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Translational Cancer Research May 2024In lung cancer, molecular testing and next-generation sequencing (NGS) are needed to identify therapeutic targets and are increasingly being used in earlier stages of...
BACKGROUND
In lung cancer, molecular testing and next-generation sequencing (NGS) are needed to identify therapeutic targets and are increasingly being used in earlier stages of the disease. Despite its longstanding use, it remains unclear whether transbronchial needle aspiration (TBNA) of peripheral lung lesions provides as adequate material for genetic testing as transbronchial forceps biopsies (TBFBs). In this study, we aim to analyze the use of TBNA using median viable cell area (MVCA) as a surrogate parameter to analyze sample quality.
METHODS
This prospective single-center study analyzed biopsy specimens or aspirates of patients who underwent bronchoscopy with transbronchial biopsy. Patients underwent bronchoscopy with TBFB and TBNA for suspected lung cancer in peripheral lung lesions. Patients were randomized 1:1 to receive either TBFB or TBNA as the first biopsy technique and then switched to the other. After routine workup, sample slides were digitally scanned, and MVCA was calculated by a pathologist blinded to the biopsy technique used. The primary endpoint was MVCA of TBNA versus TBFB. Secondary endpoints were complications categorized as bleeding, pneumothorax, and other.
RESULTS
Between August 2021 and April 2022, 15 patients were included in the per-protocol analysis. Six patients were included in cohort 1 and nine patients in cohort 2. A malignant diagnosis was confirmed in 11/15 (73.3%) cases, of which nine were primary lung malignancies. Overall, MVCA in samples obtained by TBFB was significantly larger than TBNA samples {TBFB-MVCA 9.80 mm [interquartile range (IQR), 2.70-10.39 mm] . TBNA-MVCA 2.70 mm (IQR, 0.14-8.21 mm), P=0.008}. Despite this difference, molecular testing was feasible in both TBNA and TBFB samples. No major complications were observed.
CONCLUSIONS
Despite a significantly smaller MVCA provided by TBNA, samples were still considered feasible for NGS, indicating that TBNA represents an alternative method to obtain sufficient tumor tissue in peripheral nodules as part of the diagnosis of suspected lung cancer.
PubMed: 38881945
DOI: 10.21037/tcr-23-2320 -
Resuscitation Plus Sep 2024Characterize short-term outcomes of late preterm and term infants who received positive pressure ventilation in the delivery room and compare these with infants who did...
OBJECTIVES
Characterize short-term outcomes of late preterm and term infants who received positive pressure ventilation in the delivery room and compare these with infants who did not receive resuscitation at birth.
STUDY DESIGN
Single center retrospective cohort study of infants born between 35 0/7 and 41 6/7 weeks' gestation in 2019. Baseline characteristics and outcomes of infants who received positive pressure ventilation were compared with controls who did not receive delivery room ventilation. The primary outcome was neonatal intensive care unit admission; secondary outcomes included multiple hospital morbidities and interventions.
RESULTS
Among 202 infants who received delivery room positive pressure ventilation, 77 (38.1%) received ≤1 min, and 125 (61.9%) received >1 min of positive pressure ventilation. Neonatal intensive care unit admission directly following resuscitation was more common in the ventilation cohort (33%) compared with controls (1.5%), ≤ 0.0001. After initial admission to the newborn nursery, intensive care unit transfer rates were similar in the positive pressure ventilation cohort (4%) and controls (5%). Antibiotic exposure, hypoxic ischemic encephalopathy, respiratory support in the neonatal intensive care unit, and pneumothorax were more common in the ventilation cohort. The composite outcome of any post-delivery complication occurred in 45% of positive pressure ventilation-exposed infants, compared to 15.8% of control infants (<0.0001); this was more common following >1 min (52.8%) than ≤1 min positive pressure ventilation (32.5%), = 0.002.
CONCLUSION
Post-delivery complications are common following delivery room positive pressure ventilation, emphasizing the need for post-resuscitation monitoring in either the neonatal intensive care unitor newborn nursery setting.
PubMed: 38881597
DOI: 10.1016/j.resplu.2024.100670 -
The Journal of the Association of... May 2024Secondary spontaneous pneumothoraces occur in patients with known underlying lung disease. Patients with emphysema, bullae, and cystic lesions in the lungs are at high...
Secondary spontaneous pneumothoraces occur in patients with known underlying lung disease. Patients with emphysema, bullae, and cystic lesions in the lungs are at high risk of developing pneumothorax. Cystic lung diseases like Langerhans cell histiocytosis (LCH) can present with complications like pneumothorax. Other common presenting features include maculopapular rashes and bone lesions. It can also be associated with endocrinopathies, most commonly central diabetes insipidus (CDI). We here present a case of a 22-year-old male who presented with pneumothorax, polyuria, and polydipsia. He was diagnosed with LCH on transbronchial lung biopsy, associated with CDI, and was treated with thoracoscopy-guided autologous blood patch for persistent air leak and subcutaneous cytarabine.
Topics: Humans; Histiocytosis, Langerhans-Cell; Male; Pneumothorax; Young Adult; Diabetes Insipidus; Diabetes Insipidus, Neurogenic
PubMed: 38881118
DOI: 10.59556/japi.72.0541 -
Zhonghua Zhong Liu Za Zhi [Chinese... Jun 2024As one of a major public health issue in China, the number of new cases and deaths of malignant tumors has been climbing year by year. Implantable venous access port...
As one of a major public health issue in China, the number of new cases and deaths of malignant tumors has been climbing year by year. Implantable venous access port (IVAP) is used as a safe infusion route in the treatment of malignant tumor patients such as infusion of antitumor drugs and intravenous nutrition. With the widespread application of ultrasound-guided Sedinger puncture techniques and intracardiac electrocardiogram positioning technology, IVAP in the upper arm has been recognized by the majority of medical personnel and cancer patients due to its advantages of hiding scars and completely avoiding the risk of hemothorax and pneumothorax. In order to standardize the clinical application of IVAP via the upper arm approach in cancer patients, improve the success rate of implantation, reduce complications and improve patient satisfaction, the Breast Cancer Expert Committee of the National Cancer Quality Control Center consulted guidelines and the latest evidence-based evidences and established the expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients through literature research and expert discussions, in order to provide reference for the standard application of IVAP in the upper arm. The consensus mainly introduces the indications, contraindications, preoperative evaluation, implantation site, operation procedure, utilization and maintenance, complications and management, medical staff training and patient education of IVAP in the upper arm, in order to provide reference for clinical staff.
Topics: Humans; Neoplasms; Arm; Catheters, Indwelling; Antineoplastic Agents; Catheterization, Central Venous; Consensus; China; Pneumothorax; Hemothorax; Breast Neoplasms
PubMed: 38880733
DOI: 10.3760/cma.j.cn112152-20231217-00364 -
Medicina Intensiva Jun 2024
PubMed: 38880711
DOI: 10.1016/j.medine.2024.05.014 -
The Annals of Thoracic Surgery Jun 2024Characteristics, practice patterns, and clinical outcomes of secondary spontaneous pneumothorax (SSP) with heritable connective tissue disorders (Marfan, Ehlers-Danlos,...
BACKGROUND
Characteristics, practice patterns, and clinical outcomes of secondary spontaneous pneumothorax (SSP) with heritable connective tissue disorders (Marfan, Ehlers-Danlos, and Birt-Hogg-Dubé syndromes) are unclear.
METHODS
A nationwide Japanese inpatient database, which included data on 524 patients with SSP (884 hospitalizations) and 137821 with primary spontaneous pneumothorax (PSP) between July 2010 and March 2020, was used in this study. Hospitalization for SSP (n=884) was categorized into surgical (n=459) and non-surgical (n=425) groups, and the patient characteristics, treatment, and outcomes were compared between the groups. Multivariable analyses were performed to evaluate risk factors for pneumothorax recurrence. We also compared the patient characteristics among those with different underlying heritable connective tissue disorders.
RESULTS
Compared to the non-surgical group, the surgical group had less frequent readmission for pneumothorax (26% vs. 44%; hazard ratio, 0.47; 95% confidence interval, 0.38-0.58). Young patients (hazard ratio, 2.46; 95% confidence interval, 1.83-3.32) or those with Birt-Hogg-Dubé syndrome (2.53; 1.77-3.63) had a high risk of recurrence. Pneumothorax occurred frequently in teenagers with Marfan syndrome, in those aged 20-39 years with Ehlers-Danlos syndrome, and in those aged ≥40 years with Birt-Hogg-Dubé syndrome.
CONCLUSIONS
Detailed information on the characteristics and clinical course of SSP in heritable connective tissue disorders will aid the clinical decision-making process.
PubMed: 38878950
DOI: 10.1016/j.athoracsur.2024.05.037 -
Journal of Perianesthesia Nursing :... Jun 2024The purpose of this study was to compare the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on...
PURPOSE
The purpose of this study was to compare the effect of ultrasound-guided continuous erector spinae plane block to continuous thoracic paravertebral block on postoperative analgesia in elderly patients who underwent thoracoscopic lobectomy.
DESIGN
Randomized controlled trial.
METHODS
Elderly patients (N = 50) who underwent nonemergent thoracoscopic lobectomy in the thoracic surgery department of our hospital from January 2019 to December 2020 were selected and randomly divided into continuous erector spinae block (ESPB; n = 25) group and continuous thoracic paravertebral block (TPVB; n = 25) group. The patients in the two groups were guided by ultrasound with ESPB or TPVB before anesthesia induction. The visual analog scale at rest and cough in 2 hours, 6 hours, 8 hours, 12 hours, 24 hours, 48 hours after surgery, the supplementary analgesic dosage of tramadol, time of tube placement, the stay time in postanesthesia care unit (PACU), the first ambulation time after surgery, the length of postoperative hospital stay and postoperative complications were recorded.
FINDINGS
There were no significant differences between the two groups in visual analog scale score at rest and cough at each time point and supplementary analgesic dosage of tramadol within 48 hours after surgery (P > .05). The time of tube placement and the postoperative hospital stay in ESPB group was significantly shorter than that in TPVB group (P < .05). There were no differences in PACU residence time and first ambulation time between the two groups (P > .05). There were 4 patients in TPVB group and 2 patients in ESPB group who had nausea and vomiting (P > .05), 1 case of pneumothorax and 1 case of fever in the TPVB group. There were no incision infections or respiratory depression requiring clinical intervention in either group.
CONCLUSIONS
Both ESPB and TPVB alleviated the patients postoperative pain effectively for elderly patients underwent thoracoscopic lobectomy. Compared with TPVB, patients with ESPB have a shorter tube placement time, fewer complications and faster postoperative recovery.
PubMed: 38878034
DOI: 10.1016/j.jopan.2024.01.001 -
Journal of Cardiothoracic Surgery Jun 2024Pneumothorax is the most frequent complication after CT-guided percutaneous transthoracic lung biopsy (CT-PTLB). Many studies reported that injection of autologous blood... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pneumothorax is the most frequent complication after CT-guided percutaneous transthoracic lung biopsy (CT-PTLB). Many studies reported that injection of autologous blood patch (ABP) during biopsy needle withdrawal could reduce the pneumothorax and chest tube insertion rate after CT-PTLB, but the result is debatable. The aim of this systematic review and meta-analysis is to synthesize evidence regarding the efficacy of ABP procedure in patients receiving CT-PTLB.
METHODS
Eligible studies were searched in Pubmed, Embase and Web of Science databases. The inclusion criteria were studies that assessed the relationship between ABP and the pneumothorax and/or chest tube insertion rate after CT-PTLB. Subgroup analyses according to study type, emphysema status and ABP technique applied were also conducted. Odds ratio (OR) with 95% confidence interval (CI) were calculated to examine the risk association.
RESULTS
A total of 10 studies including 3874 patients were qualified for analysis. Our analysis suggested that ABP reduced the pneumothorax (incidence: 20.0% vs. 27.9%, OR = 0.67, 95% CI = 0.48-0.66, P < 0.001) and chest tube insertion rate (incidence: 4.0% vs. 8.0%, OR = 0.47, 95% CI = 0.34-0.65, P < 0.001) after CT-PTLB. Subgroup analysis according to study type (RCT or retrospective study), emphysema status (with or without emphysema), and ABP technique applied (clotted or non-clotted ABP) were also performed and we found ABP reduced the pneumothorax and chest tube insertion rate in all subgroups.
CONCLUSIONS
Our study indicated that the use of ABP was effective technique in reducing the pneumothorax and chest tube insertion rate after CT-PTLB.
Topics: Pneumothorax; Humans; Tomography, X-Ray Computed; Image-Guided Biopsy; Lung; Blood Transfusion, Autologous; Chest Tubes
PubMed: 38877547
DOI: 10.1186/s13019-024-02781-0 -
European Journal of Trauma and... Jun 2024Thoracic trauma frequently includes a pneumothorax, hemothorax, or hemopneumothorax, which may necessitate an Intercostal drainage (ICD) for air and fluid evacuation to...
BACKGROUND
Thoracic trauma frequently includes a pneumothorax, hemothorax, or hemopneumothorax, which may necessitate an Intercostal drainage (ICD) for air and fluid evacuation to improve breathing and circulatory function. It is a simple and life-saving procedure; nevertheless, it carries morbidity, even after its removal. Efforts have been made continuously to shorten the duration of ICD, but mostly in non-trauma patients. In this study, we evaluated the impact of negative pleural suction over the duration of ICD.
METHODS
This study was a prospective randomized controlled interventional trial conducted at Level 1 Trauma Centre. Thoracic trauma patients with ICD, who met the inclusion criteria (sample size 70) were randomized into two groups, the first group with negative pleural suction up to -20 cm H2O, and the second group as conventional, i.e. ICD connected to underwater seal container only. The primary objective was to compare the duration of ICDs and the secondary objectives were the length of hospital stay and various complications of thoracic trauma.
RESULTS
Duration of ICD was measured in median days with minimum & maximum days. For the negative suction group, it was 4 days (2-16 days); for the conventional group, it was also 4 days (2-17 days). There was also no significant difference among both groups in length of hospital stay.
CONCLUSION
The beneficial effect of negative pleural suction to ICD could not be demonstrated over the duration of ICD and hospital stay. In both groups, there was no significant difference in complication rates like recurrent pneumothorax, retained hemothorax, persistent air leak, and empyema.
LEVEL OF EVIDENCE
Therapeutic Study, Level II TRIAL REGISTRATION: This trial was registered with the Clinical Trial Registry of India (CTRI) with registration no. REF/2020/11/038403.
PubMed: 38874624
DOI: 10.1007/s00068-024-02565-0 -
Frontiers in Pediatrics 2024While positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks, studies examining the association between...
BACKGROUND
While positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks, studies examining the association between specific ventilatory settings during acute-phase high-frequency oscillatory ventilation (HFOV) and pulmonary air leaks among extremely preterm infants are limited.
METHODS
This was a single-center retrospective cohort study conducted at an institution that primarily used HFOV after intubation in extremely preterm infants. We analyzed data from extremely preterm infants born between 2010 and 2021. The primary outcome was pulmonary air leakage during the first 7 days of life. The exposure variable was the maximum mean airway pressure (MAP) on HFOV during the first 7 days of life or before the onset of pulmonary air leaks. Maximum MAP was categorized into three groups: low (7-10 cmHO), moderate (11-12 cmHO), and high (13-15 cmHO) MAP categories. We conducted robust Poisson regression analyses after adjustment for perinatal confounders, using the low MAP category as the reference.
RESULTS
The cohort included 171 infants (low MAP, 123; moderate MAP, 27; and high MAP, 21). The median (interquartile range) gestational age and birth weight were 25.7 (24.3-26.7), 25.7 (24.9-26.9), and 25.3 (24.3-26.6) weeks and 760 (612-878), 756 (648-962), and 734 (578-922) g for infants in the low, moderate, and high MAP categories, respectively. Compared to infants in the low MAP category, those in the high MAP category had a higher incidence of pulmonary air leaks (4.1% vs. 33.3%; adjusted risk ratio, 5.4; 95% confidence interval, 1.6-18.5). In contrast, there was no clear difference in the risk of pulmonary air leaks between the moderate and low MAP categories (3.7% vs. 4.1%; adjusted risk ratio, 0.9; 95% confidence interval, 0.1-6.1).
CONCLUSION
Extremely preterm infants requiring high MAP (≥13 cmHO) in acute-phase HFOV had a higher risk of pulmonary air leak during the first 7 days of life.
PubMed: 38873580
DOI: 10.3389/fped.2024.1410627