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Objective Prophylactic pharmacological conversion agents could reduce the incidence of postoperative atrial fibrillation (AF) in patients undergoing thoracic operations. The current study examined whether the use of pharmacological conversion agents could help to restore sinus rhythm in patients with AF newly developed during thoracic operations. Methods Medical records of 18,605 patients from January 1, 2015 to December 31, 2019, at the Shanghai Chest Hospital were reviewed. Patients with non-sinus rhythm prior to the surgery (n = 128) were excluded from data analysis. The final analysis included 18,477 patients (n = 16,292 undergoing lung operations; n = 2,185 undergoing esophageal operations). Results Intraoperative AF (defined as AF lasting for at least 5 min) occurred in 646 out of a total of 18,477 subjects (3.49%). Within the 646 subjects, 258 received pharmacological conversion agents during the surgery. sinus rhythm was restored in 20.15% (52/248) of patients treated with pharmacological cardioversion and in 20.87% (81/399) patients not receiving pharmacological intervention. In a subgroup analysis of the 258 patients receiving pharmacological conversion agents, recovery of sinus rhythm was highest in beta-blocker group (35.59%, 21/59 vs. 15.78%, 15/95 in amiodarone group, p = 0.008, 5.55%, and 1/18 in amiodarone plus beta-blockers group, p = 0.016). The incidence of hypotension was higher in pharmacological conversion (27.5% vs. 9.3% in patients not receiving pharmacological intervention, p 98% of the cases (155/158 vs. 63/355 in subjects not receiving cardioversion; p Conclusions Our experience shows that pharmacological conversion, in general, failed to show better treatment effectiveness on intraoperative new-onset AF within period of surgery except for beta-blockers. Patients with AF persisting beyond the surgery could be effectively managed with electrical cardioversion.

Postoperative pulmonary complications (PPCs) are the most common complications following minimally invasive esophagectomy (MIE) and can be associated with adverse outcomes. This study aims to construct a nomogram based on clinical factors to predict PPCs and investigate related early outcomes. Clinical data of 969 consecutive patients receiving MIE were retrospectively collected. Univariate and multivariate analysis were performed to select independent predictors. Using independent predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal verification. Early outcomes of PPCs were analyzed. The incidence of PPCs following MIE was 39.6% (384 out of 969). In multivariate analysis, older age (Odds ratio (OR) 1.034, P

Bone cancer pain (BCP) is one of the most common types of pain in cancer patients which compromises the patient’s functional status, quality of life, and survival. Central hyperalgesia has increasingly been identified as a crucial factor of BCP, especially in the medial prefrontal cortex (mPFC) which is the main cortical area involved in the process of pain and consequent negative emotion. To explore the genetic changes in the mPFC during BCP occurrence and find possible targets for prediction, we performed transcriptome sequencing of mPFC in the BCP rat model and found a total of 147 differentially expressed mRNAs (DEmRNAs). A protein-protein interaction (PPI) network revealed that the DEmRNAs mainly participate in the inflammatory response. Meanwhile, microglia and astrocytes were activated in the mPFC of BCP rats, further confirming the presence of neuroinflammation. In addition, Gene Ontology (GO) analysis showed that DEmRNAs in the mPFC are mainly involved in antigen processing, presentation of peptide antigen, and immune response, occurring in the MHC protein complex. Besides, the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that DEmRNAs are mainly enriched in the pathways of phagosome, staphylococcus aureus infection, and antigen processing, in which MHCII participate. Furthermore, immunostaining showed that MHCII is mainly located in the microglia. Microglia are believed to be involved in antigen processing, a key cause of BCP. In vivo, minocycline (MC) treatment inhibits the activation of microglia and reduces the expression of MHCII and proinflammatory cytokines, thereby alleviating BCP and pain-related anxiety. Taken together, our study identified differentially expressed genes in the BCP process and demonstrated that the activation of microglia participates in the inflammatory response and antigen process, which may contribute to BCP.

The medial prefrontal cortex (mPFC) is the main cortical area for processing both sensory and affective aspects of pain. Recently, mPFC was reported to participate in cancer-induced bone pain (CIBP) via the mechanism of central inflammation. STING is a key component of neuroinflammation in the central neuron system by activating downstream TBK1 and NF-κB signaling pathways. We aimed to investigate whether STING regulated neuroinflammation in the mPFC in rat models of CIBP. It is worth noting that we found a significant upregulation of STING in the mPFC after CIBP, accompanied by activation of TBK1 and NF-κB signaling pathways. In addition, pain and anxiety-like behaviors were alleviated by intraperitoneal injection of the STING inhibitor C-176. Furthermore, in microglia GMI-R1 cells, C-176 reversed LPS-induced M1 polarization. Collectively, this evidence indicated that STING may contribute to cancer-induced bone pain by activating TBK1 and NF-κB, and by promoting M1 polarization of microglia in the mPFC.

Background Neuroinflammation in the peripheral nervous system has been linked to cancer metastasis-induced bone pain. The stimulator of interferon genes (STING), an innate immune sensor for cytosolic DNA, plays an important role in inflammation and cancer metastasis and is reported to be a critical regulator of nociception. Here, we examined the role of STING in primary nociceptive neurons and chronic pain to determine if it could be a new target for treating bone cancer pain (BCP). Methods Walker 256 cancer cells were injected intratibially to induce bone cancer pain in rats. STING and its downstream inflammatory factors in dorsal root ganglia (DRG) were detected using western blotting and immunofluorescent staining. Transmission electron microscopy and the BCL2-associated X (Bax) expression were used to detect the mitochondrial stress in DRG neurons. C-176, a specific inhibitor of STING, was used to block STING activation and to test the pain behavior. Results Mechanical hyperalgesia and spontaneous pain were observed in BCP rats, accompanied by the upregulation of the STING expression in the ipsilateral L4-5 DRG neurons which showed significant mitochondrion stress. The STING/TANK-binding kinase 1 (TBK1)/nuclear factor-kappa B (NF-κB) pathway activation was observed in the DRGs of BCP rats as well as increased IL-1β, IL-6, and TNF-α expression. C-176 alleviated bone cancer pain and reduced the STING and its downstream inflammatory pathway. Conclusion We provide evidence that STING pathway activation leads to neuroinflammation and peripheral sensitization. Pharmacological blockade of STING may be a promising novel strategy for preventing BCP.

ObjectiveHypotension is common in propofol anesthesia. Whether remimazolam could reduce intraoperative hypotension remains unknown. We therefore tested the primary hypothesis that remimazolam reduces the incidence of intraoperative hypotension compared with propofol in adult patients undergoing endoscopic submucosal dissection (ESD) surgery.Materials and methodsWe conducted a prospective trial to compare patients who received either remimazolam or propofol bolus induction and thereafter intravenous infusion. The hemodynamic parameters were measured using CNAP® Monitor 500 system. Our primary analysis was to compare the incidence of hypotension defined as systolic blood pressure below 90 mmHg between remimazolam and propofol during the whole anesthesia period.ResultsThe incidence of hypotension decreased by 50%, from 67.9% in propofol group to 32.1% in remimazolam group (p < 0.01). Patients received less amount of intraoperative phenylephrine in the remimazolam group than the propofol group (0 [0–40] μg vs. 80 [0–200] μg, p < 0.01). Time-weighted average and cumulative time of hypotension was lower in remimazolam group compared with propofol group (p < 0.05). Cardiac output continuously measured by CNAP was preserved much better in remimazolam group compared with propofol group (p = 0.01), while systemic vascular resistance did not differ between the groups. The median time from discontinuation until full alertness was 4 [3–11.8] min in the remimazolam group compared with 15 [12.0–19.8] min in the propofol group (p < 0.01).ConclusionRemimazolam has better hemodynamic stability than propofol in adult patients undergoing ESD surgery. The benefits of remimazolam on hemodynamic stability and hypotension prevention may be partly contributed to its better preservation of cardiac output.Clinical Trial Registration[http://www.chictr.org.cn/com/25/showproj.aspx?proj=61104], identifier [ChiCTR2000037975].

ObjectivesTo investigate the relationship between obesity status and perioperative outcomes in elderly patients undergoing thoracoscopic anatomic lung cancer surgery.MethodsFrom January 2016 to December 2018, we performed a monocentric retrospective cohort study among 4164 consecutive patients aged 65 years or older who underwent thoracoscopic anatomic lung cancer surgery at Shanghai Chest Hospital. Two groups were stratified by body mass index (BMI): nonobese (BMI2) and obese status (BMI≥28kg/m2). Using a 1:1 propensity score matching (PSM) analysis to compare perioperative outcomes between two groups.Results4035 older patients were eventually enrolled, with a mean age of 69.8 years (range: 65-87), and 305 patients were eligible for obese status, with a mean BMI of 29.8 ± 1.7kg/m2. Compared with nonobese patients, obese patients were more likely to have higher rates of intraoperative hypoxemia (1.2% vs 3.9%, P=0.001) and new-onset arrhythmia (2.3% vs 4.3%, P=0.034). The difference in intraoperative transfusion and conversion rates and postoperative outcomes regarding pulmonary complications, new-onset arrhythmia, transfusion, length of hospital stay, 30-day readmission and hospitalization costs between two groups were not significant (P>0.05). After a 1:1 PSM analysis, the difference in both intraoperative and postoperative complications among two groups were not significant (P>0.05). In subgroup analysis, patients with BMI≥30kg/m2 had a similar incidence of perioperative complications compared to patients with BMI between 28 and 30 kg/m2 (P>0.05).ConclusionsOur research data support evidence for “obesity paradox” and also contribute the growing body of evidence that obesity in older patients should not exclude candidates for thoracoscopic anatomic lung cancer surgery.

As one of the causes of bone cancer pain (BCP), central hyperalgesia has more and more supporting evidence recently. The medial prefrontal cortex (mPFC) is implicated in emotional disorders associated with BCP. Major histocompatibility complex II (MHCII) is a key component in regulating anti-inflammatory response and antigen presentation. This study aims to investigate whether MHCII of the mPFC participates in the BCP. The rat model of BCP was established by injecting Walker 256 cells into the tibia. BCP-induced decreased pain threshold, increased the expression of MHCII and the downstream protein CTSS, CD74 and upstream protein CIITA in mPFC, and the upregulation of MHCII was mainly observed in the mPFC microglia. Furthermore, pharmacological inhibition of MHCII in mPFC by intraperitoneal injecting minocycline provides relief from BCP. Importantly, the upregulation of MHCII is accompanied by significant NLRP3 inflammasome activation and inflammatory factors (IL-1β, IL-18 and TNF-α) released in the mPFC of BCP rats. Taken together, our data suggest that MHCII participates in BCP by activating NLRP3 inflammasome in microglia of the mPFC.

BackgroundThere are few studies on the impact of body position on variations in circulation and breathing, and it has not been confirmed whether body position changes can reduce the pulmonary complications of thoracoscopic-assisted oesophagectomy.MethodsA single-center retrospective study included patients undergoing thoracoscopic-assisted oesophagectomy in the prone position or semiprone position between 1 July 2020, and 30 June 2021, at the Shanghai Chest Hospital. There were 103 patients with thoracoscopic-assisted oesophagectomy in the final analysis, including 43 patients undergoing thoracoscopic-assisted oesophagectomy in the prone position. Postoperative pulmonary complication (PPC) incidence was the primary endpoint. The incidence of cardiovascular and other complications was the secondary endpoint. Chest tube duration, patient-controlled anaesthesia (PCA) pressing frequency within 24 h, ICU stay, and the postoperative hospital length of stay (LOS) were also collected.ResultsCompared with the semiprone position, the prone position decreased the incidence of atelectasis (12% vs. 30%, P = 0.032). Nevertheless, there were no considerable differences in the rates of cardiovascular and other complications, ICU stay, or LOS (P >0.05). Multivariable logistic regression analysis showed that the prone position (OR = 0.196, P = 0.011), no smoking (OR = 0.103, P ConclusionsOur study shows that artificial pneumothorax under right bronchial occlusion one-lung ventilation for patients with thoracoscopic-assisted oesophagectomy in the prone position can decrease postoperative atelectasis compared with the semiprone position.

Cross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries.We conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpOThirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpOThis retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.

The association between elevated body mass index (BMI) and perioperative and oncological outcomes among elderly patients undergoing minimally invasive McKeown esophagectomy (MIE) remains unclear.We performed a single-center retrospective analysis of 526 consecutive patients aged 65 years or older who underwent MIE for esophageal squamous cell carcinoma (SCC) between January 2016 and December 2019. Two groups were stratified by BMI: normal (18.5 ≤ BMI 24 kg/mA total of 480 elderly patients were eventually enrolled, with a mean age of 70.2 years (range: 65-87), and 185 patients were eligible for elevated BMI, with a mean BMI of 26.3 ± 1.9 kg/mAmong elderly patients undergoing MIE for esophageal SCC, there was insufficient evidence to demonstrate that elevated BMI could increase perioperative and oncological adverse outcomes.

Moderate intraoperative hypothermia promotes myocardial injury, surgical site infections, and blood loss. Whether aggressive warming to a truly normothermic temperature near 37°C improves outcomes remains unknown. We aimed to test the hypothesis that aggressive intraoperative warming reduces major perioperative complications.In this multicentre, parallel group, superiority trial, patients at 12 sites in China and at the Cleveland Clinic in the USA were randomly assigned (1:1) to receive either aggressive warming to a target core temperature of 37°C (aggressively warmed group) or routine thermal management to a target of 35·5°C (routine thermal management group) during non-cardiac surgery. Randomisation was stratified by site, with computer-generated, randomly sized blocks. Eligible patients (aged ≥45 years) had at least one cardiovascular risk factor, were scheduled for inpatient non-cardiac surgery expected to last 2-6 h with general anaesthesia, and were expected to have at least half of the anterior skin surface available for warming. Patients requiring dialysis and those with a body-mass index exceeding 30 kg/mBetween March 27, 2017, and March 16, 2021, 5056 participants were enrolled, of whom 5013 were included in the intention-to-treat population (2507 in the aggressively warmed group and 2506 in the routine thermal management group). Patients assigned to aggressive warming had a mean final intraoperative core temperature of 37·1°C (SD 0·3) whereas the routine thermal management group averaged 35·6°C (SD 0·3). At least one of the primary outcome components (myocardial injury after non-cardiac surgery, cardiac arrest, or mortality) occurred in 246 (9·9%) of 2497 patients in the aggressively warmed group and in 239 (9·6%) of 2490 patients in the routine thermal management group. The common effect relative risk of aggressive versus routine thermal management was an estimated 1·04 (95% CI 0·87-1·24, p=0·69). There were 39 adverse events in patients assigned to aggressive warming (17 of which were serious) and 54 in those assigned to routine thermal management (30 of which were serious). One serious adverse event, in an aggressively warmed patient, was deemed to be possibly related to thermal management.The incidence of a 30-day composite of major cardiovascular outcomes did not differ significantly in patients randomised to 35·5°C and to 37°C. At least over a 1·5°C range from very mild hypothermia to full normothermia, there was no evidence that any substantive outcome varied. Keeping core temperature at least 35·5°C in surgical patients appears sufficient.3M and the Health and Medical Research Fund, Food and Health Bureau, Hong Kong.For the Chinese translation of the abstract see Supplementary Materials section.

We aimed to explore the impact of opioid-sparing anesthesia on patients' quality of recovery after video-assisted thoracoscopic surgery (VATS). We tested the primary hypothesis that our predefined opioid-sparing anesthesia provides better quality of patients' recovery compared to routine anesthesia in VATS.Patients between 18 and 70 years, scheduled for elective VATS, had an American Society of Anesthesiologists (ASA) class I-III under general anesthesia, were randomly allocated to: routine anesthesia group and opioid-sparing anesthesia group. Patients in the opioid-sparing anesthesia group were mainly given preoperative thoracic paravertebral blockade with intraoperative withholding longer acting opioids. Patients in routine anesthesia group received opioid-based anesthesia. The primary outcome was the Quality of Recovery-15 scale (QoR-15) at 6 hours after surgery. The secondary outcomes included QoR-15 at 24 and 48 hours after surgery, Overall Benefit of Analgesia Score Satisfaction with pain treatment (OBAS) and acute pain intensity at 6, 24 and 48 hours after surgery, and clinical outcomes of recovery after surgery.A total of 159 patients were included in final analysis. The median difference in QoR-15 between opioid-sparing anesthesia and routine anesthesia was 4 (95% CI: 1-6) at 6 hours, 8 (95% CI: 4-12) at 24 hours and 4.7 (95% CI: 1-6) at 48 hours after surgery respectively; 73.4% of patient showed good recovery in opioid-sparing anesthesia group, compared to 53.8% in routine anesthesia group at 24 hours after surgery (P=0.01). Patients demonstrated lower OBAS in opioid-sparing anesthesia group compared to routine anesthesia at all time points after surgery (P0.05). The pain at most was significantly lower in opioid-sparing anesthesia group compared to routine anesthesia at 6 and 48 hours after surgery (P0.05). Patients exhibited faster recovery with opioid-sparing anesthesia on time to mobilize and time to first flatus (P0.01).Our intraoperative opioid-sparing anesthesia cannot improve patients' recovery at 6 hours after VATS lung surgery, but it demonstrates better outcomes at 24 hours after surgery compared to routine anesthesia, reaching to a clinically important difference.This study is registered in the Chinese Clinical Trial Registry, ChiCTR2000031609.

Despite the significant improvement in the survival rate of cancer patients, the total cure of bone cancer is still a knotty clinical challenge. Traditional surgical resectionof bone tumors is less than satisfactory, which inevitably results in bone defects and the inevitable residual tumor cells. For the purpose of realizing minimal invasiveness and local curative effects, photothermal therapy (PTT) under the irradiation of near-infrared light has made extensive progress in ablating tumors, and various photothermal therapeutic agents (PTAs) for the treatment of bone tumors have thus been reported in the past few years, has and have tended to focus on osteogenic bio-scaffolds modified with PTAs in order to break through the limitation that PTT lacks, osteogenic capacity. These so-called bifunctional scaffolds simultaneously ablate bone tumors and generate new tissues at the bone defects. This review summarizes the recent application progress of various bifunctional scaffolds and puts forward some practical constraints and future perspectives on bifunctional scaffolds for tumor therapy and bone regeneration: two hawks with one arrow.

Study Objective: This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care.Design: A prospective, randomized, controlled study.Setting: A single tertiary care center with a study period from November 2017 to December 2018.Patients: Patients over 65 years old who were scheduled for elective MIE.Interventions: The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped.Measurements: The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality.Main Results: Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, P = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, P = 0.92). Compared with those in the control group (n = 32), patients in the GDT group (n = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, P P Conclusion: The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients.Clinical Trial Number and Registry URL: ChiCTR-INR-17013352; http://www.chictr.org.cn/showproj.aspx?proj=22883

Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

Robot-assisted (RA) and thoracoscopic-assisted (TA) minimally invasive esophagectomy (MIE) are surgical techniques for the treatment of esophageal cancer. This study aims to compare short-term outcomes of RAMIE to TAMIE.We conducted a single-center retrospective analysis between January 2016 and December 2019, including 1012 consecutive patients who underwent MIE, 437 in the RAMIE group and 575 in the TAMIE group. A 1:1 propensity score matching (PSM) analysis was performed to compare short-term outcomes.The vast majority of patients had squamous cell carcinoma (972/1012, 96.0%). Radical resection (R0) was performed in 945 (93.4%) patients with a mean total number of dissected lymph nodes of 22.6±11.0. The incidence of postoperative pulmonary complications (PPCs) was 44.1% (446/1012). The median length of hospital stay was 9 days, and no 30-day mortality was observed. We evaluated short-term outcomes in 544 patients (272 pairs) treated with RAMIE or TAMIE after a 1:1 PSM. Compared with TAMIE group, patients received RAMIE had shorter operative time (291.6±60.5 vs 247.2±51.0min, P0.001), more left recurrent laryngeal lymph node dissected (2.0±1.9 vs 2.5±2.3, P=0.007), comparable total number of lymph node dissected (22.9±11.4 vs 22.8±9.8, P=0.913) and R0 resection rate (90.8% vs 93.4%, P=0.266) and similar short-term outcomes including PPCs, surgical complications, length of ICU and hospital stays, ICU readmission rate, 30-day readmission and mortality rates (P0.05).RAMIE is an alternative minimally invasive option to TAMIE, with promising oncological results especially in left RLN lymph node dissection and comparable short-term outcomes.

BACKGROUND Serratus anterior plane blocks (SAPBs) and thoracic paravertebral blocks (TPVBs) can both be used for video-assisted thoracic surgery. However, it remains unknown whether the analgesic efficacy of a SAPB is comparable to that of a TPVB. OBJECTIVE We tested the primary hypothesis that SAPBs provide noninferior analgesia compared with TPVBs for video-assisted thoracic surgery. DESIGN A noninferiority randomised trial. SETTING Shanghai Chest Hospital, between August 2018 and November 2018. PATIENTS Ninety patients scheduled for video-assisted thoracic lobectomy or segmentectomy were randomised. Patients were excluded if they were unable to perform the visual analogue pain scale, or surgery was converted to thoracotomy. INTERVENTIONS Blocks were performed after induction of general anaesthesia. The three groups were paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29); and general anaesthesia alone (n = 30). PRIMARY OUTCOME MEASURES Visual analogue pain scores (0 to 10 cm) at rest and while coughing, and Prince-Henry pain scores (0 to 4 points) were used to assess postoperative analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1 cm or one point as appropriate. RESULTS The mean difference (95% confidence intervals) in visual analogue scores between the SAPBs and TPVBs was -0.04 (-0.10 to 0.03) cm at rest, -0.22 (-0.43 to -0.01) cm during coughing and -0.10 (-0.25 to 0.05) for Prince-Henry pain scores. As the upper limit of the confidence intervals were less than 1 (all P

Although combined thoracic paravertebral blockade (TPVB)-general anesthesia (GA) could improve pain control compared to GA alone after thoracoscopic lung cancer surgery, it has not been established whether this improvement in pain control could reduce associated adverse outcomes. Thus, this study aimed to explore the association between TPVB usage and adverse outcomes after thoracoscopic lung cancer surgery.Retrospective cohort study from a prospective database.A high-volume thoracic center in China.13966 consecutive patients who received thoracoscopic lung cancer surgery from January 2016 to December 2018 in Shanghai Chest Hospital were enrolled.With a 1:1 propensity score matching (PSM) analysis, adverse outcomes between GA alone and GA-TPVB were investigated. Multivariate and multiple linear regression analysis were used to identify factors and calculate odds radio (OR) for adverse outcomes.The rate of TPVB usage was 14.8% (2070 out of 13,966). TPVB combined with GA was associated with lower rates of postoperative pulmonary complications (PPCs) (30.4% vs 33.5%, P = 0.005) and postoperative atrial fibrillation (POAF) (2.1% vs 2.9%, P = 0.041), and shorter length of hospital stay (LOS) (Median [IQR]; 5[4-5] vs 5[4-6]) days, P 0.001) compared to GA alone. After a 1:1 PSM analysis, we investigated adverse outcomes in 2640 (1320 pairs) patients with or without TPVB usage, and this association remained existed, namely, the rates of PPCs (29.8% vs 34.2%, P = 0.014) and POAF (2.2% vs 3.6%, P = 0.028) were lower and LOS was shorter (5[4-5] vs 5[4-6] days, P 0.001) in the GA-TPVB group. In multivariate analysis, the combination of GA plus TPVB was independent predictor for PPCs (OR = 0.879, 95%CI, 0.793-0.974, P = 0.014) and POAF (OR = 0.714, 95%CI, 0.516-0.988, P = 0.042), respectively. However, in multiple linear analysis, lower rates of PPCs and POAF associated with TPVB usage, rather than TPVB usage, were responsible for the reduced LOS.The usage of TPVB may be a feasible and adjustable approach to reduce the rates of PPCs and POAF and associated LOS in thoracoscopic lung cancer surgery.

Readmission to intensive care unit (ICU) after esophageal cancer surgery is a major concern and can be associated with increased adverse outcomes. This study aims to explore causes, risk factors and early outcomes. We performed a monocentric retrospective analysis in 1140 patients who received esophageal cancer surgery in a higher volume surgeon group between January 2016 and December 2019, at Shanghai Chest Hospital. Univariate and multivariate analysis were performed to identify risk factors, and 1:4 propensity score matching (PSM) analysis was conducted to compare early outcomes. The incidence of ICU readmission was about 3.8% (43 of 1140). The most common cause was respiratory failure, found in 30 patients (70%). ICU readmission mainly occurred within 3 days after surgery, accounting for 46.5% (20 of 43), with the median length of stay was 3 days. Multivariate analysis identified heavy smoking (odds ratio[OR] = 2.445, 95% CI = 1.128 to 5.301, P = 0.024), intraoperative hypoxemia (OR = 2.461, 95% CI = 1.078 to 5.621, P = 0.033), mechanical ventilation during initial ICU stay (OR = 16.036, 95% CI = 7.332 to 35.074, P

Background There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Methods Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected. Results Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups. Conclusions General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Trial registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020.

Background：There are no studies on the use of dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia (PCIA) in females undergoing thoracic surgery. We postulate that introducing dexmedetomidine to a combination of dezocine-based PCA drugs and sufentanil will increase female patients' global satisfaction degree.Methods：One hundred fifty-two female patients with physical classification type I or II according to the American Society of Anesthesiologists undergoing thoracoscopic surgery were arbitrarily classified into two categories, either receiving sufentanil and dezocine-based PCIA (group C) or incorporating dexmedetomidine with sufentanil and dezocine-based PCIA (group D). The patients' global satisfaction degree, postoperative nausea and vomiting (PONV), PCA bolus, rescue analgesia requirements, drug-related adverse effects, rest and coughing visual analogue scale (VAS) ratings, and Ramsay sedation scores (RSS) were measured at 6, 12, 24, 36 and 48 h after surgery.Results：Compared with the C group, the patient satisfaction degree was significantly higher; pain scores at rest and coughing were significantly different at 6, 12, 24, 36 and 48 h postoperatively; less rescue analgesia and PCA bolus were required; and a lower incidence of PONV was found in the D group. There were non-significant trends for the sedation scores and drug-related adverse effects in both groups.Conclusions：Dexmedetomidine combined with sufentanil and dezocine increased female patients' global satisfaction degree after thoracoscopic surgery. This effect could be linked to the improvement in postoperative analgesia and reduction in postoperative nausea and vomiting; the combined treatment did not increase drug-related adverse effects in female patients.Trial registration: Chinese Clinical Trial Registry number, ChiCTR2000030429. Registered on March 1, 2020.

Background The objective of this study was to explore the consistency and correlation of two troponin (cTn) subtypes, troponin I (cTnI) and high-sensitivity troponin T (hs-cTnT), which can be used to judge early myocardial injury after curative resection of oesophageal cancer. Methods This study is a secondary analysis of data obtained from a previous randomized controlled trial on postoperative myocardial injury in 70 patients undergoing elective curative resection of oesophageal cancer who were randomly assigned to undergo aggressive body temperature management (nasopharyngeal temperature 36.61 ± 0.18 °C) or standard body temperature management (35.80 ± 0.18 °C, n = 35 in each arm). The serum cTnI and hs-cTnT levels were measured in each patient at the 4 time points: before the operation and 6 h ~ 12 h, 24 h and 48 h after the operation. The diagnostic criteria of myocardial injury followed the third edition ESC/ACCF definition of myocardial infarction. The primary outcomes included the following: (1) the incidence of myocardial injury and the relationship between hs-cTnT and cTn and (2) the consistency and correlation of the two cTn subtypes. Results A total of 280 pairs of cTn samples were tested. The incidence of postoperative day 2 myocardial injury was 8.6% (3/35) among patients receiving aggressive body temperature management and 31.4% (11/35) among patients receiving standard body temperature management (P < 0.05). Among 3 patients who experienced myocardial injury in the aggressive body temperature management group, 2 met the diagnostic criteria for cTnI and hs-cTnT and only 1 met the diagnostic criteria for hs-cTnT. Among the 11 patients who experienced myocardial injury in the standard body temperature management group, 7 met the diagnostic criteria for cTnI and hs-cTnT and only 3 met the diagnostic criteria for hs-cTnT; only 1 met the diagnostic criteria for cTnI. The bias of cTnI and hs-cTnT was − 8.82 ± 31.91 ng/L. The consistency limit was − 71.37 ~ 53.73 ng/L. The proportion within the scope of the consistency of its corresponding boundary was 98.57%. The correlation coefficient of cTnI and hs-cTnT was 0.845 (P < 0.05). Conclusions In the evaluation of postoperative myocardial injury in patients undergoing curative resection of oesophageal cancer, cTnI and hs-cTnT exhibit high consistency and a good correlation. The combination of cTnI and hs-cTnT can improve the detection rate of myocardial injury, thus providing a better reference than a single measure alone for reducing the risk of perioperative myocardial injury in patients. Trial registration ChiCTR-INR-17011621. Registered June 10, 2017.

Background Serratus anterior and paravertebral blocks can both be used for video-assisted thoracic surgery. However, serratus anterior blocks are easier to perform, and possibly safer. We therefore tested the primary hypothesis that serratus anterior plane blocks and thoracic paravertebral blocks provide comparable analgesia for video-assisted thoracic surgery. Secondarily, we tested the hypothesis that both blocks lengthen the time to onset of surgical pain and reduce the need for rescue tramadol. Methods Patients having video-assisted thoracic lobectomy or segmentectomy were randomly allocated to ultrasound-guided thoracic paravertebral blocks, n = 30; ultrasound-guided serratus anterior plane blocks, n = 30; or, general anaesthesia alone, n = 30. Visual analogue pain scores analogue pain scores at rest, during coughing and Prince-Henry pain scores were used to assess postoperative analgesia. Our primary analysis was noninferiority of serratus anterior blocks compared with paravertebral blocks. Results Baseline characteristics were comparable among the three groups. Two hours after surgery, the mean difference in visual analogue pain scores between the serratus anterior and paravertebral blocks was 0.0 (96.8% CI -0.4 to 0.3) cm at rest, -0.2 (-0.8 to 0.4) cm during coughing and -0.1(-0.5 to 0.3) for Prince-Henry pain scores. After 24 h, the mean difference was 0.0 (-0.7 to 0.8) cm at rest, 0.1 (-0.8 to 0.9) cm during coughing and 0.1(-0.4 to 0.6) for Prince-Henry pain scores. All differences were significantly noninferior. Time to onset of pain after surgery was 19 ± 5 (SD) hours with serratus anterior blocks, 16 ± 5 h with paravertebral blocks and 12 ± 5 h with general anaesthesia. Anaesthesia with either block was associated with significantly less intra-operative propofol and sufentanil, reduced postoperative rescue analgesia (tramadol) and less postoperative nausea and vomiting compared with general anaesthesia alone. Patients with serratus anterior block had a significantly lower incidence of intra-operative hypotension and requirement for intra-operative vasopressor (3.4%), compared with general anaesthesia alone. Serratus anterior block took less time to perform than paravertebral block (5.1 ± 1.1 min versus 10.1 ± 2.9 min). Conclusion Serratus anterior plane blocks, which are easier and quicker than paravertebral blocks, provide comparable analgesia in patients having video-assisted thoracic surgery. Clinical trial number and registry url ChiCTR1800017671; http://www.chictr.org.cn/hvshowproject.aspx?id=13510.

Background: The risk of intraoperative hypothermia, which may cause myocardial ischaemia during the early postoperative period, is relatively high in middle-aged and elderly patients undergoing curative resection of oesophageal cancer. The objective of this study was to explore the value of two troponin (cTn) subtypes, troponin I (cTnI) and high-sensitivity troponin T (hs-cTnT), which can be used to judge early myocardial injury after curative resection of oesophageal cancer.Methods: Seventy patients undergoing elective curative resection of oesophageal cancer were randomly assigned to undergo aggressive body temperature management (nasopharyngeal temperature ≥36°C) or standard body temperature management (n = 35 in each arm). Venous blood samples were collected from the patients before the operation and at postoperative 6 h~12 h, 24 h and 48 h, and serum cTnI and hs-cTnT levels were measured. The primary outcomes included the following: (1) the incidence of myocardial injury and the relationship between hs-cTnT and cTn; and (2) the consistency and correlation of the two cTn subtypes.Results: The incidence of postoperative day 2 myocardial injury was 8.6% (3/35) among patients receiving aggressive body temperature management and 31.4% (11/35) among patients receiving standard body temperature management (P<0.05). Among 3 patients who experienced myocardial injury in the aggressive body temperature management group, 2 met the diagnostic criteria for cTnI and hs-cTnT and only 1 met the diagnostic criteria for hs-cTnT. Among the 11 patients who experienced myocardial injury in the standard body temperature management group, 7 met the diagnostic criteria for cTnI and hs-cTnT and only 3 met the diagnostic criteria for hs-cTnT; only 1 met the diagnostic criteria for cTnI. The bias of cTnI and hs-cTnT was -8.82±31.91 ng/L. The consistency limit was -71.37~53.73 ng/L. The proportion within the scope of the consistency of its corresponding boundary was 98.57%. The correlation coefficient of cTnI and hs-cTnT was 0.845 (P<0.05).Conclusions: In the evaluation of postoperative myocardial injury in patients undergoing curative resection of oesophageal cancer, cTnI and hs-cTnT exhibit high consistency and a good correlation. The combination of cTnI and hs-cTnT can improve the detection rate of myocardial injury, thus providing a better reference than a single measure alone for reducing the risk of perioperative myocardial injury in patients.Trial registration: ChiCTR-INR-17011621. Registered June 10, 2017

Background: To examine the influence of positive end-expiratory pressure (PEEP) settings on lung mechanics and oxygenation in elderly patients undergoing thoracoscopic surgery. Methods: One hundred patients aged >65 years were randomly allocated into either the PEEP5 or the electrical impedance tomography (EIT) group (PEEP EIT ). Each group underwent volume-controlled ventilation (tidal volume 6 mL/kg predicted body weight) with the PEEP either fixed at 5 cmH 2 O or set at an individualized EIT setting. The primary endpoint was the ratio of the arterial oxygen partial pressure to the fractional inspired oxygen (PaO 2 /FiO 2 ). The secondary endpoints included the driving pressure, and dynamic respiratory system compliance (C dyn ). Other outcomes, such as the mean airway pressure (P mean ), mean arterial pressure (MAP), lung complications and the length of hospital stay were explored. Results: The optimal PEEP set by EIT was significantly higher (range from 9–13 cmH 2 O) than the fixed PEEP. PaO 2 /FiO 2 was 47 mmHg higher (95% CI: 7–86 mmHg; P=0.021), C dyn was 4.3 mL/cmH 2 O higher (95% CI: 2.1–6.7 cmH 2 O; P 2 O lower (95% CI: 2.2–5.1 cmH 2 O; P EIT group than in the PEEP5 group. At 1 h during OLV, PaO 2 /FiO 2 was 93 mmHg higher (95% CI: 58–128 mmHg; P dyn was 4.4 mL/cmH 2 O higher (95% CI: 1.9–6.9 mL/cmH 2 O; P=0.001), and the driving pressure was 4.9 cmH 2 O lower (95% CI: 3.8–6.1 cmH 2 O; P EIT group than in the PEEP5 group. PaO 2 /FiO 2 was 107 mmHg higher (95% CI: 56–158 mmHg; P EIT group than in the PEEP5 group during double-lung ventilation at the end of surgery. Conclusions: PEEP values determined with EIT effectively improved oxygenation and lung mechanics during one lung ventilation in elderly patients undergoing thoracoscopic surgery.

The objective of this study was to explore the prevalence of undiagnosed mild cognitive impairment (MCI) and its association with adverse outcomes in elderly patients undergoing thoracic surgery.A prospective cohort study.Large tertiary medical center.The authors enrolled 170 patients aged 65 years or older who were scheduled for thoracic surgery between November 7, 2018, and April 1, 2019, at the Shanghai Chest Hospital. Patients with a history of schizophrenia or dementia disease, uncorrected vision or hearing impairment, and refusal to participate were excluded.A total of 154 elderly patients completed the Chinese version of the Montreal Cognitive Assessment (MoCA) test preoperatively and were included in the final analysis. They were categorized into a normal group (MoCA ≥ 26 scores, group N) and an abnormal group (MoCA26 scores, group AN) based on test results. Delirium was assessed with the Confusion Assessment Method twice daily during the first 3 postoperative days.The primary outcome was the incidence of postoperative delirium (POD). Secondary outcomes included the incidence of postoperative pulmonary complications (PPCs), cardiovascular complications, other complications, intensive care unit (ICU) stay, and the hospital length of stay (LOS). The incidence of MCI before thoracic surgery in elderly patients was 49.4% (76 of 154). Compared with group N, MCI could increase the incidence of POD (14.1% v 30.3%, p = 0.016) and median LOS (4 d v 5 d, p = 0.016). However, the differences in pulmonary complications, cardiovascular and other complications, and ICU stay were not significant. Multivariable logistic regression analysis showed preoperative MCI (OR = 2.573, 95% CI =1.092 to 6.060, p = 0.031) as an independent risk factor of POD. Compared with the elderly patients without POD, POD could increase the risk of PPCs (17.5% v 35.3%, p = 0.026) and median LOS (4 d v 5 d, p0.001).The incidence of MCI before thoracic surgery in elderly patients was higher and associated with a higher rate of adverse postoperative outcomes. The findings may be important for preoperative patient counseling, operative planning, and eventually reducing potential risk exposure and related outcomes.

Background Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery is a major concern and can be associated with increased adverse outcomes. Therefore, this study was conducted to identify any possible clinical risk factors and related outcomes. Methods This monocentric retrospective study was conducted between January 2016 and December 2018 and included 20,565 consecutive patients who were undergoing thoracoscopic lung operations. Planned thoracotomy, complete pneumonectomies, angioplastic or bronchoplastic or chest wall resections, bilateral lung resections, or cases with missing data were excluded. Univariate and multivariate analyses were performed to identify risk factors for conversion to thoracotomy. A 1:1 propensity score matching analysis was conducted to verify postoperative outcomes. Results The overall incidence of conversion to thoracotomy was 1.0% (205 of 20,565). The most common cause of conversion was vascular injury, found in 60 patients (29.3%). Multivariable logistic regression analysis identified age older than 60 years, male sex, preoperative chemotherapy, lesion diameter of 1.4 cm or larger, clinical nodal involvement, lymph node calcification, pleural adhesions, type of resection, location of resection, ipsilateral reoperation, and lower surgical experience as independent risk factors of conversion. Among patients who underwent conversion to thoracotomy and who had any complications, the percentages of pulmonary complications, chest tube duration, intensive care unit stay, and hospital length of stay were higher. Within the conversion groups, emergency (37 of 205; 18%) and nonemergency (168 of 205; 82%) conversion groups were similar for overall postoperative complications. Conclusions The study identified 11 potential risk factors of conversion to thoracotomy, which was associated with increased postoperative complications. The findings may be important for operative planning, preoperative patient counseling and risk adjustment, and eventually reducing conversion rates and related outcomes.

Objectives Despite a long history of concerns regarding patient safety during clinical care, some patients undergoing thoracic surgery continue to experience adverse events (AEs). AEs are a major significant source of perioperative morbidity and mortality following thoracic surgery. This study analysed the causes, treatment and prognosis of perioperative AEs to provide a reference for further surgical safety. Methods The authors collected a total of 62,571 thoracic surgery anaesthesia records via the Anaesthesia Information Management System (AIMS) from 14 August 2006 to 14 August 2017 and obtained 150 cases of perioperative serious AEs from the “adverse events registration” subsystem. The related hospitalization data of the 150 patients were analysed, including anaesthesia, recovery room time, ICU records and follow-up outcomes. The causes of these AEs were classified as follows: events related to the patients’ pathogenic conditions(P); surgery-related factors(S); anaesthesia-related factors(A); and interactions between pathogenic, surgical and anaesthesia factors (P&S&A). We then analysed the main clinical manifestations, causes and treatment of these events. Results The overall rate of perioperative AEs in thoracic surgery (n = 62,571) was 0.2%. Of these, 10.7% were. caused by P and 23.3% by A; neither cause led to patient death. S and P&S&A accounted for 55.3 and 10.7% of AEs, respectively; together, they accounted for 66%. Twelve patients with postoperative AEs caused by S or P&S&A died within 3 days (8% of 150 cases). A total of 33%(50/150) of patients experienced sudden cardiac arrest (SCA) and recovered successfully. Surgical massive haemorrhage (22%, 33/150) was reported as a predominant mortality-related outcome in this group, and 8 of the 12 deaths were caused by massive haemorrhage. Conclusions The rate of perioperative AEs after thoracic surgery was 0.2%. AEs must be identified and treated immediately. An important factor in anaesthesia-related events was respiratory management. Two major clinical manifestations of surgery-related events were cardiac arrest and massive haemorrhage. Cardiac arrest was the major factor contributing to AEs, but its adverse consequences could be avoided with timely discovery and proper treatment. Massive haemorrhage is a significant cause of mortality that can be prevented with a surgeon’s early diagnosis and appropriate interventions.

This study aims to investigate the role of Cannabinoid receptor 2 (CB2) on osteogenesis of bone marrow-derived mesenchymal stem cells (BMSCs) under hypoxia.BMSCs were isolated from Sprague-Dawley rats and cultured in the presence of cobalt chloride (CoClCoClCoCl

Risk of intraoperative hypothermia is relatively high in middle-aged and elderly patients undergoing curative resection of esophageal cancer, which may cause myocardial ischemia during the early postoperative period. The objective of this study was to compare aggressive or standard body temperature management for lowering the incidence of postoperative myocardial injury that was assessed by troponin levels collected at a priori defined set times in these patients.Seventy patients undergoing elective curative resection of esophageal cancer were randomly assigned to undergo aggressive body temperature management (nasopharyngeal temperature ≥36°C) or standard body temperature management (n = 35 in each arm). The primary outcome was myocardial injury, defined as the occurrence of elevated troponin I (0.06 µg/L) or elevated high-sensitivity troponin T (≥0.065, or 0.02 µg/L≤ high-sensitivity troponin T0.065 µg/L, but with an absolute change of at least 0.005 µg/L) or both during 2 days after surgery. Secondary outcomes included (1) severe arrhythmia, including atrial fibrillation, supraventricular tachycardia, frequent premature ventricular contractions intraoperatively or during 3 days postoperatively; (2) hypoxemia or metabolic acidosis during the first 12 h postoperatively; and (3) deep vein thrombosis or pulmonary embolism during 3 days postoperatively.Incidence of postoperative 2-day myocardial injury was 8.6% (3/35) among patients receiving aggressive body temperature management and 31.4% (11/35) among patients receiving standard body temperature management (P = .017, χ). Relative risk of myocardial injury in the aggressive body temperature management group was 0.27 (95% CI, 0.08-0.89). Incidence of intra- and postoperative 3-day severe cardiac arrhythmia was 2.9% (1/35) among patients receiving aggressive body temperature management and 28.6% (10/35) among patients receiving standard body temperature management. Incidence of postoperative 12-h hypoxia was 17.1% (6/35) with aggressive body temperature management and 40.0% (14/35) with standard body temperature management. Incidence of postoperative 12-h metabolic acidosis was 20% (7/35) among patients receiving aggressive body temperature management and 48.6% (17/35) among patients receiving standard body temperature management. Incidence of postoperative 3-day deep vein thrombosis or pulmonary embolism was 0% (0/35) with aggressive body temperature management and 2.9% (1/35) with standard body temperature management.Aggressive body temperature management may be associated with a lower incidence of postoperative myocardial injury.

BACKGROUND: Atrial fibrillation (AF) is common after thoracoscopic anatomic lung surgery and can be associated with increased adverse outcomes. However, the incidence, risk factors, and related outcomes of intraoperative AF in thoracoscopic anatomical lung surgery are unknown. METHODS: We retrospectively analyzed the files of 14,986 patients who had presented to the Shanghai Chest Hospital for thoracoscopic anatomic lung operations between January 2016 and December 2018. Univariate and multivariate analyses were conducted to identify risk factors for intraoperative AF, and a 1:1 propensity score-matched (PSM) analysis was performed to compare postoperative outcomes. RESULTS: The incidence of intraoperative AF was 1.2% (177/14,986). Multivariate analysis identified age older than or equal to 60 years [odds ratio (OR) =1.872, P

Objectives This study aims to investigate the role of Cannabinoid receptor 2 (CB2) on osteogenesis of bone marrow-derived mesenchymal stem cells (BMSCs) under hypoxia. Materials and methods BMSCs were isolated from Sprague-Dawley rats and cultured in the presence of cobalt chloride (CoCl2) to induce intracellular hypoxia. Cell proliferation was measured with MTT assay. Quantitative real-time PCR and western blot were applied to evaluate the mRNA and protein expressions of CB2 and osteogenic indicators including osteocalcin, RUNX2, collagen-1 and osterix (SP7). The osteogenic differentiation of BMSCs was further examined by ALP assay and alizarin red S (ARS) staining. Moreover, the activation of MAPKs signaling pathways was analyzed by western blot. Results CoCl2 dose-dependently increased hypoxia inducible factor while higher concentrations (200 and 400 μM) of CoCl2 markedly inhibited cell proliferation. CoCl2 induced hypoxia significantly increased the protein and mRNA expressions of osteocalcin, RUNX2, collagen-1 and osterix, along with enhanced ALP and ARS staining. Interestingly, such effects can be inhibited by the addition of CB2 inhibitor AM630. Moreover, AM630 partially inhibited hypoxia-induced p38 and ERK pathways, which may lead to a decrease in the osteogenic transcripts of RUNX2, collagen-1 and osterix. Conclusions CoCl2 induced hypoxia could promote osteogenesis of rat BMSCs possibly through CB2.

Linguistic continuous ordered weighted distance (LCOWD) measure is developed.Some properties of the LCOWD measure are discussed.Different families and extensions of the LCOWD measure are investigated.The new approach is applied to group decision making. This paper develops a new method for group decision making and introduces a linguistic continuous ordered weighted distance (LCOWD) measure. It is a new distance measure that combines the linguistic continuous ordered weighted averaging (LCOWA) operator with the ordered weighted distance (OWD) measure considering the risk attitude of decision maker. Moreover, it also can relieve the influence of extremely large or extremely small deviations on the aggregation results by assigning them smaller weights. These advantages make it suitable to deal with the situations where the input arguments are represented with uncertain linguistic information. Some of the main properties of the LCOWD measure and different particular cases are studied. The applicability of the new approach is also analyzed focusing on a group decision making problem.

OBJECTIVES This study aims to examine the effects of amiodarone in restoring sinus rhythm in patients with new-onset atrial fibrillation during thoracic operations. METHODS A total of 12 305 consecutive patients undergoing elective lung/oesophageal surgery were screened. Data analysis included 416 patients with new-onset atrial fibrillation not receiving any antiarrhythmic agents (control group, n = 235) or receiving amiodarone (amiodarone group, n = 181). RESULTS In the analysis that included all cases (lung and oesophageal surgery), the rate of recovery to sinus rhythm during surgery was 22.1% (52/235) in the control group vs 23.2% (42/181) in the amiodarone group (P = 0.795). A multivariable analysis showed that intraoperative sinus rhythm recovery was not associated with the use of amiodarone [odds ratio 0.91, 95% confidence interval (CI) 0.56-1.50]. Sinus rhythm was achieved eventually during the postoperative period in all patients who failed to achieve sinus rhythm during the surgery (n = 322). However, a Kaplan-Meier analysis showed earlier recovery in the amiodarone group (median time of 1.1 days, 95% CI 0.97-1.24 vs 1.8 days, 95% CI 1.62-2.04; P

BACKGROUND Delayed revascularization process and substitute infection remain to be key challenges in tissue engineered (TE) airway reconstruction. We propose an "in-vivo bioreactor" design, defined as an implanted TE substitutes perfused with an intra-scaffold medium flow created by an extracorporeal portable pump system for in situ organ regeneration. The perfusate keeps pre-seeded cells alive before revascularization. Meanwhile the antibiotic inside the perfusate controls topical infection. METHODS A stage IIIA squamous lung cancer patient received a 5-cm TE airway substitute, bridging left basal segment bronchus to carina, with the in-vivo bioreactor design to avoid left pneumonectomy. Continuous intra-scaffold Ringer's-gentamicin perfusion lasted for 1 month, together with orthotopic peripheral total nucleated cells (TNCs) injection twice a week. RESULTS The patient recovered uneventfully. Bronchoscopy follow-up confirmed complete revascularization and reepithelialization four months postoperatively. Perfusate waste test demonstrated various revascularization growth factors secreted by TNCs. The patient received two cycles of chemotherapy and 30 Gy radiotherapy thereafter without complications related to the TE substitute. CONCLUSIONS In-vivo bioreactor design combines the traditionally separated in vitro 3D cell-scaffold culture system and the in vivo regenerative processes associated with TE substitutes, while treating the recipients as bioreactors for their own TE prostheses. This design can be applied clinically. We also proved for the first time that TE airway substitute is able to tolerate chemo-radiotherapy and suitable to be used in cancer treatment.

Background Thoracic surgery requires the effective collapse of the non-ventilated lung. In the majority of cases, we accomplished, accelerated lung collapse using a double-lumen tube (DLT). We hypothesized that using the two-minute disconnection technique with a DLT would improve lung collapse during subsequent one-lung ventilation. Methods Fifty patients undergoing thoracoscopic surgery with physical classification I or II according to the American Society of Anesthesiologists were randomly divided into two groups for respiratory management of one-lung ventilation (OLV). In group N, OLV was initiated after the DLT was disconnected for 2 min; the initiation time began when the surgeon made the skin incision. In group C, OLV was initiated when the surgeon commenced the skin incision and scored the quality of lung collapse (using a four-point ordinal scale). The surgeon’s satisfaction or comfort with the surgical conditions was assessed using a visual analogue scale. rSO2 level, mean arterial pressure, pulse oxygen saturation, arterial blood gas analysis, intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and awakening time were determined in patients at the following time points: while inhaling air (T0), after anaesthesia induction andinhaling 100% oxygen in the supine position under double lung ventilation for five mins (T1), at two mins after skin incision (T2), at ten mins after skin incision (T3), and after the lung recruitment manoeuvres and inhaling 50% oxygen for five mins (T4). Results The two-minute disconnection technique was associated with a significantly shorter time to total lung collapse compared to that of the conventional OLV ventilation method (15 mins vs 22 mins, respectively; P

Calcium nitrate Ca(NO3)2 aqueous solution was found to be an effective aqueous electrolyte for a supercapacitor using ordered mesoporous carbon as the electrode materials. The supercapacitive behavior of ordered mesoporous carbon CMK-3 electrode in Ca(NO3)2 aqueous electrolyte was investigated utilizing cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), and galvanostatic charge/discharge measurements. CMK-3 electrode shows excellent supercapacitive behavior with wide voltage window, high specific gravimetric capacitance and satisfactory electrochemical stability in Ca(NO3)2 aqueous electrolyte. The specific gravimetric capacitance of CMK-3 electrode in Ca(NO3)2 aqueous electrolyte reaches 210 F g−1 at a current density of 1 A g−1, which is higher than that in conventional aqueous electrolytes NaNO3 and KOH solution about 40% and 54%, respectively. The high charge density of the electric double layer formed at the interface of the CMK-3 electrode and Ca(NO3)2 aqueous electrolyte and the pseudo-capacitive effect originating from the oxygen groups on the surface of CMK-3 were believed to respond for the excellent supercapacitive behavior of CMK-3 electrode in Ca(NO3)2 aqueous electrolyte.

Various tumor types including breast, prostate, and lung carcinomas preferentially metastasize to the skeleton, where they induce significant bone remodeling, destruction, and bone cancer pain (BCP).1–3 BCP is often severe and intractable and is a significant contributing factor to morbidity and loss of quality of life.4 Most of the current pharmacological treatments provide nonselective relief for pain syndromes. Even for palliative radiotherapy, the rate of complete pain relief remains low.5 Therefore, it is pivotal to investigate the pathogenesis of BCP and identify novel therapeutic targets for translational medicine. Inflammatory, neuropathic, and/or ischemic components have been reported to be involved in cancer-induced bone pain.6 In rodent BCP models, bone metastasis of cancers alters the structure, physiology, and biochemistry of the bone and concurrently induces mechanical and inflammatory hyperalgesia.7 In particular, hyperexcitability of nociceptive dorsal root ganglion (DRG) neurons is associated with inflammatory pain in rodent models.8 Emerging evidence indicates that alterations in gene expression9–15 and signaling pathways16–18 contribute to induction and maintenance of BCP. For example, upregulation of P2X3 receptors,9 sodium channels Nav1.813 and Nav1.9,10 brain-derived neurotrophic factor,11,19 acid-sensing ion channel 3,12 protease-activated receptor 2 and 4,14 and activation of cAMP-PKA,16 PI3K/Akt,17 and Hedgehog signaling18 were involved in DRG-mediated BCP in a rat model. Moreover, several studies have shown attenuation of BCP in rats. These studies included overexpression of suppressor of cytokine signaling 3 in DRG,15 suppression of asparaginyl endopeptidase in cancer cells, intrathecal injection of genetically engineered human bone marrow stem cells expressing the proenkephalin gene,20 and intraperitoneal administration of a somatostatin receptor type 4 selective agonist, J-2156. However, comprehensive gene expression profiling of DRGs in a BCP model has not been reported. Such profiling could help identify novel therapeutic targets for the relief of BCP. In this study, next-generation RNA-sequencing (RNA-seq) was performed to detect the differentially expressed genes (DEGs) in DRGs from a rat BCP model. The results showed that DEGs were enriched in signaling pathways associated with bone pain, inflammation, and degeneration. In particular, Bmp2 was significantly increased in DRG neurons in a BCP rat model, and targeting of Bmp2 by siRNA ameliorated BCP in vivo, suggesting that Bmp2 may be an attractive therapeutic target for BCP.

Background Lung injury induced by ischemia or reperfusion significantly accounts for the risk of early mortality of lung transplantation (LT). Recent studies have demonstrated that hydrogen sulfide (H 2 S) and its endogenous synthase cystathionine-γ-lyase (CSE) confer protection against injury induced by ischemia or reperfusion in various organs. This prompted us to define the role of CSE/H 2 S pathway in transplantation-induced lung injury. Methods We performed single left LT in male Sprague–Dawley rats after 3 h of cold ischemia time. H 2 S donor NaHS (14 μmol/kg, intraperitoneally) or CSE inhibitor propargylglycine (37.5 mg/kg, intraperitoneally) was administered 15 min before the start of the LT. CSE protein expression, H 2 S generation, and the severity of pulmonary graft injuries were estimated at 24 h after reperfusion. Results Both CSE protein expression and H 2 S generation were markedly decreased in transplanted rat lungs compared with those in sham-operated lungs. In the lung-transplanted rats, NaHS administration significantly improved pulmonary function and decreased lipid peroxidation and myeloperoxidase activity. In addition, NaHS inhibited the production of interleukin 1β but increased interleukin 10 levels in graft lung tissues. In contrast, propargylglycine further exacerbated pulmonary function and lung injuries after experimental orthotopic LT. Conclusions To our knowledge, this study for the first time has demonstrated that the suppression of CSE expression and H 2 S production is associated with transplantation-induced lung injury. Both exogenous and endogenous H 2 S seem to have protective effects against acute LT injury by their multiple functions including antioxidation and anti-inflammation, suggesting that modulation of H 2 S levels may be considered a potential therapeutic approach in LT.

Objective: The aim of the study was to explore the feasibility of titrating tidal volume (V T) and positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) based on ventilation distribution and oxygenation. Approach: Twenty-four consecutive patients requiring intubation with a double-lumen tube and subsequent OLV for thoracic surgical procedures were examined prospectively in lateral posture. Electrical impedance tomography (EIT), blood gases, respiratory mechanics were successfully measured in 21 patients at various combinations of V T (4 ml kg−1, 6 ml kg−1, 8 ml kg−1 body weight) and PEEP (0 cm H2O, 4 cm H2O, 8 cm H2O) during OLV. Main results: Low V T and low PEEP resulted in low global respiratory system compliance (C rs). Arterial partial pressure of O2 (PaO2) decreased with falling V T. Regional C rs measured with EIT showed high values at high V T and high PEEP in all but two patients. Regional C rs in mid and most dependent regions indicated tidal recruitment/derecruitment in eight patients at 8 ml kg−1 of V T and 4 cm H2O of PEEP; in four patients at 8 ml kg−1 and 0 cm H2O; in one patient at 6 ml kg−1 and 8 cm H2O. The changes in regional C rs induced by decreasing PEEP from 8 to 4 cm H2O were much smaller than those from 4 to 0 cm H2O. Ventilation distribution was most inhomogeneous with V T of 8 ml kg−1. All measures differed significantly among various V T and PEEP steps (p < 0.05). Significance: By using EIT in combination with PaO2, it is feasible to titrate V T and PEEP at the bedside during OLV.