Gillespieshoemaker4229
As lung cancers arising in a background of idiopathic pulmonary fibrosis (IPF) are known to show high malignancy grades, early pathologic diagnosis of peripheral pulmonary lesions (PPLs) is important. Meanwhile, the risk of complications associated with diagnostic procedures is high, which prompted us to investigate the role of bronchoscopy, a relatively safe diagnostic procedure. Therefore, we conducted this study to evaluate the usefulness of bronchoscopy for the diagnosis of PPLs in patients with IPF.
Data of consecutive patients with IPF who underwent bronchoscopy under radial endobronchial ultrasound (R-EBUS) guidance for PPLs at our institution between April 2014 and March 2019 were retrospectively reviewed. IPF was defined as usual interstitial pneumonia (UIP) or probable UIP, in accordance with the classification in the latest global guidelines. The diagnostic outcomes and the factors independently related to the diagnostic yield were analyzed.
A total of 92 patients were included in the analysis. The median (range) size of the target PPLs was 27.1 (11.4-75.3) mm, and the diagnostic yield was 82.6%. Multivariable analysis identified a larger size [P=0.017; odds ratio (OR), 5.33; 95% confidence interval (CI), 1.29-22.01], positive bronchus sign (P=0.035; OR, 4.99; 95% CI, 1.12-22.18), and not involved with UIP/probable UIP pattern (P=0.023; OR and 95% CI, unmeasurable) as being associated with a significantly higher diagnostic yield. Meanwhile, none of the patients developed acute exacerbation of IPF or pneumothorax following the diagnostic bronchoscopy.
Bronchoscopy using R-EBUS was safe and showed an acceptable diagnostic yield for PPLs, even in patients with IPF.
Bronchoscopy using R-EBUS was safe and showed an acceptable diagnostic yield for PPLs, even in patients with IPF.
It is known that survival from lung cancer can differ between countries and even between different regions of the same country. The variability between hospitals, the age and social profile, and the time when this patient was treated, can influence survival, and these factors are intrinsic to each region. Knowing the profile of patients, hospitals, and other factors associated with the treatment of stage I and II lung cancer in a given region is important to understand outcomes and propose improvements that can be replicated in any region of the world that presents the same profile of patients and care structure. This study evaluates survival and possible predictors in all patients with stage I and II lung cancer adenocarcinoma through the Hospital's Cancer Registry (HCR), responsible for the State of Sao Paulo's cancer registry, a geographical area with 40 million inhabitants.
Based on the HCR, an observational study was conducted, including 1,278 patients diagnosed with lung adenocarcinoma at clinical s000-2004.
The 5-year OS has significantly improved as long as the 5-year group analysed. Also, the 5-year OS of the patients treated in high complexity hospitals is higher than those treated in PHCCO.
The 5-year OS has significantly improved as long as the 5-year group analysed. Also, the 5-year OS of the patients treated in high complexity hospitals is higher than those treated in PHCCO.
This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium.
Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age <80 years. MI-503 mouse Perioperative Pemetrexed-Platinum regimen was administered as induction in 101 cases (65.2%) and as adjuvant treatment in 54 cases (34.8%). Extended pleurectomy/decortication was performed in 87 cases (56.12%). In 68 patients (43.87%) standard pleurectomy/decortication was performed without resection/reconstruction of diaphragm and pericardium, when tumour infiltration was deemed absent after intraoperative frozen section. The log-rank test and Cox regression model were used to assess the factors affecting overall survival and recurrence free survival.
Median follow-up was 20 months. The 2- arecurrence-free interval >12 months is predictive of an increased survival when the macroscopic complete resection is achieved.
12 months is predictive of an increased survival when the macroscopic complete resection is achieved.
For patients with locally advanced non-small cell lung cancer (NSCLC), the standard treatment is concurrent or sequential chemotherapy with radiotherapy. Most treatment schedules use radiotherapy with conventional fractionation; however, the application of hypofractionated radiotherapy (HYPO-RT) regimens is rising. A meta-analysis was performed to assess the efficacy and safety of chemotherapy combined with HYPO-RT and indirectly compare with the outcomes from previous studies employing concomitant conventional radiotherapy (CONV-RT).
Randomized controlled trials (RCTs) were identified on the electronic database sources through June 2020. Following the PRISMA guidelines, a meta-analysis was performed to assess if there were significant differences in the overall mortality (OM), local failure (LF), and disease progression (DP), comparing HYPO-RT-C
sequential chemotherapy followed HYPO-RT (HYPO-RT-S). To establish an indirect comparison with the current standard treatment, we calculate the risk ratio (RRrapy.
HYPO-RT given with chemotherapy provides satisfactory OM, LF, and DP in locally advanced NSCLC with similar rates to the CONV-RT. These findings support HYPO-RT inclusion in future clinical trials as an experimental arm in addition to the incorporation of new strategies, such as immunotherapy.
Minimally invasive esophagectomy (MIE) is a complex procedure with learning associated morbidity. The aim was to evaluate the learning curve for MIE focusing on short-term outcomes in two settings (I) experienced MIE surgeon in new hospital (Hospital 1); (II) surgeons experienced with open esophagectomy and minimally invasive surrogate surgery (Hospital 2).
In Hospital 1 and Hospital 2, on intent-to-treat basis number of MIEs were 132 and 57, respectively. The primary outcomes were major complications and anastomosis leaks. Secondary outcomes were operative time, blood loss, lymph node yield, hospital stay and 1-year mortality. Length of learning curves were analyzed with risk-adjusted cumulative sum (RA-CUSUM) method.
In Hospital 1, major complication and anastomosis leak rates were 9.8% and 4.5%, 22.8% and 12.3% in Hospital 2, respectively. In Hospital 1, complication and leak rates remained stable. In Hospital 2, improvement occurred after 34 cases in major complications and 29 cases in leaks. Of secondary outcomes, improvements were seen in Hospital 1 in operative time after 61, blood loss after 86, lymph node yield after 52, hospital stay after 19 and 1-year mortality after 24 cases. In Hospital 2, improvement occurred in operative time after 30, blood loss after 15, lymph node yield after 45, hospital stay after 50 and 1-year mortality after 15 cases.
According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase.
According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase.
This study was conducted to compare the efficacy and safety of left atrium appendage (LAA) elimination using stapled excision with those using internal suture obliteration.
In all, 158 patients with atrial fibrillation who underwent surgical elimination of the LAA during cardiac surgery and later underwent postoperative computed tomography (CT) were enrolled. Of these, 102 patients underwent stapled excision (SE group), and 56 underwent internal suture obliteration (IO group). The efficacy endpoint was LAA excision failure, including a remnant LAA (>1 cm) or communication between the left atrium (LA) and LAA. The safety endpoint was bleeding from the elimination site. The CT was performed at a median of 12.8 months (interquartile range, 0.3-39.9) after surgery.
The efficacy endpoint was observed in 5 (4.9%) and 9 patients (16.1%) in the SE and IO groups, respectively (P=0.036). In the SE group, a remnant LAA was found in 5 patients and extravasation of the dye was not observed. In the IO group, a remnant LAA, a communication between the LA and LAA, and both findings were observed in 1, 6, and 2 patients, respectively. The safety endpoint occurred in 12 (11.8%) and 0 patients (0%) in the SE and IO groups, respectively (P=0.009).
Stapled excision of the LAA was associated with a lower rate of LAA elimination failure compared to internal suture obliteration. However, care should be taken to prevent staple-related bleeding.
Stapled excision of the LAA was associated with a lower rate of LAA elimination failure compared to internal suture obliteration. However, care should be taken to prevent staple-related bleeding.
Accurate prognostic estimation for esophageal cancer (EC) patients plays an important role in the process of clinical decision-making. The objective of this study was to develop an effective model to predict the 5-year survival status of EC patients using machine learning (ML) algorithms.
We retrieved the information of patients diagnosed with EC between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) Program, including 24 features. A total of 8 ML models were applied to the selected dataset to classify the EC patients in terms of 5-year survival status, including 3 newly developed gradient boosting models (GBM), XGBoost, CatBoost, and LightGBM, 2 commonly used tree-based models, gradient boosting decision trees (GBDT) and random forest (RF), and 3 other ML models, artificial neural networks (ANN), naive Bayes (NB), and support vector machines (SVM). A 5-fold cross-validation was used in model performance measurement.
After excluding records with missing data, the final study pay be applicable in clinical practice in the future.
The XGBoost model and the complete dataset can be used to construct an accurate prognostic model for patients diagnosed with EC which may be applicable in clinical practice in the future.
Single-stage type I hybrid total aortic arch repair is a surgical treatment for extensive aortic arch disease, but the clinical outcomes were distinguishing. The purposes of this study were to share our experience and evaluate the perioperative safety and long-term durability.
Thirty-six patients who underwent single-stage type I hybrid total aortic arch repair in Fuwai Hospital between January 2010 and June 2020 were respectively reviewed. Early primary endpoint was defined as early composite adverse events, including mortality, multiple organ dysfunction syndrome (MODS), unplanned reoperation, stroke, paraplegia, acute renal failure (ARF) necessitating continuous renal replacement therapy (CRRT), respiratory failure and stents related complications. Long-term endpoints included late mortality, late aortic related reintervention and late adverse aortic events. When evaluating the early- and long-term outcomes, all patients were stratified into two subgroups by age (65 years).
All patients acquired technical success.
