SOSTIENICI
Pubblicazioni recenti - cardiac surgery
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Does Age Matter? Pulmonary Endarterectomy in the Elderly Patient with CTEPH.
Thorac Cardiovasc Surg2022 Jan;():. doi: 10.1055/s-0041-1740559.
Wiedenroth Christoph B, Bandorski Dirk, Ariobi Kanischka, Ghofrani H-Ardeschir, Lankeit Mareike, Liebetrau Christoph, Pruefer Diethard, Mayer Eckhard, Kriechbaum Steffen D, Guth Stefan,
Abstract
BACKGROUND:
?The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center.
METHODS:
?Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1:???50 years, group 2:?>?50???70 years, group 3:?>?70 years.
RESULTS:
?After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [?=?0.326]). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (?=?0.122).
CONCLUSIONS:
?PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics.
Thieme. All rights reserved.
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Left Subclavian Artery Sacrifice in Acute Aortic Dissection Repair using the Frozen Elephant Trunk.
Thorac Cardiovasc Surg2022 Jan;():. doi: 10.1055/s-0041-1741058.
Goebel Nora, Holder Simone A, Huether Franziska, Bail Dorothee H L, Franke Ulrich F W,
Abstract
OBJECTIVE:
?Surgery of acute aortic dissection using the frozen elephant trunk (FET) can be complicated when the origin of the left subclavian artery (LSA) is dissected and sacrifice by ligation is a viable option. However, the LSA is supposed to play a role in neuroprotection as a major collateral. We, therefore, analyzed our results of LSA sacrifice in this cohort.
METHODS:
?We identified a total of 84 patients from our prospectively collected database who underwent FET repair of acute aortic dissection between October 2009 and April 2018. LSA was sacrificed in 19 patients (22.6%). Results were analyzed and compared with regard to neurological outcomes.
RESULTS:
?New postoperative stroke was seen in two patients (2.4%) and spinal cord injury in three patients (3.6%) overall, none in the LSA-sacrifice group. We observed a temporary neurological deficit in five patients (6.0%) overall, none in the LSA-sacrifice group. None of the patients developed acute ischemia of the left arm. Only two patients (12.5%) came back for carotid-subclavian artery bypass due to exertion-induced weakness of the left arm 3 to 4 months after the initial surgery. In-hospital mortality was 15.5% overall, with no difference between groups.
CONCLUSION:
?LSA sacrifice was not associated with elevated postoperative risk of either central or spinal neurological injury. Thus, it can facilitate FET repair of acute aortic dissection in selected cases when the left subclavian origin cannot be preserved. Carotid-subclavian artery bypass became necessary in only a small fraction of these patients and can be performed as a second-stage procedure.
Thieme. All rights reserved.
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Redefining the bread and butter.
Eur J Cardiothorac Surg -
Surgical approach does not influence changes in circulating immune cell populations following lung cancer resection.
Lung Cancer2022 Jan;164():69-75. doi: S0169-5002(22)00001-0.
Deboever Nathaniel, McGrail Daniel J, Lee Younghee, Tran Hai T, Mitchell Kyle G, Antonoff Mara B, Hofstetter Wayne L, Mehran Reza J, Rice David C, Roth Jack A, Swisher Stephen G, Vaporciyan Ara A, Walsh Garrett L, Bernatchez Chantale, Vailati Negrao Marcelo, Zhang Jianjun, Wistuba Ignacio I, Heymach John V, Cascone Tina, Gibbons Don L, Haymaker Cara L, Sepesi Boris,
Abstract
INTRODUCTION:
The multimodal management of operable non-small cell lung cancer (NSCLC) continues to evolve rapidly. The immune milieu allowing for immunotherapeutic benefit can be affected by multiple parameters including clinicopathologic and genetic. Surgery induced physiological changes has received attention for modulating and affecting post-operative oncotaxis and immunosuppression. Here, we sought to investigate how surgical stress influences phenotype of peripheral blood mononuclear cells (PBMCs) in patients with NSCLC who underwent lobectomy.
METHODS:
Blood was prospectively collected from patients with Stage IA-IIIA NSCLC undergoing lung resection between 2016 and 2018. Samples were obtained pre-operatively, 24 h and 4 weeks after surgery. PBMCs were isolated and subject to high-dimensional flow cytometry, analyzing a total of 115 cell populations with a focus on myeloid cells, T cell activation, and T cell trafficking. We further evaluated how surgical approach influenced post-operative PBMC changes, whether the operation was conducted in an open fashion with thoracotomy, or with minimally invasive Video Assisted Thoracoscopic Surgery (VATS).
RESULTS:
A total of 76 patients met the inclusion criteria (Open n = 55, VATS n = 21). Surgical resection coincided with a decrease in T lymphocyte populations, including total CD3+ T cells, CD8+ T cells, and T effector memory cells, as well as an increase in monocytic myeloid-derived suppressor cells (mMDSC). Post-operative changes in PBMC populations were resolved after 4 weeks. Surgical-induced changes in immune populations were equivalent in patients undergoing open thoracotomy and VATS.
DISCUSSION:
Surgical stress resulted in transient reduction in T cells and T effector memory cells, and increase of mMDSC following resection in NSCLC patients. The immune profile modulation was similar regardless of surgical approach. These findings suggest that surgical approach does not seem to affect mononuclear cell lines obtained from peripheral blood. Thus, the decision regarding surgical approach should be patient centered, rather than based on post-operative treatment response optimization.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Circular RNA circFOXO3 facilitate non-small cell lung cancer progression through upregulating HMGB3 via sponging miR-545-3p/miR-506-3p.
Tissue Cell2021 Nov;75():101702. doi: S0040-8166(21)00218-4.
Yang Minglei, Zheng Enkuo, Ni Junjun, Xu Xiang, Jiang Xu, Zhao Guofang,
Abstract
PURPOSE:
Circular RNAs (circRNAs) have emerged as a pivotal regulatory element in the progression of human cancers. Being an important member of circRNAs, circFOXO3 has been implicated in tumor invasion or metastasis of non-small cell lung cancer (NSCLC); however, the molecular mechanism underlying this promoting effect remains an enigma. The present study aims to study the function of circFOXO3 and dissect the relevant intracellular network in the progression and metastasis of NSCLC.
METHODS:
Quantitative real time PCR (RT-qPCR) assay and Western blotting were used to quantify the levels of RNAs and proteins respectively. starBase v2.0 and luciferase assay were used to validate the target of circRNAs or miRNAs. Cell Counting Kit-8 (CCK-8) assay was adopted to examine cell viability. Transwell was used to determine cell invasion and migration. Xenograft model was established to detect tumor growth.
RESULTS:
RT-qPCR showed that circFOXO3 was overexpressed in NSCLC cells and tissues. Knockdown of circFOXO3 not only inhibited NSCLC cell proliferation, migration and invasion in vitro but also suppressed tumor growth in vivo. starBase v2.0 and luciferase assay results collectively suggested that circFOXO3 sponged miR-545-3p and miR-506-3p. Dual-inhibition of circFOXO3 and its target miRNAs suppressed the reduction of cell proliferation, migration and invasion induced by siRNA of circFOXO3 (si-circFOXO3), demonstrating that the effect of circFOXO3 on NSCLC was dependent on sponging miR-545-3p and miR-506-3p. Further bioinformatic analysis and biochemistry experiments revealed that miR-545-3p and miR-506-3p regulated the expression of a family member of high-mobility group box, HMGB3.
CONCLUSION:
Here, we show thatcircFOXO3 in NSCLC promotes the proliferation, migration and invasion of NSCLC cells, thereby promoting tumor growth. We further find that circFOXO3 sponges miR-545-3p/miR-506-3p that bind to 3'-UTR of HMGB3 mRNA, which constitutes the major network fulfilling the circFOXO3's promoting effect. Therefore, we proposed that circFOXO3 could be a potential therapeutic target for NSCLC.
Copyright © 2021. Published by Elsevier Ltd.
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Vertebral augmentation via the rib approach: surgical essentials and therapeutic effects.
Neurochirurgie2022 Jan;():. doi: S0028-3770(22)00001-7.
Ding Yanping, Liu Jinhai, Han Xiaofei, Yang Ying, Yin Qu-Dong,
Abstract
OBJECTIVE:
-The rib approach is a new extrapedicular approach for vertebral augmentation in the thoracic spine. This article discusses the surgical essentials and therapeutic effect.
METHODS:
-Computed tomography (CT) imagings were obtained from 100 subjects to stimulate a ? 4-mm puncture needle via the rib approach to determine the anatomical parameters of the channel and the position of the needle inserted in the vertebral body. Application results for 26 patients with T5-10 lesions were observed, four patients were treated under general anesthesia and 22 were treated under local anesthesia.
RESULTS:
-The channel diameter was 5.9-7.0 mm. In T5-10, the puncture needle could reach the middle of the midsagittal line of vertebral bodies in the transverse plane and only reached the middle and upper parts of the vertebral body in the sagittal plane. One week after surgery, the visual analog scale (VAS) sores decreased to 2.4 ± 0.8, the ODI decreased to 13.4 ± 5.9, and the anterior and posterior vertebral body height ratios recovered to 82.2 ± 13.7% and 86.3 ± 13.2%, respectively (all, P
CONCLUSIONS:
-Vertebral augmentation via the rib approach is suitable only for patients with T5-10 lesions located in the middle and upper parts of the vertebral body. The puncture needle should be inclined inward and downward. This method is characterized by simple execution and low risks of intraspinal cement leakage and nerve injury.
Copyright © 2022. Published by Elsevier Masson SAS.
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Hyperlipidemia and hypothyroidism.
Clin Chim Acta2022 Jan;():. doi: S0009-8981(22)00015-8.
Su Xin, Peng Hua, Chen Xiang, Wu Xijie, Wang Bin,
Abstract
Hypothyroidism is closely associated with increased serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). The thyroid gland plays an important role in this process because thyroid hormones (THs) modulate cholesterol production, transformation and clearance. Although recent evidence suggests that thyroid-stimulating hormone (TSH) itself also participates in hyperlipidemia, the underlying mechanism remains unclear. Others demonstrated that the pathologic development of hypothyroidism-related hyperlipidemia was associated with down-regulated THs and up-regulated TSH in serum. This finding suggests a role for hypothyroidism in hyperlipidemia and potentially in related cardio-metabolic disease. Multiple newly identified modulatory biomarkers, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), angiopoietin-like protein (ANGPTLs), and fibroblast growth factors (FGFs), might play a role in modulating the risk of hyperlipidemia induced by hypothyroidism. Moreover, hypothyroidism also contributes to the production of dysfunctional high-density lipoprotein (HDL) particles. In the present review, we examine the relationship between hypothyroidism with the risk and pathologic development of hyperlipidemia. We explore mechanisms by which hypothyroidism promotes hyperlipidemia in general and its contribution to cardio-metabolic disease specifically.
Copyright © 2022. Published by Elsevier B.V.
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Trastuzumab with trimodality treatment for oesophageal adenocarcinoma with HER2 overexpression (NRG Oncology/RTOG 1010): a multicentre, randomised, phase 3 trial.
Lancet Oncol2022 Jan;():. doi: S1470-2045(21)00718-X.
Safran Howard P, Winter Kathryn, Ilson David H, Wigle Dennis, DiPetrillo Thomas, Haddock Michael G, Hong Theodore S, Leichman Lawrence P, Rajdev Lakshmi, Resnick Murray, Kachnic Lisa A, Seaward Samantha, Mamon Harvey, Diaz Pardo Dayssy Alexandra, Anderson Carryn M, Shen Xinglei, Sharma Anand K, Katz Alan W, Salo Jonathan, Leonard Kara L, Moughan Jennifer, Crane Christopher H,
Abstract
BACKGROUND:
Trastuzumab is a monoclonal antibody against HER2 (also known as ERBB2). The primary objective of the NRG Oncology/RTOG-1010 trial was to establish whether trastuzumab improves disease-free survival when combined with trimodality treatment (paclitaxel plus carboplatin and radiotherapy, followed by surgery) for patients with untreated HER2-overexpressing oesophageal adenocarcinoma.
METHODS:
NRG Oncology/RTOG-1010 was an open label, randomised, phase 3 trial for which patients were accrued from 111 NRG-affiliated institutions in the USA. Eligible patients were adults (aged ?18 years) with newly diagnosed pathologically confirmed oesophageal adenocarcinoma, American Joint Committee on Cancer 7th edition T1N1-2 or T2-3N0-2 stage disease, and a Zubrod performance status of 0-2. Patients were stratified by adenopathy (no vs yes [coeliac absent] vs yes [coeliac present ?2 cm]) and randomly assigned (1:1) to receive weekly intravenous paclitaxel (50 mg/m intravenously over 1 h) and carboplatin (area under the curve 2, intravenously over 30-60 min) for 6 weeks with radiotherapy 50·4 Gy in 28 fractions (chemoradiotherapy) followed by surgery, with or without intravenous trastuzumab (4 mg/kg in week one, 2 mg/kg per week for 5 weeks during chemoradiotherapy, 6 mg/kg once presurgery, and 6 mg/kg every 3 weeks for 13 treatments starting 21-56 days after surgery). The primary endpoint, disease-free survival, was defined as the time from randomisation to death or first of locoregional disease persistence or recurrence, distant metastases, or second primary malignancy. Analyses were done by modified intention to treat. This study is registered with Clinicaltrials.gov, NCT01196390; it is now closed and in follow-up.
FINDINGS:
606 patients were entered for HER2 assessment from Dec 30, 2010 to Nov 10, 2015, and 203 eligible patients who were HER2-positive were enrolled and randomly assigned to chemoradiotherapy plus trastuzumab (n=102) or chemoradiotherapy alone (n=101). Median duration of follow-up was 2·8 years (IQR 1·4-5·7). Median disease-free survival was 19·6 months (95% CI 13·5-26·2) with chemoradiotherapy plus trastuzumab compared with 14·2 months (10·5-23·0) for chemoradiotherapy alone (hazard ratio 0·99 [95% CI 0·71-1·39], log-rank p=0·97). Grade 3 treatment-related adverse events occurred in 41 (43%) of 95 patients in the chemoradiotherapy plus trastuzumab group versus 52 (54%) of 96 in the chemoradiotherapy group and grade 4 events occurred in 20 (21%) versus 21 (22%). The most common grade 3 or worse treatment-related adverse events for both groups were haematological (53 [56%] of 95 patients in the chemoradiotherapy plus trastuzumab group vs 55 [57%] of 96 patients in the chemotherapy group) or gastrointestinal disorders (28 [29%] vs 20 [21 %]). 34 (36%) of 95 patients in the chemoradiotherapy plus trastuzumab group and 27 (28%) of 96 patients in the chemoradiotherapy only group had treatment-related serious adverse events. There were eight treatment-related deaths: five (5%) of 95 patients in the chemoradiotherapy plus trastuzumab group (bronchopleural fistula, oesophageal anastomotic leak, lung infection, sudden death, and death not otherwise specified), and three (3%) of 96 in the chemoradiotherapy group (two multiorgan failure and one sepsis).
INTERPRETATION:
The addition of trastuzumab to neoadjuvant chemoradiotherapy for HER2-overexpressing oesophageal cancer was not effective. Trastuzumab did not lead to increased toxicities, suggesting that future studies combining it with or using other agents targeting HER2 in oesophageal cancer are warranted.
FUNDING:
National Cancer Institute and Genentech.
Copyright © 2022 Elsevier Ltd. All rights reserved.
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Tracheal Reconstruction for Congenital Tracheal Stenosis: A 950-gram Neonate.
Ann Thorac Surg2022 Jan;():. doi: S0003-4975(22)00043-1.
Zibdawi Rami, El-Andari Ryaan, Noga Michelle, Hicks Matthew, Muhieldin M, Phillipos Ernest, Holinski Paula, El-Hakim Hamdy, Al Aklabi Mohammed,
Abstract
Congenital tracheal stenosis (CTS) is a rare but life-threatening malformation of the trachea. Surgical reconstruction is high-risk, and not frequently performed in neonates born of extreme prematurity and low birthweight. We present the case of an extremely premature 950-gram neonate with severe CTS who underwent tracheal reconstruction. Complete repair, with no residual stenosis, was achieved with slide tracheoplasty without the need for cardiopulmonary bypass.
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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A "Valve-Closing" Starvation Strategy for Amplification of Tumor-Specific Chemotherapy.
Adv Sci (Weinh)2022 Jan;():e2104671. doi: 10.1002/advs.202104671.
Li Xianglong, Jiang Cong, Wang Qinghua, Yang Shaobo, Cao Yuanyuan, Hao Ji-Na, Niu Dechao, Chen Yan, Han Bo, Jia Xin, Zhang Peng, Li Yongsheng,
Abstract
Starvation-dependent differential stress sensitization effect between normal and tumor cells provides a potentially promising strategy to amplify chemotherapy effects and reduce side effects. However, the conventional starvation approaches such as glucose oxidase (Gox)-induced glucose depletion and nanomedicine-enabled vascular embolism usually suffer from aggravated tumor hypoxia, systemic toxicity, and unpredictable metabolic syndrome. Herein, a novel "valve-closing" starvation strategy is developed to amplify the chemotherapy effects via closing the "valve" of glucose transported into tumor cells, which is accomplished by a glucose transporters 1 (GLUT1, valve of glucose uptake) inhibitor (Genistein, Gen) and chemotherapeutic agent (Curcumin, Cur) coloaded hybrid organosilica-micelles nanomedicine (designated as (Gen + Cur)@FOS) with controllable stability. In vitro and in vivo results demonstrate that (Gen + Cur)@FOS can effectively reduce glucose/adenosine triphosphate levels in tumor cells by inhibiting GLUT1 expression (i.e., "valve-closing") to induce the starvation of tumor cells, thus weakening the resistance of tumor cells to apoptosis caused by chemotherapy, and consequently contributing to the remarkably improved antitumor efficiency and minimized side effects based on the stress sensitization effect mediated by GLUT1 inhibition-induced starvation. This "valve-closing" starvation strategy provides a promising paradigm for the development of novel nanotherapeutics with amplified chemotherapy effect.
© 2022 The Authors. Advanced Science published by Wiley-VCH GmbH.
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Comparing analgesic efficacy of peripheral nerve blocks with thoracic epidural block after major abdominal cancer surgery: Study design is important.
J Surg Oncol -
Matching the perforating branch of the internal thoracic artery and the deep inferior epigastric artery for breast reconstruction using multi-detector row computed tomography.
Jpn J Radiol2022 Jan;():. doi: 10.1007/s11604-021-01235-0.
Komemushi Takayoshi, Okuda Itsuko, Komemushi Atsushi, Nakajima Yasuo, Mimura Hidefumi, Kajikawa Akiyoshi,
Abstract
PURPOSE:
Matching the diameter of the deep inferior epigastric artery (DIEA) and perforating branch (PB) of the internal thoracic artery (ITA) is important for arterial anastomosis during breast reconstruction using the DIEA flap. An anatomic investigation of these arteries was performed using multidetector row computed tomography (MDCT).
PATIENTS AND METHODS:
Contrast-enhanced MDCT data of 50 women (aged 18-90 years) covering the neck to the groin were analyzed. The diameter of the PBs of the ITA at their origins from the first to the sixth intercostal space and of the DIEA 20 mm from the bifurcation of the external iliac artery were measured.
RESULTS:
The mean diameters of the right and left DIEAs were 1.53?±?0.263 mm and 1.53?±?0.306 mm, respectively. The diameter of the PBs in the second and third intercoastal spaces was the same as the diameter of the DIEA, bilaterally.
CONCLUSION:
It is suggested that anastomosis of the DIEA with PBs of the ITA in the second and third intercoastal spaces is optimal for DIEA flap grafting. Our results could contribute to making vascular anastomosis easier, thereby reducing the burden on both surgeons and patients.
© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
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In vivo and in vitro inhibition of SCLC by combining dual cancer-specific recombinant adenovirus with Etoposide.
J Cancer Res Clin Oncol2022 Jan;():. doi: 10.1007/s00432-021-03899-7.
Li Tingyu, Fang Jinbo, Chu Jihao, Liu Xing, Li Yiquan, Zhu Yilong, Li Shanzhi, Xiu Zhiru, Li Yaru, Jin Ningyi, Zhu Guangzhe, Sun Lili, Li Xiao,
Abstract
PURPOSE:
Oncolytic virotherapy is emerging as an important modality in cancer treatment. In a previous study, we designed and constructed Ad-Apoptin-hTERTp-E1a (Ad-VT), a dual cancer-selective anti-tumor recombinant adenovirus.
METHODS:
To explore the therapeutic effect of recombinant adenovirus Ad-VT together with Etoposide on small cell lung cancer, the ability of Ad-VT alone, Etoposide alone, and a combination of Ad-VT?+?Etoposide to inhibit proliferation of NCI-H446 and BEAS-2B cells was investigated using the WST-1 method. According to the inhibitory action of different combinations, a combination index (CI) was estimated by CalcuSyn software to select the best combination. The inhibitory effect of Ad-VT combined with Etoposide on NCI-H446 and BEAS-2B cells was detected by crystal violet staining and the CFST method. Hoechst, Annexin V and JC-1 staining were used to explore the inhibitory pathway of Ad-VT combined with Etoposide on NCI-H446 cells. The migratory and invasive abilities of treated NCI-H446 cells were assessed by Transwell and BioCat methods. Tumor volume, body weight and survival rate were measured to analyze the anti-tumor and toxic effects of different treatments in tumor-bearing mice.
RESULTS:
Ad-VT (20 MOI) combined with Etoposide (400 nM) significantly inhibited NCI-H446 cell proliferation with reduced toxicity of Etoposide to normal cells. Ad-VT induced apoptosis of NCI-H446 cells mainly through the mitochondrial apoptosis pathway, an effect significantly increased by the combined treatment. Ad-VT together with Etoposide significantly inhibited migration and invasion of NCI-H446 cells, inhibited tumor growth in vivo and prolonged the survival of tumor-bearing mice.
CONCLUSIONS:
The above results indicate that when combined with Etoposide, Ad-VT may have an important role in synergistically inhibiting tumors.
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.
Intensive Care Med2022 Jan;():. doi: 10.1007/s00134-021-06604-x.
Papazian Laurent, Schmidt Matthieu, Hajage David, Combes Alain, Petit Matthieu, Lebreton Guillaume, Rilinger Jonathan, Giani Marco, Le Breton Camille, Duburcq Thibault, Jozwiak Mathieu, Wengenmayer Tobias, Roux Damien, Parke Rachael, Loundou Anderson, Guervilly Christophe, Boyer Laurent,
Abstract
PURPOSE:
Previous studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients.
METHODS:
We performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not mentioned in the original articles. The main objective was to compare 28-day survival in vvECMO patients with PP to vvECMO patients without PP (controls).
RESULTS:
Thirteen studies with a combined population of 1836 patients satisfied the inclusion criteria. PP was associated with a significant improvement in 28-day survival (503 survivors among 681 patients in the PP group [74%; 95% CI 71-77] vs. 450 survivors among 770 patients in the control group [58%, 95% CI 55-62]; RR 1.31 [95% CI 1.21-1.41]; I 22% [95% CI 0-62%]; P?0.0001). Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival). In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP (mean difference 11.4 days [95% CI 9.2-13.5]; 0.64 [95% CI 0.50-0.78]; I 8%; P?0.0001).
CONCLUSION:
According to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO. The impact of this combination on survival should be investigated in prospective randomized controlled trials.
© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.
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miR-31-5p modulates cell progression in lung adenocarcinoma through TNS1/p53 axis.
Strahlenther Onkol2022 Jan;():. doi: 10.1007/s00066-021-01895-x.
Zhu Chaonan, Wang Shuai, Zheng Maogen, Chen Zhiquan, Wang Guochen, Ma Jun, Zhang Bin, Huang Wuhao, Sun Xiaoyan, Wang Changli,
Abstract
OBJECTIVE:
To clarify the modulatory mechanism of miR-31-5p in lung adenocarcinoma (LUAD) progression in vivo and in vitro.
METHODS:
The Cancer Genome Atlas (TCGA) database was employed to access LUAD-related miRNA and mRNA expression data. Downstream targets of miR-31-5p were predicted by public databases. The interaction between miR-31-5p and TNS1 was determined by dual-luciferase reporter assay. Quantitative real-time polymerase chain reaction (qRT-PCR) was utilized to measure miR-31-5p and TNS1 expression levels in LUAD cells. Western blot was introduced to test protein expression levels of TNS1, p53, and apoptosis-related proteins. In-vitro functional assays were conducted to evaluate the biological effects of miR-31-5p on cell proliferation, colony formation, migration, and apoptosis. In-vivo tumor xenograft experiment was applied to examine the effects of miR-31-5p on LUAD tumor growth, followed by immunochemistry assays for assessing TNS1 and p53 expression levels in the tumor tissue.
RESULTS:
miR-31-5p was prominently upregulated in LUAD tissue and was identified to present a similar trend in LUAD cell lines H1299, H23, and A549. miR-31-5p overexpression exerted an active role in cell proliferation and migration, but it suppressed cell apoptosis. Additionally, a reverse correlation between miR-31-5p and TNS1 regarding the expression level was identified, and TNS1 was verified to be a direct target of miR-31-5p. Besides, it was further validated by the rescue experiments that the tumor-promoting effects of miR-31-5p on LUAD cell functions were attenuated by TNS1 overexpression to some extent. The results based on the tumor xenograft experiment revealed that LUAD cell growth could be facilitated by miR-31-5p via the TNS1/p53 axis.
CONCLUSION:
miR-31-5p facilitates LUAD cell progression mediated by the TNS1/p53 axis.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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Thoracoscopic pneumonectomy in patient with unilateral absence of the left pulmonary artery accompanied by the left lung cancer.
Interact Cardiovasc Thorac Surg2022 Jan;():. doi: ivab364.
Kononets Pavel V, Akhmedov Parvin I, Topol Konstantin Y,
Abstract
Unilateral absence of the pulmonary artery is a rare congenital cardiovascular anomaly. Unilateral absence of the pulmonary artery is often accompanied by cardiovascular disorders but also can occur in an isolated manner. We present a case of female patient, in which the absence of the left pulmonary artery was revealed and the left lower lobe adenocarcinoma was diagnosed.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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[Catamenial pneumothorax].
Medicina (B Aires)2022 ;82(1):147-150.
Toffolo Pasquini Mariana, Auvieux Rodolfo, Tchercansky Ariel, Buero Agustín, Chimondeguy Domingo, Mendez Julián,
Abstract
Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spontaneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.
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Staphylococcus aureus sepsis and hemoptysis as messengers of a rather impractically located mycotic aneurysm.
Acta Chir Belg2022 Jan;():1-15.
Tournaye Elfi, Hollering Paul, de Roover Dominik, Dossche Karl, Vercauteren Sven Rw,
Abstract
CASE PRESENTATION:
A 79-year-old patient was hospitalized with staphylococcus aureus sepsis and MAA originating from the ostium of the left common carotid artery (CCA). Initial treatment consisted of high-dose antibiotics and blood pressure control. After 48?hours a CT-angiography revealed rapid growth of the MAA with imminent rupture. Various treatment options were considered: a covered stent in the left CCA, a carotid-subclavian bypass with ligation of the left CCA ostium or arch replacement, or an extra-anatomical transposition of the supra-aortic vessels with thoracic endoprosthesis. The last option was selected and, combined with six weeks of antibiotics, proved successful in controlling the impending rupture and treating the MAA.
CONCLUSIONS:
Endovascular techniques are used if open surgery is refused, when surgical risks are prohibitively high (as definitive or palliative treatment), or as an emergency temporary treatment until definitive surgical treatment is feasible. Our high-risk patient underwent endovascular treatment for MAA as a definitive treatment. Endovascular treatment is increasingly becoming the treatment of choice due to the high morbidity and mortality of open surgical repair. Although the main concern using endovascular treatment is absence of debridement, recent studies show that combining endovascular treatment and long-term antibiotic therapy represents a potentially durable treatment and viable alternative to open surgical repair.
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Azacitidine-induced massive pericardial effusion in a child with myelodysplastic syndrome.
J Oncol Pharm Pract2022 Jan;():10781552211073884. doi: 10.1177/10781552211073884.
Fogaça da Mata Miguel, Vieira Martins Miguel, Rato João, Madeira Márcio, Gonçalves Jean-Pierre, Teixeira Ana, Anjos Rui,
Abstract
INTRODUCTION:
Pericardial effusions are rare yet potentially fatal conditions in children. Azacitidine is a DNA-hypomethylating agent used in the treatment of myelodysplastic syndrome. Although seldomly described in adults, no cases of azacitidine-induced pericardial effusion have been reported in children.
CASE REPORT:
A 7-year-old boy with myelodysplastic syndrome presented with a large pericardial effusion with risk for cardiac tamponade after his first azacitidine cycle.
MANAGEMENT & OUTCOME:
The patient was admitted to a pediatric ICU, antibiotic and steroid therapy were initiated. Pericardiocentesis was done due to hemodynamic instability. Serum and pericardial fluid complementary evaluation excluded infectious and malignant causes. The pericardial effusion did not reappear and additional pleural and ascitic slight effusions responded well to diuretics. Follow-up azacitidine cycles were administered by tapering daily dosages and using adjunctive steroid therapy, with no additional adverse events.
DISCUSSION:
We report the first pediatric case of large pericardial effusion secondary to azacitidine therapy in a child with MDS. This adverse reaction has not been described in pediatric patients, in which this therapeutic option has been increasingly used. We seek to raise awareness on the potential life-threatening cardiotoxicity of azacitidine in pediatric patients.
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Risk factors for postoperative delirium after cardiac surgical procedures with cardioplegic arrest.
Eur J Cardiothorac Surg2022 Jan;():. doi: ezab570.
Andrási Terézia B, Talipov Ildar, Dinges Gerhard, Arndt Christian, Rastan Ardawan J,
Abstract
OBJECTIVES:
The pathophysiology of delirium after cardiac surgery is complex. The present study aims to determine perioperative risk factors and construct a scoring system for postoperative delirium based on the type of surgery.
METHODS:
Three hundred patients undergoing coronary artery bypass grafting (CABG; n = 150) or valve and/or aortic surgery ± CABG (n = 150) were retrospectively evaluated.
RESULTS:
The incidence of delirium (32%) was similar in subgroups (28.7% and 33.33%, P = 0.384). Delirium patients were older [71.3 (standard deviation: 8.5) vs 66.6 (standard deviation: 9.5), P
CONCLUSIONS:
Age, CPB time, ventilation, transfusion and atrial fibrillation are differently associated with delirium depending on the operative characteristics. Optimization of intraoperative parameters and use of risk calculators may enable early institution of pharmacotherapy and improve overall outcome after cardiac surgery.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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