Hasil untuk "Surgery"

J. Roth, F. Fossella, R. Komaki et al.

L. Wilkins

R. Collins, A. Scrimgeour, S. Yusuf et al.

Fiona J. Smith, C. Holman, R. Moorin et al.

L. Rosato, N. Avenia, P. Bernante et al.

D. Warltier, J. Laffey, J. Boylan et al.

W. Powers, W. Clarke, R. Grubb et al.

A. Shaw, S. Bagshaw, S. Goldstein et al.

M. Jaklitsch, F. Jacobson, J. Austin et al.

OBJECTIVE Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer-specific mortality by 20%. METHOD The American Association for Thoracic Surgery created a multispecialty task force to create screening guidelines for groups at high risk of developing lung cancer and survivors of previous lung cancer. RESULTS The American Association for Thoracic Surgery guidelines call for annual lung cancer screening with low-dose computed tomography screening for North Americans from age 55 to 79 years with a 30 pack-year history of smoking. Long-term lung cancer survivors should have annual low-dose computed tomography to detect second primary lung cancer until the age of 79 years. Annual low-dose computed tomography lung cancer screening should be offered starting at age 50 years with a 20 pack-year history if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years. Lung cancer screening requires participation by a subspecialty-qualified team. The American Association for Thoracic Surgery will continue engagement with other specialty societies to refine future screening guidelines. CONCLUSIONS The American Association for Thoracic Surgery provides specific guidelines for lung cancer screening in North America.

K. Tobias, S. Johnston

Cheng-Le Zhuang, Xing-zhao Ye, Xiao-dong Zhang et al.

Pradeep K. Bhatia, Ghansham Biyani

Dewi Novitasari Arifin, Pramana Adhityo, Nabila Ardia Pramono et al.

Abstract Background Intussusception is a common cause of intestinal obstruction in pediatric patients. Early recognition and treatment are essential to prevent potentially fatal complications. Identifying the risk of failure of hydrostatic reduction as non-operative management in children with intussusception would provide significant clinical advantages. It would allow prompt identification of the need for early surgical intervention and potentially prevent complications that can arise from prolonged intestinal strangulation. To address this issue, our study proposed a scoring system that evaluates the likelihood of hydrostatic reduction failure in pediatric intussusception cases. Methods The medical records of 61 children with intussusception who underwent hydrostatic reduction were analyzed retrospectively to determine a scoring system using the following variables: age, weight, vomiting, duration of symptoms, currant jelly stool, abdominal distention, mass location, and pseudoportio sign. Results Among the 61 eligible patients, hydrostatic reduction was successful in 23 (37.7%) and failed in 38 (62.3%). There was a significant association between the failure of hydrostatic reduction with age ≤12 months (p=0.002), body weight ≤10 kg (p=0.001), vomiting (p=0.0006), duration of symptoms >48 hours (p=0.003), abdominal distension (p=0.001), location of mass (p=0.00004), currant jelly stool (p=0.00005), and pseudoportio sign (p=0.001). Multivariate analysis showed that the onset of symptoms >48 hours (p=0.014; OR=17.34 [95% CI=1.76-170.45]), left-sided mass (p=0.003; OR=17.74 [95% CI=2.66-118.17]), and currant jelly stool (p=0.029; OR=9.05 [95% CI=1.26-65.03]) were strongly associated with failure of hydrostatic reduction. Prediction scores ranged from 0 to 3. A score of ≥2 predicted a higher possibility of reduction failure, while a score of <2 predicted a lower possibility of reduction failure (p<0.000). Conclusion The scoring system might serve as a valuable prognostic tool for pediatric surgeons in evaluating the risk of hydrostatic reduction failure in children with intussusception. Our findings indicate that three critical indicators—the duration of symptoms exceeding 48 hours, the presence of currant jelly stool, and a left-sided mass of the abdomen—are associated with the failure of hydrostatic reduction. This scoring system may facilitate patients' decision-making and guide the need for early surgical intervention.

LIN Tianlong, SHEN Yuguang, ZHAO Enhao

Objective To explore the effect of the case three-dimensional teaching method (CTTM) + standardized patient (SP) in the teaching of clinical interns in the department of gastrointestinal surgery.Methods Clinical medical students who interned in the department of gastrointestinal surgery of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from December 2023 to December 2024 were selected as study subjects, and were classified into the study group and the control group. The study group adopted CTTM+SP teaching method, whereas the control group received the traditional teaching method. After completion of the teaching, the teaching results were evaluated by theoretical examination, Mini-clinical Evaluation Exercise (Mini-CEX), Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV), learning conditions and satisfaction questionnaire.Results A total of 100 subjects were included, 50 in each group. The theoretical knowledge mastery and case analysis ability in the study group were significantly higher than those in the control group (P

Peng Luo, Xiankai Chen, Yafan Yang et al.

Abstract Objective To explore whether the upper and/or middle mediastinal nodes (UMMN) should be dissected in Siewert type II adenocarcinoma (AC) according to the incidence of lymph node metastasis. Additionally, to investigate the association between the length of esophageal involvement (LEI) and the UMMN metastases. Methods A cohort with Siewert type II AC who were operated on by a surgical team that routinely treated esophagogastric junction (EGJ) tumors with esophagectomy and extended lymphadenectomy were assessed retrospectively. The primary endpoint of the research was the metastasis rate of UMMN. Results A total of 94 patients with EGJ tumor from July 2018 to September 2022 were enrolled. Station 106recR (6.4%, 6/94) was the only station among upper mediastinal nodes (UMN) that presented positive nodes. Middle mediastinal nodes (MMN) metastases of station 107, 109 and station 108 were 2.1% (2/94) and 5.0% (4/80), respectively. Among the 11 patients with MMN or UMN metastases, 63.6% (7/11) had lesser than seven metastatic nodes, and 54.5% (6/11) had a pathological N stage ≤2. LEI >3 cm (p = 0.042) showed a higher risk for MMN metastases in univariable logistic analysis. However, no independent risk factor for mediastinal node metastases was detected. Conclusion This study demonstrated that the incidence of positive MMN and UMN is relatively low in resectable Siewert type II AC, which indicated that it is not necessary to perform a routine dissection upon these stations. LEI >3 cm might be associated with higher risk for mediastinal node metastasis. Certain patients could benefit from extended lymphadenectomy since most of the patients with positive MMN or UMN have a limited number of metastatic nodes.

Yi‐Xian Liang, Yan‐Ping Xie, Huan‐Ming Yu et al.

ABSTRACT Introduction Lung adenocarcinoma (LUAD) is one of the major histopathological types of non‐small cell lung cancer (NSCLC), including solid, acinar, lepidic, papillary and micropapillary subtypes. Increasing evidence has shown that micropapillary LUAD is positively associated with a higher percentage of driver gene mutations, a higher incidence of metastasis and a poorer prognosis, while lepidic LUAD has a relatively better prognosis. However, the novel genetic change and its underlying mechanism in the progression of micropapillary LUAD have not been exactly determined. Methods A total of 181 patients with LUAD who underwent surgery at the First Affiliated Hospital of Huzhou University from January 2020 to December 2022 were enrolled. Three predominant lepidic and three predominant micropapillary LUAD tissue samples were carried out using whole‐exome sequencing. Comprehensive analysis of genomic variations and the difference between lepidic and micropapillary LUAD was performed. In addition, the TMEM229A Q200del mutation was verified using our cohort and TCGA‐LUAD datasets. The correlations between the TMEM229A Q200del mutation and the clinicopathological characteristics of patients with LUAD were further analyzed. The functions and mechanisms of TMEM229A Q200del on NSCLC cell proliferation and migration were also determined. Results The frequency of genomic changes in patients with micropapillary LUAD was higher than that in patients with lepidic LUAD. Mutations in EGFR, ATXN2, C14orf180, MUC12, NOTCH1, and PKD1L2 were concomitantly detected in three predominant micropapillary and three predominant lepidic LUAD cases. The TMEM229A Q200del mutation was only mutated in lepidic LUAD. Additionally, the TMEM229A Q200del mutation had occurred in 16 (8.8%) patients, and not found TMEM229A R76H and M346T mutations in our cohort, while TMEM229A mutations (R76H, M346T, and Q200del) occurred only in 1.0% of the TCGA‐LUAD cohort. Further correlation analysis between the TMEM229A Q200del mutation and clinicopathological characteristics suggested that a lower frequency of the Q200del mutation was significantly associated with positive lymph node metastasis, advanced TNM stage, positive cancer thrombus, and pathological features. Finally, overexpression of TMEM229A Q200del suppressed NSCLC cell proliferation and migration in vitro. Mechanistically, overexpression of TMEM229A and TMEM229A Q200del both reduced the expression level of phosphorylated (p)‐ERK and p‐AKT (Ser473), and the reduced protein level of p‐ERK in the TMEM229A Q200del group was more pronounced compared to the TMEM229A group. Conclusion Our results demonstrated that the TMEM229A Q200del mutant may play a protective role in the progression of LUAD via inactivating ERK pathway, providing a potential therapeutic target in LUAD.

Rui Xiong, Boxin Geng, Wenyang Jiang et al.

Abstract Background Epithelial mesenchymal transformation (EMT) in alveolar type 2 epithelial cells (AT2) is closely associated with pulmonary fibrosis (PF). Histone deacetylase 3 (HDAC3) is an important enzyme that regulates protein stability by modulating the acetylation level of non-histones. Here, we aimed to explore the potential role and regulatory mechanisms associated with HDAC3 in PF. Methods We quantified HDAC3 expression both in lung tissues from patients with PF and from bleomycin (BLM)-treated mice. HDAC3 was also detected in TGF-β1-treated AT2. The mechanistic activity of HDAC3 in pulmonary fibrosis and EMT was also explored. Results HDAC3 was highly expressed in lung tissues from patients with PF and bleomycin (BLM)-treated mice, especially in AT2. Lung tissues from AT2-specific HDAC3-deficient mice stimulated with BLM showed alleviative fibrosis and EMT. Upstream of HDAC3, TGF-β1/SMAD3 directly promoted HDAC3 transcription. Downstream of HDAC3, we also found that genetic or pharmacologic inhibition of HDAC3 inhibited GATA3 expression at the protein level rather than mRNA. Finally, we found that intraperitoneal administration of RGFP966, a selective inhibitor of HDAC3, could prevent mice from BLM-induced pulmonary fibrosis and EMT. Conclusion TGF-β1/SMAD3 directly promoted the transcription of HDAC3, which aggravated EMT in AT2 and pulmonary fibrosis in mice via deacetylation of GATA3 and inhibition of its degradation. Our results suggest that targeting HDAC3 in AT2 may provide a new therapeutic target for the prevention of PF.

Christian G. Ziegler, Carina Riediger, Matthias Gruber et al.

Pheochromocytomas (PCCs) are rare but potentially lethal tumors that arise from the adrenal medulla. The clinical suspicion and diagnosis of PCC can be challenging due to the non-specific nature of signs and symptoms. In many patients, infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could lead to long-term symptoms including fatigue, headaches, and cognitive dysfunction. Here, we present the case of a patient incidentally diagnosed with an adrenal mass that proved to be a PCC after imaging was performed due to persisting complaints after coronavirus disease 2019 (COVID-19) infection. A 37-year-old male patient was referred to our center because of a right-sided inhomogeneous adrenal mass, incidentally found during a computed tomographic scan of the thorax performed due to cough and dyspnea that persisted after COVID-19 infection. Other complaints that were present prior to COVID-19 infection included profuse sweating, dizziness, exhaustion with chronic fatigue, and concentration difficulties. The patient had no history of hypertension, his blood pressure was normal, and the 24-h ambulatory blood pressure monitoring confirmed normotension but with the absence of nocturnal dipping. Plasma normetanephrine was 5.7-fold above the upper limit (UL) of reference intervals (738 pg/ml, UL = 129 pg/ml), whereas plasma metanephrine and methoxytyramine were normal at 30 pg/ml (UL = 84 pg/ml) and &lt;4 pg/ml (UL = 16 pg/ml), respectively. Preoperative preparation with phenoxybenzamine was initiated, and a 4-cm tumor was surgically resected. Profuse sweating as well as dizziness was resolved after adrenalectomy pointing toward PCC and not COVID-19-associated patient concerns. Altogether, this case illustrates the difficulties in recognizing the possibility of PCC due to the non-specific nature of signs and symptoms of the tumor, which in this case did not include hypertension and coincided with some of the symptoms of long COVID-19.

Madeleine Orban, MD, Steffen Massberg, MD

W J Bom, F B M Joosten, M M G J van Borren et al.

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. Methods: A retrospective cohort study of the first 103 patients receivin g RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the per centage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after si ngle-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achie ved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 mL (range 2.0–58.0 mL ). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of th e next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patient s. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR <50% and in those with regrowth to exclude underlying malignancy.