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Current Cardiology Reports Jun 2024Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes... (Review)
Review
BACKGROUND
Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes remain uncertain.
METHODS
We systematically searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov for studies comparing LPs and TVPs. A restricted maximum likelihood random-effects model was used for all outcomes. Heterogeneity was assessed using I statistics. We performed a subgroup analysis with studies with multivariate-adjusted data.
RESULTS
We included 21 studies involving 47,229 patients, of whom 12,199 (25.8%) underwent LP implantation. Compared with TVPs, LPs were associated with a significantly lower risk of overall complications (OR 0.61; 95% CI 0.45-0.81; p < 0.01), dislodgement (OR 0.34; 95% CI 0.20-0.56; p < 0.01), and pneumothorax (OR 0.27; 95% CI 0.16-0.46; p < 0.01). No significant difference in all-cause mortality was observed in the overall analysis (OR 1.43; 95% CI 0.65-3.15; p = 0.35) and in studies with multivariate-adjusted data (OR 1.34; 95% CI 0.65-2.78; p = 0.43). However, LPs were associated with a higher risk of pericardial effusion (OR 2.47; 95% CI 1.39-4.38; p < 0.01) and cardiac tamponade (OR 3.75; 95% CI 2.41-5.83; p < 0.01). LPs also demonstrated a lower pacing capture threshold (MD -0.19 V; 95% CI [-0.23 V]-[-0.16 V]; p < 0.01), but no significant difference in impedance (MD 32.63 ohms; 95% CI [-22.50 ohms]-[87.76 ohms]; p = 0.25).
CONCLUSIONS
These findings suggest that LPs were associated with lower overall complication rates and similar effectiveness to TVPs. However, randomized controlled trials are warranted to validate these results.
PubMed: 38869811
DOI: 10.1007/s11886-024-02079-6 -
Minerva Anestesiologica Jun 2024To investigate the non-inferiority of ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block compared to thoracic paravertebral block (TPVB) in... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Comparison of ultrasound-guided rhomboid intercostal and subserratus plane block versus thoracic paravertebral block for analgesia in thoracoscopic surgery: a randomized, controlled, non-inferiority trial.
BACKGROUND
To investigate the non-inferiority of ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block compared to thoracic paravertebral block (TPVB) in postoperative analgesia for thoracoscopic surgeries.
METHODS
This study consecutively enrolled 50 patients undergoing elective thoracoscopic surgery. Following general anesthesia, the RISS group received a unilateral block with 40 mL of 0.25% ropivacaine, while the TPVB group received with 30 mL of 0.33% ropivacaine. The primary outcome measure was the 24-hour postoperative resting VAS score. Secondary outcome measures included nerve block operation time for two groups, postoperative 1, 2, 4, 8, 48-hour resting VAS scores, and different time points coughing VAS scores, time to first postoperative ambulation, total intravenous analgesic consumption at different time points postoperatively, complications related to the block.
RESULTS
There were no significant statistical differences between the two groups in terms of postoperative rest and cough VAS scores at each time (P>0.05), and the mean difference in rest VAS scores did not exceed the non-inferiority margin in 95% CI. There were no significant differences in total intraoperative and postoperative analgesic consumption at different time points (P>0.05), and no significant differences in time to first postoperative ambulation (P>0.05). Compared to the TPVB group, the RISS group had a shorter nerve block operation time (259.43±30.11 vs. 335.23±30.96 s, P<0.001) and fewer instances of intraoperative hypotension (two vs. seven cases, P=0.022), bleeding at the puncture site, pneumothorax, and arrhythmia.
CONCLUSIONS
In thoracoscopic surgeries, the postoperative analgesic efficacy of ultrasound-guided RISS block is not inferior to TPVB. Compared to TPVB, RISS block is simpler, quicker, and associated with fewer puncture-related complications.
Topics: Humans; Nerve Block; Male; Female; Ultrasonography, Interventional; Thoracoscopy; Middle Aged; Pain, Postoperative; Adult; Analgesia; Intercostal Nerves; Thoracic Vertebrae; Aged
PubMed: 38869265
DOI: 10.23736/S0375-9393.24.17927-8 -
Cureus May 2024Background The report of epidemiological data on coronavirus disease 2019 (COVID-19) patients treated using extracorporeal membrane oxygenation (ECMO) in Japan has been...
Background The report of epidemiological data on coronavirus disease 2019 (COVID-19) patients treated using extracorporeal membrane oxygenation (ECMO) in Japan has been limited. Our study seeks to fill the existing gap in knowledge by providing an in-depth analysis of the clinical epidemiological characteristics and diverse medical outcomes of COVID-19 patients treated with ECMO in Japan. Methods This study used the COVID-19 Registry Japan nationwide database. We included patients aged 18 years or older enrolled between March 17, 2020, and February 1, 2022, with traceable ECMO data. The items on clinical epidemiological characteristics and various medical outcomes were collected. Statistical analysis included a median and interquartile range (IQR) for continuous variables and frequencies for categorical variables. Results The number of participating hospitals was 731, and the number of patients enrolled for analysis was 49,590. Of these, 196 (0.4%) patients received ECMO. Hospital mortality was 33.2%, and discharge to home was 23.0% in the ECMO group. The complications during hospitalization included pneumothorax (9.7%), seizures (4.1%), stroke (4.6%), and pulmonary thromboembolism (2.0%). At discharge, 38.3% had worsened self-care ability, and 38.8% had worsened ambulatory function. Conclusions The results of ECMO treatment in Japan showed that the mortality and complication rates were well-controlled compared with those worldwide.
PubMed: 38868250
DOI: 10.7759/cureus.60202 -
Heliyon Jun 2024We present an AIDS patient coinfected with nontuberculous mycobacteria, and COVID-19, who finally recovered from the coinfection. The 36-year-old man had two...
We present an AIDS patient coinfected with nontuberculous mycobacteria, and COVID-19, who finally recovered from the coinfection. The 36-year-old man had two hospitalizations. In the first hospitalization, the patient was diagnosed with , HIV, and COVID-19 quickly and accurately, and the corresponding treatment worked well. The second hospitalization can be divided into four stages: (1) Persistent fever period; (2) Persistent fever and Pulmonary Progression; (3) ICU period; and (4) Pneumothorax period. During the second hospitalization, the diagnosis of Mycobacterium colombiense was hard because the NGS, acid-fast bacilli, and culture of vomit, sputum, and bronchoalveolar lavage fluid were all negative. Still, we detected acid-fast bacilli in the blood mycobacterium culture. In conclusion, we report a severe pneumonia AIDS patient coinfected with , COVID-19, and Mycobacterium colombiense who finally recovered from the disease. Nontuberculous mycobacteria infection is common in HIV patients, but bronchoalveolar lavage fluid NGS cannot identify nontuberculous mycobacteria in our report. Traditional blood culture was useful in detecting acid-fast bacilli in our study and then detecting the pathogens with NGS. Combining traditional microbial culture and emerging rapid NGS methods is more conducive to clinical diagnosis and treatment.
PubMed: 38867990
DOI: 10.1016/j.heliyon.2024.e31729 -
Journal of Special Operations Medicine... Jun 2024Thoracic trauma occurs frequently in combat and is associated with high mortality. Tube thoracostomy (chest tube) is the treatment for pneumothorax resulting from...
BACKGROUND
Thoracic trauma occurs frequently in combat and is associated with high mortality. Tube thoracostomy (chest tube) is the treatment for pneumothorax resulting from thoracic trauma, but little data exist to characterize combat casualties undergoing this intervention. We sought to describe the incidence of these injuries and procedures to inform training and materiel development priorities.
METHODS
This is a secondary analysis of a Department of Defense Trauma Registry (DoDTR) data set from 2007 to 2020 describing prehospital care within all theaters in the registry. We described all casualties who received a tube thoracostomy within 24 hours of admission to a military treatment facility. Variables described included casualty demographics; abbreviated injury scale (AIS) score by body region, presented as binary serious (=3) or not serious (<3); and prehospital interventions.
RESULTS
The database identified 25,897 casualties, 2,178 (8.4%) of whom received a tube thoracostomy within 24 hours of admission. Of those casualties, the body regions with the highest proportions of common serious injury (AIS >3) were thorax 62% (1,351), extremities 29% (629), abdomen 22% (473), and head/neck 22% (473). Of those casualties, 13% (276) had prehospital needle thoracostomies performed, and 19% (416) had limb tourniquets placed. Most of the patients were male (97%), partner forces members or humanitarian casualties (70%), and survived to discharge (87%).
CONCLUSIONS
Combat casualties with chest trauma often have multiple injuries complicating prehospital and hospital care. Explosions and gunshot wounds are common mechanisms of injury associated with the need for tube thoracostomy, and these interventions are often performed by enlisted medical personnel. Future efforts should be made to provide a correlation between chest interventions and pneumothorax management in prehospital thoracic trauma.
Topics: Humans; Thoracostomy; Thoracic Injuries; Pneumothorax; Male; Chest Tubes; Emergency Medical Services; Female; Military Personnel; Adult; Registries; Abbreviated Injury Scale; Young Adult; United States; Military Medicine
PubMed: 38866695
DOI: 10.55460/RAZM-U139 -
A&A Practice Jun 2024The ultrasound-guided erector spinae plane (ESP) block is an emerging fascial plane block, first described in 2016 for treating thoracic neuropathic pain. Since its...
The ultrasound-guided erector spinae plane (ESP) block is an emerging fascial plane block, first described in 2016 for treating thoracic neuropathic pain. Since its introduction, it has been incorporated into multiple surgical procedures and has demonstrated proven benefits such as postoperative analgesia and reduction in opioid consumption. Being a superficial plane block, it avoids complications such as pneumothorax and hematoma, making it a safe mode of analgesia. We report a rare case of hematoma formation following ESP block in a patient who underwent mitral valve repair under cardiopulmonary bypass.
Topics: Humans; Nerve Block; Hematoma; Male; Ultrasonography, Interventional; Paraspinal Muscles; Pain, Postoperative; Middle Aged; Cardiopulmonary Bypass; Mitral Valve
PubMed: 38864537
DOI: 10.1213/XAA.0000000000001803 -
Scientific Reports Jun 2024The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for... (Observational Study)
Observational Study
Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma.
The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for predicting the Critical Administration Threshold (CAT) has not been well-studied. This study aimed to evaluate the prognostic value of SI in predicting CAT in PTTrauma patients and compare its performance with the Assessment of Blood Consumption (ABC) and Revised Assessment of Bleeding and Transfusion (RABT) scores. We conducted a prognostic type 2, single-center retrospective observational cohort study on patients with PTTrauma and an Injury Severity Score (ISS) > 9. The primary exposure was SI at admission, and the primary outcome was CAT. Logistic regression and decision curve analysis were used to assess the predictive performance of SI and the PTTrauma score, a novel model incorporating clinical variables. Of the 620 participants, 53 (8.5%) had more than one CAT. An SI > 0.9 was associated with CAT (adjusted OR 4.89, 95% CI 1.64-14.60). The PTTrauma score outperformed SI, ABC, and RABT scores in predicting CAT (AUC 0.867, 95% CI 0.826-0.908). SI is a valuable predictor of CAT in PTTrauma patients. The novel PTTrauma score demonstrates superior performance compared to existing scores, highlighting the importance of developing targeted predictive models for specific injury patterns. These findings can guide clinical decision-making and resource allocation in the management of PTTrauma.
Topics: Humans; Male; Female; Blood Transfusion; Adult; Retrospective Studies; Thoracic Injuries; Middle Aged; Prognosis; Injury Severity Score; Wounds, Penetrating; Hemorrhage; Shock
PubMed: 38862533
DOI: 10.1038/s41598-024-62579-x -
Academic Radiology Jun 2024Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the...
RATIONALE AND OBJECTIVES
Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the breath-hold phase during this can be challenging, affecting image quality and increasing complications. With the advent of hybrid operating rooms (HORs), this procedure can be performed with endotracheal tube (ETGA) intubation under general anesthesia with lung separation, ensuring precise imaging in a single-stage setting. Lung separation provides surgical exposure of one lung while ensuring ample gas exchange with the other. This study evaluated tumor ablations performed in an HOR equipped with cone beam CT and laser guidance.
MATERIALS AND METHODS
This retrospective study included patients who underwent lung tumor ablation under general anesthesia with an ETGA in an HOR between July 2020 and May 2023. Anesthesia considerations, perioperative management, and postoperative follow-ups were evaluated.
RESULTS
65 patients (78 tumors) underwent ablation using two types of lung ventilation methods including a single-lumen tube with a blocker (SLT/BL) (n = 15) and double-lumen tube (DLT) (n = 50). Most patients experienced desaturation during the apnea phase of dynamic CT and needling. The average SpO value was significantly lower in the DLT group than in the SLT/BL group during the procedure (81.1% versus 88.7%, P = 0.033). Five, three, and two patients developed pneumothorax, subcutaneous emphysema, and pleural effusion, respectively.
CONCLUSION
Percutaneous ablation under general anesthesia with endotracheal intubation and lung separation performed in HORs was feasible and safe. The setup minimized complication risks and maintained a balance between patient safety and successful procedures.
PubMed: 38862349
DOI: 10.1016/j.acra.2024.04.049 -
Journal of Biomedical Informatics Jun 2024Pneumothorax is an acute thoracic disease caused by abnormal air collection between the lungs and chest wall. Recently, artificial intelligence (AI), especially deep...
OBJECTIVE
Pneumothorax is an acute thoracic disease caused by abnormal air collection between the lungs and chest wall. Recently, artificial intelligence (AI), especially deep learning (DL), has been increasingly employed for automating the diagnostic process of pneumothorax. To address the opaqueness often associated with DL models, explainable artificial intelligence (XAI) methods have been introduced to outline regions related to pneumothorax. However, these explanations sometimes diverge from actual lesion areas, highlighting the need for further improvement.
METHOD
We propose a template-guided approach to incorporate the clinical knowledge of pneumothorax into model explanations generated by XAI methods, thereby enhancing the quality of the explanations. Utilizing one lesion delineation created by radiologists, our approach first generates a template that represents potential areas of pneumothorax occurrence. This template is then superimposed on model explanations to filter out extraneous explanations that fall outside the template's boundaries. To validate its efficacy, we carried out a comparative analysis of three XAI methods (Saliency Map, Grad-CAM, and Integrated Gradients) with and without our template guidance when explaining two DL models (VGG-19 and ResNet-50) in two real-world datasets (SIIM-ACR and ChestX-Det).
RESULTS
The proposed approach consistently improved baseline XAI methods across twelve benchmark scenarios built on three XAI methods, two DL models, and two datasets. The average incremental percentages, calculated by the performance improvements over the baseline performance, were 97.8% in Intersection over Union (IoU) and 94.1% in Dice Similarity Coefficient (DSC) when comparing model explanations and ground-truth lesion areas. We further visualized baseline and template-guided model explanations on radiographs to showcase the performance of our approach.
CONCLUSIONS
In the context of pneumothorax diagnoses, we proposed a template-guided approach for improving model explanations. Our approach not only aligns model explanations more closely with clinical insights but also exhibits extensibility to other thoracic diseases. We anticipate that our template guidance will forge a novel approach to elucidating AI models by integrating clinical domain expertise.
PubMed: 38862083
DOI: 10.1016/j.jbi.2024.104673 -
International Journal of Surgery Case... Jul 2024Congenital lobar emphysema (CLE) is a rare but important lung malformation typically discovered in the newborn period. Some rare cases are reported in adults. It can...
INTRODUCTION AND SIGNIFICANCE
Congenital lobar emphysema (CLE) is a rare but important lung malformation typically discovered in the newborn period. Some rare cases are reported in adults. It can present with various respiratory symptoms. Diagnosis relies primarily on chest CT scans, and the main treatment is surgery.
CASE PRESENTATION
We present a case of a young girl with recurrent respiratory infections who was misdiagnosed with a pneumothorax. A chest tube was inserted. Later, CLE was identified, and the affected lung lobe was surgically removed.
CLINICAL DISCUSSION
This case highlights the importance of including CLE in the differential diagnosis for hyperinflation of a lung lobe. A CT scan is crucial for confirmation.
CONCLUSION
Congenital lobar emphysema is a rare disease that primarily affects children. Most children with CLE experience symptoms and require surgery. In adults, CLE is uncommon, and surgery is based on the severity of symptoms and radiological findings.
PubMed: 38861815
DOI: 10.1016/j.ijscr.2024.109852