Zhang Guochao, Lei Yuanyuan, Xue Liyan, Zheng Bo, Fan Tao, Zheng Yujia, Tan Fengwei, Xue Qi, Gao Shugeng, Li Chunxiang, He Jie,
Abstract
Combination therapies based on photodynamic therapy (PDT) have received much attention in various cancers due to their strong therapeutic effects. Here, we aimed to explore the safety and effectiveness of a new mitochondria-targeting photodynamic material, TPE-IQ-2O, in combination therapies (combined with surgery or immunotherapy). The safety and effectiveness of TPE-IQ-2O PDT were verified with cytotoxicity evaluation and a zebrafish xenograft model , respectively. The effectiveness of TPE-IQ-2O PDT combined with surgery or immune checkpoint inhibitors (ICIs) was verified in tumor-bearing mice. Small animal imaging, immunohistochemistry, and flow cytometry were used to determine the underlying mechanism. TPE-IQ-2O PDT can not only reduce tumor recurrence in surgical treatment but also effectively improve the response to ICIs in immunotherapy without obvious toxicity. It was also found to ameliorate the immunosuppressive tumor microenvironment and promote the antitumor immunity induced by ICIs by increasing CD8 tumor-infiltrating lymphocyte accumulation. Thus, TPE-IQ-2O PDT is a safe and effective antitumor therapy that can be combined with surgery or immunotherapy.
Guarda su PubMed
-
?2-microglobulin as a biomarker of pulmonary fibrosis development in COPD patients.
Aging (Albany NY)2020 Dec;13(1):1251-1263. doi: 10.18632/aging.202266.
Wu Zhenchao, Yan Mengdie, Zhang Min, Wu Nan, Ma Guoyuan, Wang Bingbing, Fan Youbo, Du Xintong, Ding Can, Liu Yi,
Abstract
Expression of ?2-microglobulin (?2M) is involved in fibrosis progression in kidney, liver, and heart. In this case-controlled retrospective study, we investigated the role of ?2M in the development of pulmonary fibrosis in patients with chronic obstructive pulmonary disease (COPD). Analysis of 450 COPD patients revealed that patients with decreased pulmonary diffusing capacity (DLCO) had increased ?2M serum levels. Compared to patients with lower ?2M serum levels, patients with increased ?2M levels exhibited increased alveolar wall/septal thickening and lung tissue ?2M expression. In addition, patients with increased ?2M levels had increased lung expression of TGF-?1, Smad4, and a-SMA. Animal experiments showed that increased ?2M expression resulted in epithelial-mesenchymal transition (EMT), alveolar wall/septal thickening, and pulmonary fibrosis in a rat COPD model. Together, these results indicate that ?2M serum levels may serve as a new indicator for assessment of pulmonary diffusion function and pulmonary fibrosis severity in clinical practice and may provide a potential target for treatment of pulmonary fibrosis in the future.
Guarda su PubMed
-
Development and validation of a clinical risk score to predict the risk of SARS-CoV-2 infection from administrative data: A population-based cohort study from Italy.
PLoS One2021 ;16(1):e0237202. doi: 10.1371/journal.pone.0237202.
Orlando Valentina, Rea Federico, Savaré Laura, Guarino Ilaria, Mucherino Sara, Perrella Alessandro, Trama Ugo, Coscioni Enrico, Menditto Enrica, Corrao Giovanni,
Abstract
BACKGROUND:
The novel coronavirus (SARS-CoV-2) pandemic spread rapidly worldwide increasing exponentially in Italy. To date, there is lack of studies describing clinical characteristics of the people at high risk of infection. Hence, we aimed (i) to identify clinical predictors of SARS-CoV-2 infection risk, (ii) to develop and validate a score predicting SARS-CoV-2 infection risk, and (iii) to compare it with unspecific scores.
METHODS:
Retrospective case-control study using administrative health-related database was carried out in Southern Italy (Campania region) among beneficiaries of Regional Health Service aged over than 30 years. For each person with SARS-CoV-2 confirmed infection (case), up to five controls were randomly matched for gender, age and municipality of residence. Odds ratios and 90% confidence intervals for associations between candidate predictors and risk of infection were estimated by means of conditional logistic regression. SARS-CoV-2 Infection Score (SIS) was developed by generating a total aggregate score obtained from assignment of a weight at each selected covariate using coefficients estimated from the model. Finally, the score was categorized by assigning increasing values from 1 to 4. Discriminant power was used to compare SIS performance with that of other comorbidity scores.
RESULTS:
Subjects suffering from diabetes, anaemias, Parkinson's disease, mental disorders, cardiovascular and inflammatory bowel and kidney diseases showed increased risk of SARS-CoV-2 infection. Similar estimates were recorded for men and women and younger and older than 65 years. Fifteen conditions significantly contributed to the SIS. As SIS value increases, risk progressively increases, being odds of SARS-CoV-2 infection among people with the highest SIS value (SIS = 4) 1.74 times higher than those unaffected by any SIS contributing conditions (SIS = 1).
CONCLUSION:
Conditions and diseases making people more vulnerable to SARS-CoV-2 infection were identified by the current study. Our results support decision-makers in identifying high-risk people and adopting of preventive measures to minimize the spread of further epidemic waves.
Guarda su PubMed
-
Is the Combination of Convex Compression for the Proximal Thoracic Curve and Concave Distraction for the Main Thoracic Curve Using Separate-rod Derotation Effective for Correcting Shoulder Balance and Thoracic Kyphosis?
Clin Orthop Relat Res2021 Jan;():. doi: 10.1097/CORR.0000000000001643.
Lee Choon Sung, Park Sehan, Lee Dong-Ho, Hwang Chang Ju, Cho Jae Hwan, Park Jae Woo, Park Kun-Bo,
Abstract
BACKGROUND:
Posterior correction of the proximal thoracic curve in patients with adolescent idiopathic scoliosis has been recommended to achieve shoulder balance. However, finding a good surgical method is challenging because of the small pedicle diameters on the concave side of the proximal thoracic curve. If the shoulder height can be corrected using screws on the convex side, this would appear to be a more feasible approach.
QUESTIONS/PURPOSES:
In patients with adolescent idiopathic scoliosis, we asked: (1) Is convex compression with separate-rod derotation effective for correcting the proximal thoracic curve, shoulder balance, and thoracic kyphosis? (2) Which vertebrum is most appropriate to serve as the uppermost-instrumented vertebra? (3) Is correction of the proximal thoracic curve related to the postoperative shoulder balance?
METHODS:
Between 2015 and 2017, we treated 672 patients with scoliosis. Of those, we considered patients with elevated left shoulder, Lenke Type 2 or 4, or King Type V idiopathic scoliosis as potentially eligible. Based on that, 17% (111 of 672) were eligible; 5% (6 of 111) were excluded because of other previous operations and left-side main thoracic curve, 22% (24 of 111) were excluded because they did not undergo surgery for the proximal thoracic curve with only pedicle screws, 21% (23 of 111) were excluded because the proximal thoracic curve was not corrected by convex compression and separate rod derotation, and another 3% (3 of 111) were lost before the minimum study follow-up of 2 years, leaving 50% (55 of 111) for analysis. During the study period, we generally chose T2 as the uppermost level instrumented when the apex was above T4, or T3 when the apex was T5. Apart from the uppermost-instrumented level, the groups did not differ in measurable ways such as age, sex, Cobb angles of proximal and main thoracic curves, and T1 tilt. However, shoulder balance was better in the T3 group preoperatively. The median (range) age at the time of surgery was 15 years (12 to 19 years). The median follow-up duration was 26 months (24 to 52 months). Whole-spine standing posteroanterior and lateral views were used to evaluate the improvement of radiologic parameters at the most recent follow-up and to compare the radiologic parameters between the uppermost-instrumented T2 (37 patients) and T3 (18 patients) vertebra groups. Finally, we analyzed radiologic factors related to shoulder balance, defined as the difference between the horizontal lines passing both superolateral tips of the clavicles (right-shoulder-up was positive), at the most recent follow-up.
RESULTS:
Convex compression with separate-rod derotation effectively corrected the proximal thoracic curve (41° ± 11° versus 17° ± 10°, mean difference 25° [95% CI 22° to 27°]; p < 0.001), and the most recent shoulder balance changed to right-shoulder-down compared with preoperative right-shoulder-up (8 ± 11 mm versus -8 ± 10 mm, mean difference 16 mm [95% CI 12 to 19]; p < 0.001). Proximal thoracic kyphosis decreased (13° ± 7° versus 11° ± 6°, mean difference 2° [95% CI 0° to 3°]; p =.02), while mid-thoracic kyphosis increased (12° ± 8° versus 18° ± 6°, mean difference -7° [95% CI -9° to -4°]; p < 0.001). Preoperative radiographic parameters did not differ between the groups, except for shoulder balance, which tended to be more right-shoulder-up in the T2 group (11 ± 10 mm versus 1 ± 11 mm, mean difference 10 mm [95% CI 4 to 16]; p = 0.002). At the most recent follow-up, the correction proportion of the proximal thoracic curve was better in the T2 group than the T3 group (67% ± 10% versus 49% ± 22%, mean difference 19% [95% CI 8% to 30%]; p < 0.001). In the T2 group, T1 tilt (6° ± 4° versus 6° ± 4°, mean difference 1° [95% CI 0° to 2°]; p = 0.045) and shoulder balance (-14 ± 11 mm versus -7 ± 9 mm, mean difference -7 mm [95% CI -11 to -3]; p = 0.002) at the most recent follow-up improved compared with those at the first erect radiograph. The most recent shoulder balance was correlated with the correction proportion of the proximal thoracic curve (r = 0.29 [95% CI 0.02 to 0.34]; p = 0.03) and change in T1 tilt (r = 0.35 [95% CI 0.20 to 1.31]; p = 0.009).
CONCLUSION:
Using the combination of convex compression and concave distraction with separate-rod derotation is an effective method to correct proximal and main thoracic curves, with reliable achievement of postoperative thoracic kyphosis and shoulder balance. T2 was a more appropriate uppermost-instrumented vertebra than T3, providing better correction of the proximal thoracic curve and T1 tilt. Additionally, spontaneous improvement in T1 tilt and shoulder balance is expected with upper-instrumented T2 vertebrae. Preoperatively, surgeons should evaluate shoulder balance because right-shoulder-down can occur after surgery in patients with a proximal thoracic curve.
LEVEL OF EVIDENCE:
Level III, therapeutic study.
Copyright © 2021 by the Association of Bone and Joint Surgeons.
Guarda su PubMed
-
Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction.
Coron Artery Dis2021 Jan;():. doi: 10.1097/MCA.0000000000001000.
Sheikh Muhammad A, Ngendahimana David, Deo Salil V, Raza Sajjad, Altarabsheh Salah E, Reed Grant W, Kalra Ankur, Cmolik Brian, Kapadia Samir, Eagle Kim A,
Abstract
OBJECTIVE:
We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission.
METHODS:
We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission.
RESULTS:
A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001).
CONCLUSION:
In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Guarda su PubMed
-
VATS tracheal resection and reconstruction.
Multimed Man Cardiothorac Surg2020 Dec;2020():. doi: 10.1510/mmcts.2020.069.
Sastre Ignacio, España Manuel, Ceballos Roberto Jorge, Bustos Mario Eduardo F,
Abstract
Tracheal resection followed by reconstruction is one of the most difficult procedures in thoracic surgery. Intrathoracic tracheal injuries were usually treated by sternotomy, thoracotomy, or a combination of these techniques. In the last decade, minimally invasive surgical techniques have become an innovative trend in the treatment of thoracic tracheal conditions. Recent authors have proven the feasibility and safety of tracheal operations using video-assisted thoracoscopic surgery (VATS). This video tutorial demonstrates our technique for intrathoracic tracheal resection performed by VATS, using 2 ports, for the resection of postintubation stenosis. We show the steps performed by the surgical team and pay special attention to the maneuvers needed to operate with greater safety and achieve a tension-free reconstruction. This tutorial provides a method for treating this type of tracheal injury. It is of special interest for surgeons who specialize in the airway.
© The Author 2021. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Guarda su PubMed
-
HN1L promotes invasion and metastasis of the esophagogastric junction adenocarcinoma.
Thorac Cancer2021 Jan;():. doi: 10.1111/1759-7714.13842.
Wang Zhao Yang, Xiao Wen, Jiang Yuan Zhu, Dong Wei, Zhang Xiang Wei, Zhang Lin,
Abstract
BACKGROUND:
Adenocarcinoma of the esophagogastric junction (AEG) refers to cancer that crosses the line of the gastroesophageal junction and includes distal esophageal cancer and proximal gastric cancer. It is characterized by early metastasis and a poor prognosis and has few treatment options. Here, we report a novel potential therapeutic target, hematological and neurological expressed 1-like (HN1L), in AEG.
METHODS:
A total of 38 patients who underwent surgical resection of AEG at the Department of Thoracic Surgery of Shandong Provincial Hospital from September 2018 to June 2019 were enrolled into the study. We detected the expression of HN1L in AEG and adjacent nontumor tissues by IHC staining. The clinicopathological characteristics of HN1L were statistically analyzed. Then, the expression of HN1L in different cell lines was detected by RT-q PCR. Finally, AGS and HGC-27 cell lines were performed to inhibit HN1L by shRNA in order to explore its role in the development of AEG.
RESULTS:
Immunohistochemical staining showed that the expression of HN1L in cancer tissues was higher than that in nontumor tissue (p < 0.001). High expression of HN1L was significantly correlated with TNM stage (p = 0.013) and lymph node metastasis (p = 0.03). The expression of HN1L was upregulated in tumor cell lines compared with normal cell line. Additionally, Cell function studies demonstrated that lentivirus-mediated shRNA silencing of HN1L expression could effectively reduce the proliferation, invasion, and metastasis of tumor cell lines and promote their apoptosis (p < 0.05).
CONCLUSIONS:
HN1L expression might contribute to the invasion and metastasis of AEG and is a promising therapeutic target.
© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.
Guarda su PubMed
-
Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma.
Cochrane Database Syst Rev2021 Jan;1():CD011490. doi: 10.1002/14651858.CD011490.pub2.
Staerkle Ralph F, Vuille-Dit-Bille Raphael Nicolas, Soll Christopher, Troller Rebekka, Samra Jaswinder, Puhan Milo A, Breitenstein Stefan,
Abstract
BACKGROUND:
Pancreatic and periampullary adenocarcinomas account for some of the most aggressive malignancies, and the leading causes of cancer-related mortalities. Partial pancreaticoduodenectomy (PD) with negative resection margins is the only potentially curative therapy. The high prevalence of lymph node metastases has led to the hypothesis that wider excision with the removal of more lymphatic tissue could result in an improvement of survival, and higher rates of negative resection margins.
OBJECTIVES:
To compare overall survival following standard (SLA) versus extended lymph lymphadenectomy (ELA) for pancreatic head and periampullary adenocarcinoma. We also compared secondary outcomes, such as morbidity, mortality, and tumour involvement of the resection margins between the two procedures.
SEARCH METHODS:
We searched CENTRAL, MEDLINE, PubMed, and Embase from 1973 to September 2020; we applied no language restrictions.
SELECTION CRITERIA:
Randomised controlled trials (RCT) comparing PD with SLA versus PD with ELA, including participants with pancreatic head and periampullary adenocarcinoma.
DATA COLLECTION AND ANALYSIS:
Two review authors independently screened references and extracted data from study reports. We calculated pooled risk ratios (RR) for most binary outcomes except for postoperative mortality, for which we estimated a Peto odds ratio (Peto OR), and mean differences (MD) for continuous outcomes. We used a fixed-effect model in the absence of substantial heterogeneity (I² < 25%), and a random-effects model in cases of substantial heterogeneity (I² > 25%). Two review authors independently assessed risk of bias, and we used GRADE to assess the quality of the evidence for important outcomes.
MAIN RESULTS:
We included seven studies with 843 participants (421 ELA and 422 SLA). All seven studies included Kaplan-Meier curves for overall survival. There was little or no difference in survival between groups (log hazard ratio (log HR) 0.12, 95% confidence interval (CI) -3.06 to 3.31; P = 0.94; seven studies, 843 participants; very low-quality evidence). There was little or no difference in postoperative mortality between the groups (Peto odds ratio (OR) 1.20, 95% CI 0.51 to 2.80; seven studies, 843 participants; low-quality evidence). Operating time was probably longer for ELA (mean difference (MD) 50.13 minutes, 95% CI 19.19 to 81.06 minutes; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 88%; P < 0.00001). There may have been more blood loss during ELA (MD 137.43 mL, 95% CI 11.55 to 263.30 mL; two studies, 463 participants; very low-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P = 0.02). There may have been more lymph nodes retrieved during ELA (MD 11.09 nodes, 95% CI 7.16 to 15.02; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P < 0.00001). There was little or no difference in the incidence of positive resection margins between groups (RR 0.81, 95% CI 0.58 to 1.13; six studies, 783 participants; very low-quality evidence).
AUTHORS' CONCLUSIONS:
There is no evidence of an impact on survival with extended versus standard lymph node resection. However, the operating time may have been longer and blood loss greater in the extended resection group. In conclusion, current evidence neither supports nor refutes the effect of extended lymph lymphadenectomy in people with adenocarcinoma of the head of the pancreas.
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Guarda su PubMed
-
Resection and postoperative radiation therapy for desmoid fibromatosis of the chest wall in a young woman.
Surg Case Rep2021 Jan;7(1):28. doi: 10.1186/s40792-020-01006-5.
Noda Daiki, Abe Miyuki, Takumi Yohei, Anami Kentaro, Miyawaki Michiyo, Takeuchi Hideya, Osoegawa Atsushi, Sugio Kenji,
Abstract
BACKGROUND:
Surgery is an effective treatment for desmoid fibromatosis, but it may be difficult, depending on the location or local spread of the tumor, and the decision to perform surgery must be made carefully. We herein report a case of desmoid fibromatosis of the chest wall in a young woman suspected of having invasion to the 1st, 2nd and 3rd ribs.
CASE PRESENTATION:
A 35-year-old woman had been aware of dry cough and right chest pain, so she was referred to our hospital. Chest computed tomography showed a localized pleural tumor mainly at the first rib. Magnetic resonance imaging revealed a 75?×?65?×?27-mm tumor with a smooth surface, with partial contact from the first rib to third rib and partial extension to the 1st intercostal space. The tumor showed growth in the two months after the first visit, so resection was performed. The tumor was completely resected, and adjuvant radiation therapy (50 Gy) was performed for the small margin. The pathological diagnosis was desmoid fibromatosis. The postoperative course has been uneventful, without recurrence at 14 months after surgery.
CONCLUSIONS:
In chest wall tumors located ventral of the pulmonary apex, we suggest that a combination of the Grunenwald method and Masaoka anterior approach may be a useful option. In cases where margin is not enough, adjuvant radiation therapy should be considered.
Guarda su PubMed
-
Predictive risk factors for intra-abdominal hypertension after cardiac surgery.
Interact Cardiovasc Thorac Surg2021 Jan;():. doi: ivaa336.
Tyson Nathan, Efthymiou Christopher,
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is it possible to identify predictive risk factors for the development of intra-abdominal hypertension (IAH) or abdominal compartment syndrome after cardiac surgery. Altogether 131 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 755 patients were included, with the incidence of IAH between 26.9% and 83.3%. The limited evidence on IAH after cardiac surgery should be interpreted with caution. Obesity is a strong predictor of postoperative IAH, although not confined to a central pattern and body mass index is correlated with intra-abdominal pressure (IAP). Prolonged cardiopulmonary bypass and aortic cross-clamp time predisposed to IAH in 4 cohorts. IAH in cardiac surgery patients is associated with hepatic and renal impairment, and corresponding biochemical markers may be helpful in screening, although lacking specificity. In contrast to the development of IAH in other settings, the evidence for the role of fluid balance is poor. Accurate prediction of IAH remains elusive. Based on the available evidence, routine IAP measurement should be considered postoperatively in patients with obesity, particularly those with renal or hepatic impairment, prolonged cardiopulmonary bypass or operative time, requiring vasopressor support, to prevent the deleterious effects of IAH.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Guarda su PubMed
