Keeganbyrd1151

902. Similarly, focal amplifications were also found on chromosome 5, 16 and 22, where tumor related gene PCDHA@, ADAMTS18 and CRKL were located. Focal deletions were also found in chr1, 8, 10 and 16, where genes SFTPA1/2, DLC1, PTEN and CDH1 are located. Conclusions The results suggest cell free DNA copy number might be a useful peripheral blood tumor biomarker for predicting intrinsic resistance of EGFR targeted therapy and prognosis. 2020 Journal of Thoracic Disease. All rights reserved.Background One-lung ventilation (OLV) is becoming an essential component of thoracic anesthesia. The two principal devices used for OLV are a double-lumen tube (DLT) and a bronchial blocker (BB). We hypothesized that the use of a BB with the disconnection technique would improve the quality of lung collapse in video-assisted thoracoscopic surgery (VATS). Methods Seventy-five patients undergoing scheduled VATS were enrolled in this study and were randomly divided into two groups a left-sided DLT group (Group D) and a BB with the disconnection technique group (Group B). OLV was initiated when the surgeon performed the skin incision. In Group D, the left channel of the DLT was opened to the air. In Group B, the lung was deflated via the disconnection technique, thus opening the breathing circuit to the air fifteen seconds after opening the pleura. The mean arterial pressure (MAP) and heart rate (HR) during induction; the quality of lung collapse 1 and 10 minutes after pleural opening; the time required for complete lung collapse; the correct placement of the device; and the number of patients suffering from a sore throat after surgery were recorded. Results Compared with the use of the DLT, the use of the BB with the disconnection technique was associated with a similar quality of lung collapse, a comparable required time for total lung collapse (P>0.05, respectively), a lower incidence of sore throat both when leaving the PACU and 24 hours after surgery (34.2% vs. 13.5%, 15.8% vs. 5.4%, P less then 0.05, respectively) and fewer hemodynamic fluctuations after intubation both one and ten minutes after pleural opening. Conclusions The use of a BB with the disconnection technique in VATS offers an effective method for improving the quality of lung collapse and reducing postoperative sore throat. 2020 Journal of Thoracic Disease. All rights reserved.Background Deep sternal wound infection (DSWI) is a life-threatening complication after cardiac surgery. The aim of this study was to retrospectively evaluate the outcomes of reconstructing infected poststernotomy wounds with either vacuum-assisted closure (VAC) after previous debridement or bilateral pectoralis major muscle flaps (BPMMFs). Methods In total, 565 patients with postoperative DSWI were enrolled in this study from January 1, 2014, to June 1, 2018. Of these patients, 247 received BPMMFs. To address the indicated biases, a 11 propensity score-matched cohort was created based on age, body mass index, preoperative diabetes mellitus, chronic obstructive pulmonary disease (COPD), internal thoracic artery grafting (ITAG), type of cardiac surgery, time before treatment for DSWI and wound classification. After matching, 132 patients who had similar risk profiles were enrolled in the study population (66 in the VAC group 66 in the BPMMF group). Results At 21.9±12.1 (median 24, IQR 14-28) months of follow-up, the survival rate was 93.9% in the BPMMF group and 74.4% in the VAC group (P less then 0.01). Compared with the VAC group, the BPMMF group had a significantly decreased length of hospital stay (P less then 0.01). At the spirometry assessment, the forced expiratory volume in the 1st second (FEV1), vital capacity (VC), and FEV1/VC ratio showed no significant differences in survival between the VAC group and BPMMF group. Conclusions In our study, compared with VAC therapy, BPMMFs guaranteed better early- and late-term outcomes, as shown by less length of hospital stay, a higher rate of long-term survival and unimpaired respiratory function. 2020 Journal of Thoracic Disease. All rights reserved.Background Ultrasound-guided lung biopsy (USLB) is a minimally invasive, real-time, safe and effective way to diagnose peripheral lung lesions. USLB is now widely used in clinical practice. However, the accuracy of USLB lacks large sample studies, and specimens from USLB are seldom used for microbial cultures. In this study, the efficiency of diagnosing tumours and infectious diseases with USLB is investigated, and the safety of USLB is evaluated. Methods From September 2015 to August 2018, a total of 507 cases of USLB were retrospectively reviewed, including the pathological results, microbial culture results and complications. The final diagnosis was confirmed by clinical diagnosis and follow-up. The technical success rate and accuracy of USLB were calculated. Results Six patients were excluded because they were lost to follow-up. A total of 501 patients were finally included (335 males and 166 females). The diagnostic accuracy of USLB was 82.0%. The accuracy of USLB in diagnosing lung tumours was 88.5% and that for diagnosing special infections was 55.2%. The positive rate of USLB lung tissue cultures was 18.3%. USLB can diagnose some microbial infections with high accuracy, such as mycobacterial infections, and Cryptococcus neoformans, Aspergillus fumigatus and Burkholderia cepacia infections. Conclusions USLB is a safe and effective method for diagnosing peripheral lung lesions with high accuracy and a low complication rate. Lung tissue pathology and cultures have good diagnostic value for tuberculosis and fungi infections. Lung tissue cultures can also diagnose bacterial infections and can contribute to the selection of antibiotics. 2020 Journal of Thoracic Disease. All rights reserved.Background There is uncertainty about best selection criteria for extracorporeal cardiopulmonary resuscitation (eCPR) in the setting of refractory cardiac arrest. We aimed to identify factors associated with a favorable neurological outcome, and to build a score calculable at the time of ECMO insertion predicting the prognosis. Methods Retrospective analysis of all patients who underwent eCPR between 2010 and 2017 in a single university hospital. Primary end point was survival with favorable neurological outcome at intensive care unit (ICU) discharge defined as a Cerebral Performance Category of 1 or 2. Results Overall low-flow time of the 113 included patients was 84 [55-122] minutes. Eighteen patients (16%) survived with a favorable neurological outcome. By multivariate logistic regression analysis, initial shockable rhythm, and arterial blood pH at the time of eCPR implantation ≥7.0, were independent predictors of survival with favorable neurological outcome. selleck products All of the patients presenting with both non-shockable rhythm and pH less then 7.0 at the time of eCPR implantation died in the ICU. Conclusions At the time of eCPR start, only initial shockable rhythm and arterial pH ≥7.0 predicted neurological outcome. A selection of the patients who might benefit from eCPR, based upon initial rhythm and arterial pH rather than on low flow time, should be further evaluated. 2020 Journal of Thoracic Disease. All rights reserved.Background This study aimed to assess the impact of pre-existing pulmonary interstitial lesions (PIL) on the efficacy and prognosis of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitor (TKI). Methods Patients with advanced NSCLC harboring EGFR exon 19 deletion (E19 del) or exon 21 (E21) L858R were enrolled in this study. All patients underwent high resolution computed tomography (HRCT) chest scans prior to EGFR-TKI treatment. Pre-existing PIL was graded according to HRCT imaging (PIL 0, 1, 2, and 3). Cox proportional-hazards regression models were used to identify the prognostic factors for progression-free survival (PFS). Results A total of 134 eligible patients were enrolled. The overall objective response rate (ORR) and median PFS were 73.1% and 10.0 months (95% CI 7.51-12.49), respectively. There were 62 (46.3%), 25 (18.7%), 28 (20.9%), and 19 (14.1%) cases of PIL grade 0, 1, 2, and 3, respectively, with median PFS and ORR of 12.9 months and 80.6%, 11.0 months and 72.0%, 10.0 months and 71.4%, and 7.0 months and 52.6%, respectively. Multivariate analysis showed that squamous cell carcinoma (vs. adenocarcinoma, HR =4.33), E21 L858R (vs. E19 del, HR =1.57), and PIL grade 3 (vs. grade 0-2, HR =1.60-2.48) were poor prognostic factors for PFS (P less then 0.05 for all). Conclusions Pre-existing PIL grade is an independent prognostic factor for predicting resistance to EGFR-TKIs in patients with EGFR-mutant advanced NSCLC. Higher PIL grade suggests higher risk of early progression. 2020 Journal of Thoracic Disease. All rights reserved.Background Diabetes mellitus is a recognized risk factor for esophageal squamous cell carcinomas (ESCC), and metformin is a recognized protective factor for some gastrointestinal tumors. But knowledge is limited regarding the effect of metformin on survival outcome of ESCC patients with type 2 diabetes mellitus (T2DM). We assessed the impact of post-diagnosis metformin use on overall survival (OS) and disease-free survival (DFS) in ESCC with T2DM undergoing surgical resection. Methods A retrospective analysis was performed on 3,523 patients with ESCC who met the study conditions after surgical resection. Log-rank and Cox regression models were used to evaluate the relationship between metformin and T2DM and ESCC survival rate, and adjusted according to age, gender, BMI, smoking, drinking and staging, et al. Results Among included ESCC patients, 619 were associated with type 2 diabetes, while the remaining 2,904 were not associated with type 2 diabetes. The 5-year OS (28.43%) of patients with T2DM was significantly lower than that of patients without T2DM (32.75%), P=0.037. DFS in 5 years were 27.30% (with T2DM) and 31.75% (without T2DM) (P=0.030), respectively. Compared with patients without T2DM, patients with T2DM presented worse OS [adjusted risk ratio (HRadj) =1.19] and DFS (HRadj =1.17; P less then 0.001). Among the 619 patients with type 2 diabetes, 485 were treated with metformin and 134 were not treated with metformin. Patients treated with metformin had significantly improved OS [adjusted risk ratio (HRadj) =0.89; P=0.031) and DFS (HRadj =0.90; P=0.013). Conclusions T2DM was again associated with poorer survival in ESCC patients, and metformin may improve the prognosis of these patients. 2020 Journal of Thoracic Disease. All rights reserved.Background Lung cancer is the leading cause of cancer incidence and mortality. Non-small cell lung cancer (NSCLC) accounts for the vast majority of lung cancer, which lacks comprehensive prognostic biomarkers to predict the prognosis of patients. This research was performed to assess the potential prognostic role of circular RNAs (circRNAs) in patients with NSCLC. Methods We searched the following databases PubMed, Web of Science, Embase, and Ovid MEDLINE(R) up to May 20, 2019 to identify studies which explored the association between circRNAs and NSCLC. Newcastle-Ottawa Scale (NOS) was applied to assess the quality of the included studies. Pooled hazard ratios (HRs) and the corresponding 95% confidence interval (CI) were calculated to assess the prognostic value of circRNAs in patients with NSCLC. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg's funnel plot. Sensitivity analysis was performed to test the stability of pooled results.