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Pubblicazioni recenti - cardiac surgery
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F-FDG PET/CT in lung adenosquamous carcinoma and its correlation with clinicopathological features and prognosis.
Ann Nucl Med2020 Feb;():. doi: 10.1007/s12149-020-01450-1.
Li Yuan, Wu Xiaodong, Huang Yan, Bian Dongliang, Jiang Lei,
Abstract
OBJECTIVE:
Lung adenosquamous carcinoma (ASC) is a rare histological subtype of non-small cell lung cancer (NSCLC). Due to its rarity, the studies about F-FDG PET/CT in this kind of pulmonary tumor were quite limited. Thus, this study investigated F-FDG PET/CT findings in ASC and its correlation with clinicopathological features and clinical outcomes.
METHODS:
Preoperative F-FDG PET/CT findings and parameters of maximum standard uptake value (SUV), metabolic tumor volume and total lesion glycolysis of primary lesion (MTV-P, TLG-P), combination of primary lesion and metastases (MTV-C, TLG-C), and clinicopathological features were retrospectively investigated in patients with ASC. Moreover, progression-free survival (PFS) was also analyzed.
RESULTS:
All 41 patients (25 men; 16 women; age: 60?±?7 years) had single ASC with the mean diameter of 33?±?14 mm. Six lesions were located centrally and 35 peripherally. Serum tumor markers were abnormally increased sporadically. Twenty-two cases were at TNM stage I, 9 at II, and 10 at III. The primary tumors were FDG-avid in all cases, with the average SUV of 11.5?±?6.0. SUV was significantly associated with tumor location, size, and TNM stage (P?
CONCLUSIONS:
ASC of the lung displayed high SUV on F-FDG PET/CT, which was associated with tumor location, size, TNM stage, and predominant histologic component. Moreover, metabolic parameters of F-FDG PET/CT were independent prognostic factors of this rare lung malignancy.
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Clinical phenotypes based on clinical prognostic factors in patients with secondary hip osteoarthritis: preliminary findings from a prospective cohort study.
Clin Rheumatol2020 Feb;():. doi: 10.1007/s10067-020-04988-7.
Tateuchi Hiroshige, Akiyama Haruhiko, Goto Koji, So Kazutaka, Kuroda Yutaka, Ichihashi Noriaki,
Abstract
OBJECTIVES:
Recently, several clinical prognostic factors for hip osteoarthritis (OA) progression such as spinal malalignment, reduced spinal mobility, and excessive daily cumulative hip loading have been identified. This study aimed to identify clinical phenotypes based on clinical prognostic factors in patients with secondary hip OA using data from prospective cohort studies and to define the clinical features of each phenotype.
METHODS:
Fifty patients participated. Two-step cluster analysis was performed to identify the phenotypes using the following potential prognostic factors for hip OA progression: spinal inclination in standing, thoracolumbar spine mobility, daily cumulative hip moment, and minimum joint space width (JSW) at baseline. Comprehensive basic and clinical features (age, body mass index, hip pain, Harris hip score, JSW, radiographic hip morphology, hip impairments, spinal alignment and mobility, and gait-related variables) and ratio of progressors in 12 months were compared among the phenotypes using bootstrap method (unadjusted and adjusted for age).
RESULTS:
Three phenotypes were identified and each phenotype was characterized as follows (P?
CONCLUSION:
Three phenotypes with similar progression risk were identified. This finding will help in designing treatment tailored to each phenotype for hip OA progression prevention.Key Points? Three phenotypes with similar progression risk were identified based on clinical prognostic factors.? Phenotype 1 was characterized by young age and higher daily cumulative hip loading.? Phenotype 2 was relatively old age and had reduced JSW and less spinal mobility.? Phenotype 3 had changed thoracic spine alignment and less thoracic spine mobility.
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Optimal method for measuring invasive size that predicts survival in invasive mucinous adenocarcinoma of the lung.
J Cancer Res Clin Oncol2020 Feb;():. doi: 10.1007/s00432-020-03158-1.
Oki Tomonari, Aokage Keiju, Nomura Shogo, Tane Kenta, Miyoshi Tomohiro, Shiiya Norihiko, Funai Kazuhito, Tsuboi Masahiro, Ishii Genichiro,
Abstract
PURPOSE:
The purpose of this study was to determine the optimal method for measuring pathological invasive size that predicts prognosis in invasive mucinous adenocarcinoma (IMA).
METHODS:
We analyzed patients who underwent complete surgical resection for lung IMA. The invasive size of IMA was measured using two methods: (1) excluding lepidic method (ELM), that is, lepidic component was excluded from the invasive area regardless of alveolar mucin and (2) including lepidic method (ILM), that is, lepidic component was included as invasive area if alveolar space was filled with mucin. The prognostic predictability of ELM and ILM on survival was assessed using univariable and multivariable Cox regression models. The discriminative power was assessed using concordance probability estimate (CPE) and Akaike's information criteria (AIC), and the prognostic impact of the newly redefined pathological stage according to ELM or ILM was also assessed.
RESULTS:
A total of 101 patients were included. The median invasive size via ELM and ILM was 1.4 cm (range, 0.0-7.7 cm) and 2.1 cm (range, 0.0-14.2 cm), respectively. ELM had better discriminative power than ILM (ELM, HR?=?1.38, AIC?=?110.19, CPE?=?0.671; ILM, HR?=?1.19, AIC?=?111.52, CPE?=?0.655). Although the survival curves based on ILM crossed between T3 and T4, the overall survival (OS) curves based on ELM were sufficiently distinct from one another.
CONCLUSIONS:
ELM has higher discriminative power for OS, and thus the optimal method for measuring the pathological invasive size of IMA should exclude the lepidic component regardless of alveolar mucin.
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Computed tomography fluoroscopy-guided cutting needle biopsy of pulmonary nodules ?8 mm: A retrospective study including 117 nodules.
Eur J Radiol2020 Feb;125():108903. doi: S0720-048X(20)30092-9.
Zhao Yanqing, Matsui Yusuke, Hiraki Takao, Iguchi Toshihiro, Tomita Koji, Uka Mayu, Gobara Hideo, Toyooka Shinichi, Kanazawa Susumu,
Abstract
PURPOSE:
To evaluate the diagnostic yield and safety of computed tomography (CT) fluoroscopy-guided cutting needle biopsy (CNB) for pulmonary nodules ? 8 mm.
METHOD:
Data of CT fluoroscopy-guided CNB for pulmonary nodules ? 8 mm performed in a single institution were retrospectively analyzed. One hundred and seventeen biopsy procedures for 117 pulmonary nodules (mean size, 7.4 mm) in 114 patients were included in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Univariate analyses were performed to elucidate the risk factors for diagnostic failure (i.e., non-diagnostic, false-positive, or false-negative results). Complications were graded per the Clavien-Dindo Classification.
RESULTS:
One (0.9 %) non-diagnostic biopsy result was found. The diagnostic accuracy was 95.7 % (112/117). The sensitivity and specificity were 95.8 % (91/95) and 95.5 % (21/22), respectively. PPV and NPV were 98.9 % (91/92) and 87.5 % (21/24), respectively. Univariate analyses showed that nodules in the lower lobes (p = 0.006) and prone biopsy position (p = 0.021) were the significant risk factors for diagnostic failure. The incidence of pneumothorax requiring chest tube placement (Grade IIIa) was 6.8 % (8/117). No Grade IIIb or higher complications were observed.
CONCLUSION:
CT fluoroscopy-guided CNB for pulmonary nodules ? 8 mm showed a high diagnostic yield without severe complications.
Copyright © 2020. Published by Elsevier B.V.
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Adherence to the mediastinal staging guideline and unforeseen N2 disease in patients with resectable non-small cell lung cancer: Nationwide results from the Dutch Lung Cancer Audit - Surgery.
Lung Cancer2020 Feb;142():51-58. doi: S0169-5002(20)30305-6.
Bousema Jelle E, Heineman David J, Dijkgraaf Marcel G W, Annema Jouke T, van den Broek Frank J C,
Abstract
OBJECTIVES:
Invasive mediastinal staging is advised by guidelines in patients with resectable non-small cell lung cancer (NSCLC) and suspicious lymph nodes (cN1-3) or for central, FDG-non-avid or peripheral tumours >3 cm. Our objective was to assess current guideline adherence and consequent unforeseen N2 disease (uN2) in NSCLC patients having various indications for mediastinal staging.
MATERIALS AND METHODS:
We analysed the Dutch Lung Cancer Audit - Surgery data of all patients who underwent a primary lung resection with lymph node dissection for NSCLC in 2017-2018. Based on the 2015 ESTS-ERS-ESGE guideline we assessed the use of initial endosonography and confirmatory mediastinoscopy as well as uN2 rates.
RESULTS:
A total of 2238 patients were analysed. 43 % (95 %-CI: 41-45) underwent initial endosonography followed by a confirmatory mediastinoscopy in 44 % (95 %-CI:40-47) of them, resulting in a 19 % (95 %-CI: 17-20) rate of properly staged patient according to the guidelines. uN2 was demonstrated in 12.5 % (95 %-CI: 9.7-16.0) of correctly staged patients compared to 10.9 % (95 %-CI: 9.6-12.4) who were not (p = .36). The highest uN2 rate was found in cN1-3 patients who were not staged (23.0 %, 95 %-CI: 16.4-31.2) compared to 13.0 % (95 %-CI: 9.7-17.1) who were (p = .01).
CONCLUSION:
Guideline adherence in Dutch NSCLC patients with an indication for invasive mediastinal staging is poor. The highest uN2 rate was found in unstaged cN1-3 patients, suggesting that this subgroup may benefit from an appropriate staging conform guidelines.
Copyright © 2020. Published by Elsevier B.V.
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Validating the surgical indication value of the LTB-S classification system for Drug-Resistant Tuberculosis.
Int J Infect Dis2020 Feb;():. doi: S1201-9712(20)30088-6.
Wang Lin, Wang Yifei, Wen Zilu, Xia Fan, Chen Hui, Zhu Yijun, Xiao Heping, Lu Shuihua, Dai Xiyong, Wang Haijiang, Huang Chaolin, Chang Wei, Wong Ka-Wing, Song Yanzheng,
Abstract
BACKGROUND:
Currently there is no guideline based on preoperative clinical parameters for assessing the prognosis of the adjunctive surgery for drug-resistant tuberculosis.
METHODS:
We retrospectively analyzed 138 patients who have undergone surgical resection as a treatment for drug-resistant tuberculosis after 24 months. Four clinical parameters on lesion type, treatment history, body physiological status, and surgery approach were evaluated. Categorical preoperative clinical parameters were analyzed by ordinal logistic regression model when considering postoperative complications as outcomes ordered in terms of severity. Statistically significant parameters were then combined in a single classification system for predicting the outcomes of the adjunctive surgery.
FINDINGS:
Diffused, progressive bilateral lesions, or active/progressive extra pulmonary tuberculosis (L3), history of less than 2 months treatment before surgery (T3) were the strongest predicative parameters for postoperative complications and for surgery failure. Classification system based on the four parameters were found to have a statistically significant effect on postoperative complications and postoperative efficacy. 24-month follow up indicated high cure rate (above 95.5%) among patients without T3, L3, or severe physiological complications (B3).
INTERPRETATION:
A classification system based on objective clinical parameters showed predicative value for the prognosis of the adjunctive surgery and could guide management of drug-resistant Tuberculosis.
Copyright © 2020. Published by Elsevier Ltd.
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Postoperative Outcomes of Patients with Obstructive Sleep Apnea Undergoing Cardiac Surgery.
Ann Thorac Surg2020 Feb;():. doi: S0003-4975(20)30218-6.
Gali Bhargavi, Glasgow Amy E, Greason Kevin L, Johnson Rebecca L, Albright Robert C, Habermann Elizabeth B,
Abstract
BACKGROUND:
Obstructive sleep apnea (OSA) is associated with increased risk of postoperative complications in non-cardiac surgery, with limited literature on cardiac surgical patients. We compared perioperative outcomes of patients with OSA to those without OSA undergoing cardiac surgery.
METHODS:
This was a retrospective single center cohort study of adult patients who underwent cardiac surgery from January 2010 to April 2017. Our aim was to compare outcomes of patients with OSA to those without OSA including length of stay, readmissions, hospital mortality, and short-term outcomes.
RESULTS:
8612 patients during the study period included 2636 (30.6%) with OSA. Patients with OSA had a higher median length-of-stay (6 vs 5 days, P < 0.001), higher incidence of prolonged (> 7 days) length of stay (26.3% vs 23.0%, P < 0.001), and less likely to discharge to home (78.2% vs 84.4%, P < 0.001). OSA patients also had a higher 30-day readmission rate (14.7% vs 10.4%, P < 0.001). Acute kidney injury was more common in OSA patients (25.2% vs 19.9%, P < 0.001). Our multivariable model found postoperative atrial fibrillation was associated with older age and not OSA status (age < 50 years compared to > 75 years odd ratio: 4.10, 95% confidence interval: 3.39-4.96).
CONCLUSIONS:
OSA patients had a higher mean length-of-stay, were more likely to have a prolonged length-of-stay, more likely to discharge to location other than home, and had a higher 30-day readmission rate. This suggests higher resource utilization is required to care for OSA patients following cardiac surgery.
Copyright © 2020. Published by Elsevier Inc.
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Intra thoracic migration of abdominal viscera in pregnancy.
Ann Thorac Surg2020 Feb;():. doi: S0003-4975(20)30220-4.
Athiel Yoann, Pinton Anne, Solomon David, Goffinet François, Bobbio Antonio,
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Post-kyphoplasty cement embolism migrating to the peritoneum through the right ventricle.
J Cardiovasc Comput Tomogr2020 Feb;():. doi: S1934-5925(19)30755-5.
Plateker Olivier, Daix Thomas, Boulogne Cyrille, Rousselle Virginie, Vignon Philippe, Porterie Jean,
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[Quality of spirometry in Primary Care in Cantabria 10 years later. EspiroCan Study].
Semergen2020 Feb;():. doi: S1138-3593(20)30008-3.
Viejo Casas A, Gómez Molleda F, Astruga Tejerina C, Rodríguez Porres M, de Las Cuevas Allende R, Conde Diez S,
Abstract
INTRODUCTION:
To study the quality of spirometry performed in Primary Care in Cantabria (Spain) and the level of compliance with the regulations of this technique of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR).
MATERIAL AND METHODS:
Cross-sectional descriptive study in the Community of Cantabria using an original questionnaire based on the latest SEPAR regulations. The questionnaire was distributed in 2018 by internal mail to the 42 Primary Care Centres of the Cantabrian Health Service, with the coordinators of the PCC and the nurses responsible having been personally contacted by the researchers or by telephone. This is an original survey, based on the regulations of the SEPAR, which evaluates the quality of the material used (model, years of operation, calibration, cleanliness), as well as the training of personnel who perform spirometry.
RESULTS:
The health personnel responsible for performing spirometry were surveyed in the 42 Primary Care Centres of the Cantabrian Health Service throughout the Cantabrian area. A mean of 564 spirometries are performed per month. A significant number (13%) of spirometers are never calibrated, and only 10.5% of the spirometers are calibrated by the personnel who perform the test in the centre itself. More than half (54, 53.7%) of these professionals have never received specific training to perform spirometry, and only 3.8% of them have experience in performing the test as recommended by SEPAR. As for the cleaning of the devices, 30% of the technicians do not clean the spirometer or the adapter.
CONCLUSIONS:
10 years after our initial study lack of training is still being observed in the professionals, and probably translates into invalid spirometry.
Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
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Worsening Renal Function in Cardiac Mechanical Support.
Heart Lung Circ2019 Dec;():. doi: S1443-9506(19)31538-0.
Tsay Julie, Pinkhas Daniel, Lee Bryan C, Guo Aaron, Ferrall Joel, Derbala Mohamed H, Lampert Brent C, Emani Sitaramesh, Whitson Bryan A, Smith Sakima A,
Abstract
BACKGROUND:
Venous congestion in heart failure (HF) may lead to worsening renal failure (WRF). We hypothesised that WRF in patients hospitalised for left ventricular assist device (LVAD) implantation is associated with increased 1-year mortality. There is limited data regarding WRF in HF patients with mechanical support. The objective of this paper is to determine whether WRF in HF patients hospitalised for LVAD implantation is associated with increased 1-year mortality and to identify risk factors for WRF.
METHODS:
We performed a single centre retrospective chart analysis of 162 patients who received an LVAD between August 2006 and December 2014 with pre-LVAD right heart catheterisation data. We stratified patients to those who demonstrated WRF and the use of haemodialysis (HD) or ultrafiltration (UF).
RESULTS:
Patients with a higher central venous pressure (CVP) >16 mmHg (17-24 mmHg range) developed WRF (29.7% vs. 14.1%, p=0.019). A CVP ?16 and glomerular filtration rate (GFR) <30 ml/min/1.74m increased the odds of WRF. Worsening renal failure and HD/UF use were associated with increased 1-year mortality. Furthermore GFR <30, atherosclerosis, and right ventricular failure were independent predictors for increased 1-year mortality. A GFR <30 increased the odds of developing WRF five-fold (OR 4.14, CI [1.95-8.78], p<0.0001), and GFR <30 and central venous pressure (CVP) >16 increased the odds of requiring HD/UF.
CONCLUSIONS:
Worsening renal failure is associated with a higher CVP at the time of LVAD implantation and increases the risk of 1-year mortality and the odds of requiring HD/UF. Careful evaluation of renal function and comorbid conditions during LVAD implantation is critical to reduce mortality and for risk stratification.
Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation.
J Heart Lung Transplant2020 Jan;():. doi: S1053-2498(20)31363-2.
Kirk Richard, Dipchand Anne I, Davies Ryan R, Miera Oliver, Chapman Gretchen, Conway Jennifer, Denfield Susan, Gossett Jeffrey G, Johnson Jonathan, McCulloch Michael, Schweiger Martin, Zimpfer Daniel, Ablonczy László, Adachi Iki, Albert Dimpna, Alexander Peta, Amdani Shahnawaz, Amodeo Antonio, Azeka Estela, Ballweg Jean, Beasley Gary, Böhmer Jens, Butler Alison, Camino Manuela, Castro Javier, Chen Sharon, Chrisant Maryanne, Christen Urs, Danziger-Isakov Lara, Das Bibhuti, Everitt Melanie, Feingold Brian, Fenton Matthew, Garcia-Guereta Luis, Godown Justin, Gupta Dipankar, Irving Claire, Joong Anna, Kemna Mariska, Khulbey Sanjeev Kumar, Kindel Steven, Knecht Kenneth, Lal Ashwin K, Lin Kimberly, Lord Karen, Möller Thomas, Nandi Deipanjan, Niesse Oliver, Peng David M, Pérez-Blanco Alicia, Punnoose Ann, Reinhardt Zdenka, Rosenthal David, Scales Angie, Scheel Janet, Shih Renata, Smith Jonathan, Smits Jacqueline, Thul Josef, Weintraub Robert, Zangwill Steve, Zuckerman Warren A,
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
Copyright © 2020 International Society for Heart and Lung Transplantation. All rights reserved.
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We Want to OPERATE!
Eur J Vasc Endovasc Surg2020 Feb;():. doi: S1078-5884(20)30120-9.
Gombert Alexander, Van Herzeele Isabelle,
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Survival of the fittest: Impact of cardiorespiratory fitness on outcomes in men and women with cardiovascular disease.
Clin Ther2020 Feb;():. doi: S0149-2918(20)30050-3.
Safdar Basmah, Mangi Abeel A,
Abstract
Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther. 2020; 42:XXX-XXX) © 2020 Elsevier Inc.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Coronary Artery Disease Assessed by Computed Tomography-Based Leaman Score in Patients With Low-Risk Transcatheter Aortic Valve Implantation.
Am J Cardiol2020 Jan;():. doi: S0002-9149(20)30063-1.
Ozaki Yuichi, Garcia-Garcia Hector M, Rogers Toby, Torguson Rebecca, Craig Paige E, Hideo-Kajita Alexandre, Gordon Paul, Ehsan Afshin, Parikh Puja, Bilfinger Thomas, Butzel David, Buchanan Scott, Levitt Robert, Hahn Chiwon, Buchbinder Maurice, Hanna Nicholas, Garrett Robert, Wilson Sean R, Goncalves John A, Ali Syed, Asch Federico M, Weissman Gaby, Shults Christian, Ben-Dor Itsik, Satler Lowell F, Waksman Ron,
Abstract
We aimed to evaluate the burden of coronary artery disease (CAD) using the computed tomography (CT) Leaman score in low-risk transcatheter aortic valve implantation (TAVI) patients. The extent of CAD in low-risk patients with aortic stenosis who are candidates for TAVI has not been accurately quantified. The CT Leaman score was developed to quantify coronary CT angiography (CCTA) atherosclerotic burden and has been validated to evaluate the extent of CAD. CT Leaman score >5 has been associated with an increase in major adverse cardiac events over long-term follow-up. The study population included patients enrolled in the Low Risk TAVI trial who underwent CCTA before the procedure. For the CT Leaman score, we used 3 sets of weighting factors: (1) location of coronary plaques, (2) type of plaque, and (3) degree of stenosis. A total of 200 patients were enrolled in the Low Risk TAVI trial. Excluded were 31 patients who had no analyzable CCTA imaging. For the remaining 169 patients, the mean CT Leaman score was 6.27 ± 0.27, of whom 102 (60.4%) had CT Leaman score >5. Nearly all analyzed patients (97%) had coronary plaques. Furthermore, 33 patients (19.5%) had potentially obstructive coronary plaques (>50% stenosis by CCTA) in proximal segments. Most low-risk TAVI patients have significant CAD burden by CCTA. It should be a priority for future TAVI devices to guarantee unimpeded access to the coronary arteries for selective angiography and interventions.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Adenosine A receptor activation prevents DOCA-salt induced hypertensive cardiac remodeling via iBAT.
Biochem Biophys Res Commun2020 Feb;():. doi: S0006-291X(20)30301-6.
Zhou Yan-Ping, Ruan Cheng-Chao, Kong Ling-Ran, Gao Ping-Jin,
Abstract
Hypertensive cardiac remodeling is a constellation of abnormalities that includes cardiomyocyte hypertrophy and death and tissue fibrosis. Adenosine is a long-known vasodilator, through interacting with its four cell surface receptor subtypes in cardiovascular system. However, it is unclear that whether adenosine A receptor (AR) activation is involved in the cardiac remodeling in hypertension. WT mice were utilized to induce DOCA-salt sensitive hypertension and received AR agonist CGS21680 or antagonist KW6002 treatment. Cardiac functional phenotyping measurement by echocardiography showed that CGS21680 improved cardiac dysfunction in DOCA-salt mice. Moreover, CGS21680 reduced cardiomyocyte hypertrophy, cardiac inflammation and fibrosis. However, iBAT depletion surgery induces dramatic cardiac remodeling in DOCA-salt mice, and the protective function of CGS21680 was blocked without intact iBAT. Mechanistically, AR agonist CGS21680 increased iBAT-derived fibroblast growth factor 21 (FGF21). Our data suggest that activation of AR could be a potential therapeutic strategy in preventing heart damage in hypertension.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Preoperative prediction of unresectability in malignant pleural mesothelioma.
J Thorac Cardiovasc Surg2019 Nov;():. doi: S0022-5223(19)33489-0.
Burt Bryan M, Lee Hyun-Sung, Raghuram Anjali C, Strange Chad, Mason James, Strange Taylor, Delgado Juan, Sugarbaker David J,
Abstract
OBJECTIVE:
Diffuse chest wall invasion (DCWI) is a common finding in patients undergoing intended resection for malignant pleural mesothelioma. We sought to determine the incidence and preoperative predictors of this finding, and to test our anecdotal impression that contraction of the ipsilateral hemithorax is associated with DCWI.
METHODS:
This was a single-institution retrospective study of 170 patients undergoing intended macroscopic complete resection for malignant pleural mesothelioma from 2014-2018. A novel metric of thoracic cage volume was calculated by preoperative chest computed tomography. Univariable analyses were performed to determine associations of preoperative variables with DCWI.
RESULTS:
Macroscopic complete resection was achieved by pleurectomy/decortication in 104 patients (61%) and by extrapleural pneumonectomy in 39 patients (23%). Unresectable disease was discovered at thoracotomy in 27 (16%) of patients; 24 (14%) by DCWI and 3 (2%) by intrathoracic organ invasion. In univariable analysis, decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI (P = .009) with >5% decrease in thoracic cage volume representing the optimal cutoff (P = .014; area under the curve, 0.67). Other preoperative variables associated with DCWI included preoperative chest pain requiring opioids (P = .028), prior pleurodesis (P = .036), decreased forced vital capacity (P = .023), decreased ipsilateral lung perfusion by ventilation/perfusion lung scan (P = .007), and magnetic resonance imaging findings of chest wall invasion (P = .035).
CONCLUSIONS:
Preoperative identification of DCWI will avoid unnecessary thoracotomy and accelerate initiation of nonsurgical therapy in malignant pleural mesothelioma. Our data suggest that contraction of thoracic cage volume has merit in predicting malignant pleural mesothelioma unresectability and should be validated in prospective studies.
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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Commentary: Can and should the National Inpatient Sample be used to evaluate trends in ventricular assist device use and outcomes?
J Thorac Cardiovasc Surg -
Commentary: Robot-assisted segmentectomy is safe and expensive-What is the debate?
J Thorac Cardiovasc Surg -
Commentary: Tick-tock.
J Thorac Cardiovasc Surg
