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Pubblicazioni recenti - cardiac surgery
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The Incidence and Outcomes for Children with Cleft Palate and/or Lip and CHARGE Syndrome.
Cleft Palate Craniofac J2022 Dec;():10556656221134558. doi: 10.1177/10556656221134558.
Farid Mohammed, Cafferky Louise, Kirk Jeremy, Kershaw Melanie, Slator Rona,
Abstract
OBJECTIVES:
Published literature on children with cleft palate and/or lip (CP?+?/-L) and CHARGE syndrome (CS) is limited. This study investigated cleft characteristics including surgery, and feeding and communication outcomes in children identified with CP?+?/-L and CS.
DESIGN:
Retrospective cross-sectional review.
SETTING:
Regional Referral Centre for Paediatric Cleft Surgery.
PATIENTS:
All children diagnosed with CP?+?/-L and CS (based on clinical features and/or CHD7 mutation testing) between 1989-2019.
MAIN OUTCOME MEASURES:
Cleft type, timing of CP?+?/-L repair, reasons for 'delayed' repair, feeding methods and communication modality.
RESULTS:
Twenty-two children with CP?+?/-L and CS were identified. Cleft sub-types (%) were: Eleven (50%) had bilateral cleft lip and palate (BCLP), six (27%) had unilateral cleft lip and palate (UCLP) and five (23%) had cleft palate (CP). Cleft repair was delayed compared to protocol care for non-syndromic children with CP?+?/-L. Median age for lip repair?+?/- vomerine flap was 9 months (range 4-22 months), and palate repair was 21 months (range 11-40 months). Median age for isolated CP repair was 13 months (range 7-23). Surgery for cardiac anomalies (36%) before cleft repair, and (59%) were classed as having severe systemic disease at the time of cleft surgery. Only 27% of the children in this study had both full oral feeding and verbal communication.
CONCLUSIONS:
Children with CP?+?/-L and CS had severe cleft types and complex medical problems leading to delayed cleft surgery. Feeding and speech outcomes were better in the children aged over ten years.
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Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review.
Crit Care2022 Dec;26(1):375. doi: 10.1186/s13054-022-04249-w.
Charbonneau Francis, Chahinian Karina, Bebawi Emmanuel, Lavigueur Olivier, Lévesque Émilie, Lamarche Yoan, Serri Karim, Albert Martin, Noly Pierre-Emmanuel, Cournoyer Alexis, Cavayas Yiorgos Alexandros,
Abstract
PURPOSE:
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO-surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.
METHOD:
We systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never "successfully weaned." We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).
RESULTS:
We screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.
CONCLUSIONS:
In adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.
© 2022. The Author(s).
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Integrative stemness characteristics associated with prognosis and the immune microenvironment in lung adenocarcinoma.
BMC Pulm Med2022 Dec;22(1):463. doi: 10.1186/s12890-022-02184-8.
Wang Han, Wang Ying, Luo Wei, Zhang Xugang, Cao Ran, Yang Zhi, Duan Jin, Wang Kun,
Abstract
BACKGROUND:
To comprehensively analyze the stemness characteristics related to prognosis and the immune microenvironment in lung adenocarcinoma (LUAD).
METHODS:
The OCLR machine learning method was used to calculate the stemness index (mRNAsi) of the LUAD samples. DEGs common between the low mRNAsi, normal, and high mRNAsi groups were screened and the immune-stemness genes were obtained. Then the PPI network was created and enrichment analyses were performed. Moreover, different subtypes based on immune-stemness genes associated with prognosis were identified, and the relationships between LUAD stemness and TIME variables were systematically analyzed, followed by TMB analysis.
RESULTS:
Patients in the high mRNAsi groups with poor prognosis were screened along with 144 immune-stemness genes. IL-6, FPR2, and RLN3 showed a higher degree in the PPI network. A total of 26 immune-stemness genes associated with prognosis were screened. Two clusters were obtained (cluster 1 and cluster 2). Survival analysis revealed that patients in cluster 2 had a poor prognosis. A total of 12 immune cell subpopulations exhibited significant differences between cluster 1 and cluster 2 (P?0.05). A total of 10 immune checkpoint genes exhibited significantly higher expression in cluster 1 (P?0.05) than in cluster 2. Further, the TMB value in cluster 2 was higher than that in cluster 1 (P?0.05).
CONCLUSION:
Immune-stemness genes, including L-6, FPR2, and RLN3, might play significant roles in LUAD development via cytokine-cytokine receptor interaction, neuroactive ligand?receptor interaction, and the JAK?STAT pathway. Immune-stemness genes were related to tumor-infiltrating immune cells, TMB, and expression of immune checkpoint gene.
© 2022. The Author(s).
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Analgesic efficacy of a bilateral erector spinae plane block versus a fentanyl constant rate infusion in dogs undergoing hemilaminectomy: a retrospective cohort study.
BMC Vet Res2022 Dec;18(1):423. doi: 10.1186/s12917-022-03523-x.
Viilmann Inga, Drozdzynska Maja, Vettorato Enzo,
Abstract
BACKGROUND:
Erector spinae plane block (ESPB) is an ultrasound-guided interfascial plane block used to provide analgesia in dogs undergoing hemilaminectomy. The aim of this study is to compare the analgesic efficacy of a bilateral ESPB with a fentanyl constant rate infusion (CRI) in dogs undergoing hemilaminectomy.
METHODS:
This is a retrospective cohort study. Anaesthetic records of client-owned dogs undergoing hemilaminectomy (June 2019-August 2020), and in which a bilateral ESPB was performed (group ESPB), were retrieved and compared to a cohort of 39 dogs that underwent hemilaminectomy (September 2014 - June 2017) and in which a fentanyl CRI (2??g/kg bolus followed by 5??g/kg/hour) was used as a primary intraoperative analgesia (group CRI). The prevalence of dogs in which intraoperative rescue fentanyl boluses were administered, the total dose of rescue fentanyl boluses administered, the postoperative methadone requirement and anaesthetic complications during the first 24 postoperative hours were evaluated. Univariate statistical analysis was used.
RESULTS:
Group ESPB comprised of 93 dogs. The bilateral ESPB was performed using a median (range) levobupivacaine volume of 1 (0.5-1.7) mL/kg per side, at a concentration of 0.125% (0.12-0.25). At least one rescue fentanyl bolus was administered in 54.8% and in 56.4% of dogs in group ESPB and CRI, respectively (p?>?0.99). The number of rescue fentanyl boluses was higher in group CRI (p?=?0.006), especially during lumbar hemilaminectomy. Rescue fentanyl boluses were more frequently administered from skin incision to end of vertebral lamina drilling in group CRI (p?=?0.001), and from end of vertebral lamina drilling to end of surgery in group ESPB (p?=?0.0002). During the first 6 (p?=?0.0035) and 6-12 (p?=?0.0005) postoperative hours, the number of dogs that required at least one dose of methadone was higher in group CRI. In group ESPB, dogs were more likely to become hypothermic (p?=?0.04). One dog, not included in the study, developed sinus arrest after performing a caudal thoracic ESPB.
CONCLUSIONS:
Under the conditions of this study, a bilateral ESPB was associated with a lower number of rescue fentanyl boluses administered in dogs undergoing hemilaminectomy, especially between skin incision to end of vertebral lamina drilling. Despite ESPB being associated with a reduced opioid consumption during the first 12?hours postoperatively, differences in the postoperative management precluded any firm conclusion regarding its postoperative effect.
© 2022. The Author(s).
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Safety and efficacy of using portable coagulation monitor for INR examination after left-sided mechanical prosthetic valve replacement.
J Cardiothorac Surg2022 Dec;17(1):297. doi: 10.1186/s13019-022-02046-8.
Shen Yue, Zhong Fu-Xiu, Huang Xue-Shan,
Abstract
BACKGROUND:
Time in therapeutic range (TTR) is an index to assess the effectiveness of anticoagulation and is important to predict the risk of bleeding and thrombosis in patients taking warfarin. In recent years, the portable coagulation monitor, a point-of-care testing device for patients to perform self-management international normalized ratio (INR) examination, has provided an opportunity to improve the quality of oral warfarin treatment. In this study, we applied TTR to evaluate the safety and efficacy of the portable coagulation monitor for patients with oral anticoagulant warfarin after left-sided mechanical prosthetic valve (MPV) replacement.
METHODS:
It is a single-centre cohort study. From September 2019 to June 2021, a total of 243 patients who returned to our institution for outpatient clinic revisit at 3 months after left-sided MPV replacement, met the inclusion criteria and agreed to be followed up were included. Self-management group used portable coagulation monitor for INR examination, and patients in the conventional group had their INR monitored in routine outpatient visits. Clinical data of the patients would be recorded for the next 12 months, and results were compared between the two groups to assess the effect of the coagulation monitor on TTR and complications related to bleeding and thrombosis in patients with left-sided MPV replacement.
RESULTS:
A total of 212 individuals provided complete and validated INR data spanning of 1 year. Those who applied the portable coagulation monitor had higher TTR values and larger number of tests for INR. No significant differences were seen between the two groups in postoperative bleeding and thromboembolic complications, but portable coagulation monitor showed a trend toward fewer bleeding events.
CONCLUSION:
Portable devices for coagulation monitoring are safe and can achieve a higher TTR. Patients who use the portable coagulation monitor for home INR self-management can achieve a safe and effective warfarin therapy.
© 2022. The Author(s).
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Tissue plasminogen activator with prolonged dwell time effectively evacuates pleural effusions.
BMC Pulm Med2022 Dec;22(1):464. doi: 10.1186/s12890-022-02261-y.
Townsend Alexandra, Raju Harsha, Serpa Krystina A, Pruett Rachel, Razi Syed S, Tarrazzi Francisco A, Tami Catherine M, Block Mark I,
Abstract
OBJECTIVES:
Fibrinolytic therapy can be effective for management of complex pleural effusions. Tissue plasminogen activator (tPA, 10 mg) and deoxyribonuclease (DNAse) every 12 h with a dwell time of one hour is a common strategy based on published data. We used a simpler protocol of tPA (4 mg) without DNAse but with a longer dwell time of 12 h, repeated daily. We reviewed our results.
METHODS:
Charts were reviewed and demographics, clinical data and treatment information were abstracted. Outcomes were assessed based on radiographic findings and need for surgery.
RESULTS:
Two hundred and fifteen effusions in 207 patients (8 bilateral) were identified. 85% were either infectious or malignant. Two hundred and forty nine chest tubes were used: 84% were 10 Fr or 12 Fr and 7% were PleurX®. Five hundred and thirty one doses of tPA were given. The median number of doses per effusion was 2 (range 1-10), and 84% of effusions were treated with three or fewer doses. There were no significant bleeding complications. Median time to chest tube removal was 6 days (range 1 to 98, IQR 4 to 10). Drainage was considered complete for 78% of effusions, while 6% required decortication.
CONCLUSIONS:
Low dose tPA daily with a 12 h dwell time may be as effective as the standard regimen of tPA and DNAse twice daily with one hour dwell. For most patients only three doses were required, and small pigtail catheters were sufficient. This regimen uses less medication and is logistically much easier than the current standard.
© 2022. The Author(s).
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Case-Control Study of 3D Morphology in Isolated Mesenteric Artery Dissection.
Cardiovasc Eng Technol2022 Dec;():. doi: 10.1007/s13239-022-00649-9.
Ben Abdallah Iannis, Craiem Damian, Casciaro Mariano, Deza Damian, Ronot Maxime, Corcos Olivier, Castier Yves, El Batti Salma,
Abstract
INTRODUCTION:
Isolated mesenteric artery dissection (IMAD) is uncommon and has not been investigated in detail. This study aimed to accurately identify the morphological differences of IMAD patients with control individuals using a detailed 3D volumetric analysis.
METHODS:
In this retrospective case-control study, cases were patients with acute symptomatic IMAD treated in a French intestinal stroke center between January 2016 and November 2019. Case-control matching was (1:3) by age, gender, and body mass index (BMI). The semi-automatic morphological analysis of the mesenteric artery included volumetric measurements of the true and false lumen size, the centerline curvature and the 3D aortomesenteric angles.
RESULTS:
Seventeen IMAD cases (mean age 56?±?4 years, 94% men) were matched with 51 controls. The mean overall lumen (OL) volume was higher in IMAD patients as compared to controls (+?64%, p?0.001). In the same way, the mean OL cross-sectional area and diameters were higher in IMAD patients:?+?77% for OL area (0.001) and?+?34% for OL diameters (0.001). Meanwhile, no significant difference was found in terms of true lumen (TL) volume (p?=?0.16) or cross-sectional area (p?=?0.30) between IMAD patients and controls, whereas the mean TL diameter was lower in the IMAD group (p?0.05). Patients with acute mesenteric ischemia had a lower [TL/OL volume] ratio (45% vs. 59%, p?0.05) and longer dissections (63 mm vs. 48 mm, p?0.01). The 3D aortomesenteric angle was significantly higher in IMAD patients at both 2 cm (p?0.01) and 4 cm (p?0.05) from the ostium.
CONCLUSION:
Using an original 3D semi-automated analysis, this study shows that IMAD induces significant morphological changes compared to control individuals: a larger aortomesenteric 3D angle, an increased overall volume and area. IMAD patients with acute mesenteric ischemia presented with a more severe morphological profile.
© 2022. The Author(s) under exclusive licence to Biomedical Engineering Society.
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Cellular mechanisms and molecular pathways linking bitter taste receptor signalling to cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction in heart diseases.
Inflammopharmacology2022 Dec;():. doi: 10.1007/s10787-022-01086-9.
Welcome Menizibeya O, Dogo Dilli, Nikos E Mastorakis ,
Abstract
Heart diseases and related complications constitute a leading cause of death and socioeconomic threat worldwide. Despite intense efforts and research on the pathogenetic mechanisms of these diseases, the underlying cellular and molecular mechanisms are yet to be completely understood. Several lines of evidence indicate a critical role of inflammatory and oxidative stress responses in the development and progression of heart diseases. Nevertheless, the molecular machinery that drives cardiac inflammation and oxidative stress is not completely known. Recent data suggest an important role of cardiac bitter taste receptors (TAS2Rs) in the pathogenetic mechanism of heart diseases. Independent groups of researchers have demonstrated a central role of TAS2Rs in mediating inflammatory, oxidative stress responses, autophagy, impulse generation/propagation and contractile activities in the heart, suggesting that dysfunctional TAS2R signalling may predispose to cardiac inflammatory and oxidative stress disorders, characterised by contractile dysfunction and arrhythmia. Moreover, cardiac TAS2Rs act as gateway surveillance units that monitor and detect toxigenic or pathogenic molecules, including microbial components, and initiate responses that ultimately culminate in protection of the host against the aggression. Unfortunately, however, the molecular mechanisms that link TAS2R sensing of the cardiac milieu to inflammatory and oxidative stress responses are not clearly known. Therefore, we sought to review the possible role of TAS2R signalling in the pathophysiology of cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction in heart diseases. Potential therapeutic significance of targeting TAS2R or its downstream signalling molecules in cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction is also discussed.
© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity.
Obes Surg2022 Dec;():. doi: 10.1007/s11695-022-06381-6.
Khaitan Leena, Hill Michael, Michel Michael, Chiasson Patrick, Woodworth Philip, Bell Reginald, Sadek Ragui, Hoffman Aaron, Loing Kari, Veldhuis Paula, Petraiuolo William, Anciano Carlos,
Abstract
BACKGROUND:
Patients with medically intractable GERD after laparoscopic sleeve gastrectomy (LSG) have limited surgical options. Fundoplication is difficult post-LSG. Roux-en-Y gastric bypass may be used as a conversion procedure but is more invasive with potential for serious complications. Magnetic sphincter augmentation (MSA) is a less invasive GERD treatment alternative. The objective of this study was to assess safety and efficacy outcomes of MSA after LSG.
METHODS:
The primary outcome of this observational, multicenter, single-arm prospective study was the rate of serious device and/or procedure-related adverse events (AEs). The efficacy of the LINX device was measured comparing baseline to 12-month post-implant reductions in distal acid exposure, GERD-HRQL score, and average daily PPI usage.
RESULTS:
Thirty subjects who underwent MSA implantation were followed 12 months post-implant. No unanticipated adverse device effects were observed. There were two adverse events deemed serious (dysphagia, pain, 6.7%) which resolved without sequelae. GERD-HRQL scores showed significant improvement (80.8%, P?0.001), and reduction in daily PPI usage was seen (95.8%, P?0.001). Forty-four percent of subjects demonstrated normalization or?>??=?50% reduction of total distal acid exposure time (baseline 16.2%, 12 months 11%; P?=?0.038).
CONCLUSIONS:
Post-LSG, MSA showed an overall improvement of GERD symptoms, and reduction in PPI use with explants within anticipated range along with improvement in distal esophageal acid exposure time.
© 2022. The Author(s).
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Minimum protamine dose required to neutralize heparin in cardiac surgery: a single-centre, prospective, observational cohort study.
Can J Anaesth2022 Dec;():. doi: 10.1007/s12630-022-02364-4.
Taneja Ravi, Szoke Daniel J, Hynes Zachary, Jones Philip M,
Abstract
PURPOSE:
Excess protamine contributes to coagulopathy following cardiopulmonary bypass (CPB) and may increase blood loss and transfusion requirements. The primary aim of this study was to find the least amount of protamine necessary to neutralize residual heparin following CPB using the gold standard assays of anti-IIa and anti-Xa activity. Secondary objectives were to evaluate whether the post-CPB activated clotting time could be used as a surrogate marker for quantifying heparin neutralization.
METHODS:
Twenty-eight consecutive patients undergoing elective cardiac surgery were enrolled. Protamine administration was standardized through an infusion pump at 25 mg·min. Blood samples were withdrawn prior to and following administration of 150, 200, 250, and 300 mg protamine and analyzed for activated clotting time and anti-IIa and -Xa activity.
RESULTS:
Following a mean (standard deviation) cumulative heparin dose of 67,700 (19,400) units and a CPB duration of 113 (71) min, protamine requirements varied widely. Eight out of 25 (32%) patients showed complete neutralization of anti-IIa and -Xa activity at the first sampling point (150 mg protamine; protamine:heparin ratio, 0.3 [0.1]). A protamine:heparin ratio of 0.5 (0.2) was sufficient for heparin neutralization in > 90% of patients. After CPB, a low to mid-range activated clotting time correlated well with anti-IIa and -Xa activity.
CONCLUSIONS:
The protamine:heparin ratio required to neutralize residual unfractionated heparin (UFH) following CPB is variable. A protamine:heparin ratio of 0.3 was sufficient to neutralize UFH in some patients, while a ratio of 0.5 is sufficient to neutralize both residual anti-IIa and -Xa activity in most patients. Larger studies are necessary to confirm these findings and evaluate their clinical implications.
STUDY REGISTRATION:
ClinicalTrials.gov (NCT03787641); registered 26 December 2018.
© 2022. Canadian Anesthesiologists' Society.
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Incidental finding of Clostridium perfringens on human corpses used for the anatomy course.
Anat Sci Int2022 Dec;():. doi: 10.1007/s12565-022-00699-y.
Kerner Alexander M, Grisold Andrea J, Smolle-Jüttner Freyja-Maria, Hammer Niels,
Abstract
Post-mortem specimens used for anatomy teaching are commonly embalmed using compositions of chemicals, with the objective to maintain tissue quality and to avoid putrefaction. Monitoring for bacterial or fungal contamination is becoming increasingly important especially when measures are taken to minimize exposure by chemicals such as formaldehyde. In this case, random swabs were taken from six corpses embalmed with ethanol-glycerin and Thiel embalming. Cultures and MALDI-TOF analyses yielded four cases of Clostridium perfringens contamination. C. perfringens is of special interest as a human pathogen. A potential source was identified in the containers filled with the moistening solution. Cross contamination with Clostridium species has likely occurred between corpses sharing the moistening solution and soaking the cover linen directly within the containers. To minimize any risk for those exposed, the moistening solutions were discarded and all equipment thoroughly disinfected. The specimens had to be cremated as they formed a potential source of Clostridium spores. Deviating from previous routines it was formalized that the cover linen must not be submerged in the moistening contains rather than moistening the specimens directly with dedicated vessels. Follow-up analyses yielded no further contamination with C. perfringens.
© 2022. The Author(s).
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Postoperative prosthetic mitral valve occlusion due to left atrial thrombus during veno-arterial extracorporeal membrane oxygenation: a case report.
JA Clin Rep2022 Dec;8(1):93. doi: 10.1186/s40981-022-00586-5.
Kiuchi Naoto, Seino Yusuke, Yamamoto Mai, Katagiri Seidai, Takagi Shunichi, Nomura Takeshi, Suzuki Takahiro,
Abstract
BACKGROUND:
Anticoagulation using heparin is generally used to prevent thrombus formation during mechanical circulatory support, such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, during the early period following cardiac surgery, anticoagulation becomes more difficult due to the greater risk of critical bleeding complications.
CASE PRESENTATION:
A 71-year-old man presented with acute prosthetic valve occlusion caused by left atrial thrombus formation and bioprosthetic valve thrombosis during peripheral VA-ECMO following mitral valve replacement (MVR) despite continuous heparin administration and loading of antiplatelet agents. The VA-ECMO flow rate decreased 10 h after the intensive care unit (ICU) admission after MVR. Exploratory transesophageal echocardiography (TEE) examination revealed a left atrial thrombus, prosthetic valve obstruction by the thrombus, and an intrapericardial hematoma.
CONCLUSIONS:
Intracardiac thrombus formation might occur during VA-ECMO despite appropriate anticoagulation and loading of antiplatelet agents. Exploratory TEE examination was helpful in the detection of intra-atrial thrombus formation after cardiac surgery and surgical decision-making.
© 2022. The Author(s).
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USP36 facilitates esophageal squamous carcinoma progression via stabilizing YAP.
Cell Death Dis2022 Dec;13(12):1021. doi: 10.1038/s41419-022-05474-5.
Zhang Wenhao, Luo Junwen, Xiao Zhaohua, Zang Yifeng, Li Xin, Zhou Yougjia, Zhou Jie, Tian Zhongxian, Zhu Jian, Zhao Xiaogang,
Abstract
Esophageal squamous carcinoma (ESCC) is the major subtype of esophageal cancer in China, accounting for 90% of cases. Recent studies revealed that abnormalities in the Hippo/YAP axis are pervasive in ESCC and are recognized as the important driver of ESCC progression. Since the activity of Hippo signaling is controlled by phosphorylation cascade, it is a mystery why the major effector YAP is still over-activated when the cascade is inhibited. Several studies suggested that in addition to phosphorylation, other protein modifications such as ubiquitination also play important roles in manipulating Hippo/YAP signaling activity. Since YAP protein stability is controlled via an appropriate balance between E3 ubiquitin ligases and deubiquitinases, we performed deubiquitinase siRNA screening and identified USP36 as a deubiquitinase significantly related to Hippo/YAP signaling activity and ESCC progression. USP36 expression was elevated in ESCC samples and correlated with poor differentiation. USP36 expression was correlated with YAP protein levels in ESCC samples. Molecular studies demonstrated that USP36 associated with the YAP protein and enhanced YAP protein stability by blocking the K48-linked polyubiquitination of YAP. In conclusion, our study revealed a novel deubiquitinase in regulating Hippo signaling in ESCC, which could be an encouraging drug target for Hippo-driven ESCC.
© 2022. The Author(s).
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Duration of antimicrobial therapy after video-assisted thoracoscopic surgery for thoracic empyema and complicated parapneumonic effusion: A single-center study.
Respir Investig2022 Dec;():. doi: S2212-5345(22)00150-2.
Yukumi Shungo, Ishimaru Kei, Suzuki Hideaki, Abe Masahiro, Morimoto Masamitsu, Senba Mayuko, Yamamoto Tetsuya, Mori Yu, Sakao Nobuhiko, Sano Yoshifumi,
Abstract
BACKGROUND:
There are no evidence-based reports on the proper duration of antimicrobial therapy following video-assisted thoracoscopic surgery debridement (VATS-D) in thoracic empyema (TE) or complicated parapneumonic effusion (PPE). This study aimed to investigate the optimal duration of antimicrobial therapy after VATS-D.
METHODS:
Between January 2011 and December 2019, 33 patients corresponding to American College of Chest Physicians (ACCP) category 3 or 4 undergoing VATS-D were included. The times until the body temperature (BT) was confirmed to be less than 37.5 °C and 37.0 °C, white blood cell count (WBC) less than 10,000/?l, segmented neutrophils (seg) less than 80%, and C-reactive protein (CRP) level less than 25% of the preoperative value were retrospectively analyzed.
RESULTS:
The median time from the onset of TE/PPE to surgery was 13 days. The median durations of preoperative and postoperative antibiotic use were five and seven days, respectively. Major complications occurred in four cases (three and one cases of respiratory failure and cerebral infarction, respectively). The median postoperative hospital stay was 14 days. Recurrence or progression to chronic empyema was seen in four cases. The median numbers of days until the conditions were met were three days for BT
CONCLUSIONS:
The proper duration of antimicrobial therapy after VATS-D for TE/PPE is approximately three to seven days. Urgent VATS-D may shorten the total antibiotic usage.
Copyright © 2022 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
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Robot-assisted versus thoracolaparoscopic oesophagectomy for locally advanced oesophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.
Eur J Surg Oncol2022 Nov;():. doi: S0748-7983(22)00830-7.
Jiang Haoyao, Guo Xufeng, Sun Yifeng, Hua Rong, Li Bin, Li Zhigang,
Abstract
INTRODUCTION:
Robot-assisted oesophagectomy (RAE) and thoracolaparoscopic oesophagectomy (TLE) are surgical techniques for the treatment of oesophageal cancer. This study aimed to compare the perioperative and mid-term outcomes of RAE versus TLE for patients with locally advanced oesophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (nCRT).
METHODS:
Consecutive patients receiving nCRT plus RAE or TLE were retrospectively included in this single-institution study from January 2016 to January 2021. Perioperative outcomes were compared and survival analysis was performed.
RESULTS:
This study enrolled 251 patients, 80 (31.9%) in RAE and 171 (68.1%) in TLE. The conversion rate was equivalent in RAE versus TLE (3.8% vs 2.9%, P = 1). Median operative time in RAE was significantly shorter than that in TLE (254 vs 289 min, P
CONCLUSIONS:
Compared to TLE, RAE could achieve shorter operative duration and better lymph nodes dissection along the bilateral RLN for locally advanced ESCC after nCRT, with comparable short-term outcomes. A long-term survival remains to be verified.
Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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Evaluation of ferritin and the ferritin index as prognostic biomarkers in septic shock.
Aust Crit Care2022 Dec;():. doi: S1036-7314(22)00225-9.
Gunasekaran Chandrasekaran, Eastwood Glenn M, Peck Leah, Young Helen, Serpa Neto Ary, Bellomo Rinaldo,
Abstract
BACKGROUND:
Ferritin, an acute phase reactant, and the ferritin index (FI = observed ferritin level/upper limit of normal level for age and sex) may be prognostic biomarkers in septic shock and cardiac surgery patients.
OBJECTIVE:
The purpose of this exploratory study is to assess the outcome associations of ferritin and FI levels in septic shock compared to post-cardiac surgery patients.
DESIGN:
This was a prospective, double-centre, observational study.
SETTING:
The study setting involved two adult intensive care units (ICUs) in Victoria, Australia.
PARTICIPANTS:
Sixty-one septic shock and 30 post-cardiac surgery patients participated in this study.
MAIN OUTCOME MEASURES:
We measured ferritin and FI on ICU admission (T1) and 24 h later (T2) to assess its correlation with mortality, illness severity, and hospital length of stay (LOS).
RESULTS:
The baseline characteristics of patients in the septic shock group and cardiac surgery group were similar apart from illness severity scores (APACHE III and modified SOFA score). Septic shock patients had more physiological derangements as well as greater use and higher doses of norepinephrine at both T1 and T2. Septic shock patients had significantly higher median ferritin levels (372 ?g/L versus 198 ?g/L; p
CONCLUSION:
In septic shock patients, ferritin levels and FI were twice the level compared to post-cardiac surgery patients. Both had no association with mortality, but levels above the median at 24 h were associated with longer ICU and hospital LOS.
Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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Thoracic anaesthetic research: 90 years of sustained progress.
Br J Anaesth2022 Dec;():. doi: S0007-0912(22)00623-7.
Shelley Ben, Licker Marc, Slinger Peter,
Abstract
Over the 90 years since the first description of one-lung ventilation, the practice of thoracic surgery and anaesthesia continues to develop. Minimally invasive surgical techniques are increasingly being used to minimise the surgical insult and facilitate improved outcomes. Challenging these outcomes, however, are parallel changes in patient characteristics with more older and sicker patients undergoing surgery. Thoracic anaesthesia as a speciality continues to respond to these challenges with evolution of practice and strong academic performance.
Copyright © 2022 British Journal of Anaesthesia. All rights reserved.
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Stop the Bleed: Airway hemorrhage following pulmonary thromboendarterectomy.
Ann Thorac Surg2022 Dec;():. doi: S0003-4975(22)01530-2.
Till Brian M, Tchantchaleishvili Vakhtang, Rajagopal Keshava,
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ACCURACY OF PRELIMINARY PATHOLOGY FOR ROBOTIC BRONCHOSCOPIC BIOPSY.
Ann Thorac Surg2022 Dec;():. doi: S0003-4975(22)01501-6.
Vu Linh H, Lee-Mateus Alejandra Yu, Edell Eric S, Hartley Christopher, Vierkant Robert A, Fernandez-Bussy Sebastian, Reisenauer Janani,
Abstract
BACKGROUND:
Diagnosis and treatment of peripheral pulmonary lesions (PPLs) currently require at least two procedures. An all-in-one approach would require diagnosing malignancy with preliminary cytology results. We investigate the concordance between preliminary cytology and final pathology results in biopsies of PPLs obtained by shape-sensing robotic-assisted bronchoscopy (ssRAB).
METHODS:
A retrospective, consecutive, single-arm, single center study of 110 ssRAB for PPLs. Concordance is defined as agreement between preliminary cytology and final pathology results. Accuracy, sensitivity, specificity, positive and negative predictive values, and safety outcomes were examined.
RESULTS:
The concordance was 89% for needle biopsies, 85% for forceps biopsies, and 92% overall, with substantial agreement. There was no significant association of concordance with patients' demographics or lesion characteristics. Preliminary cytology resulted in malignant diagnosis in 70%, nonmalignant in 4%, nondiagnostic in 26%, with accuracy of 86% and sensitivity of 84%. Total complication rate was 3.6%, with a pneumothorax rate of 1.8%.
CONCLUSIONS:
This is the first study to compare the concordance of preliminary pathology to final pathology for ssRAB biopsies in PPLs. Our results show that preliminary samples have a high concordance with final pathology and may enable management of PPLs with a single anesthetic procedure including biopsy, staging and treatment.
Copyright © 2022. Published by Elsevier Inc.
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Bilateral axillary artery perfusion for aortic arch surgery: Worth the effort?
Ann Thorac Surg
