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Background: With increased early detection efforts, surgery for early-stage lung cancer is expected to rise. Pafolacianine is the first FDA approved targeted optical imaging agent indicated as an adjunct for intraoperative identification of malignant and nonmalignant pulmonary lesions in adult patients with known or suspected cancer in the lung., Methods: This is a retrospective review of the malignant and nonmalignant lesions identified by pafolacianine with intraoperative molecular imaging (IMI) in the multi-center Phase 2 and Phase 3 ELUCIDATE clinical trials. All lesions meeting the intent to treat criteria from the combined studies were included. Histopathology for malignant and nonmalignant lesions and immunohistochemistry (ICH) for folate receptor alpha (FRα) and folate receptor beta (FRβ), which pafolacianine binds to, were assessed., Results: A total of 273 lesions resected from 191 patients were analyzed. The identification of primary and occult malignant lesions with pafolacianine in combination with standard practice was improved (P < .001) when compared to standard practice alone. A range of histologies were demonstrated including adenocarcinoma (primary and metastatic), squamous cell carcinoma, adenoid cystic carcinoma, chordoma, lymphoma, and papillary thyroid cancer. Ninety-two percent (205 of 223) of lesions tested for folate expression were positive for FRα or FRβ expression., Conclusions: While initially intended to identify adenocarcinoma, IMI with pafolacianine targets a broad histological cross-section of malignant and nonmalignant primary and metastatic lesions in the lung. As real-world use expands, additional insight will continue to inform utility of pafolacianine in clinical practice and may broaden clinical applicability., Competing Interests: Disclosure The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Doctors Murthy, Singhal, Reddy, Martin, Rice, and Sarkaria were investigators in the sponsored trials and report financial support, administrative support, equipment, drugs, or supplies, provided by On Target Laboratories during the course of the clinical trials. No compensation was paid directly to the investigators from On Target Laboratories. Timothy Biro and Tina Barrett report a relationship with On Target Laboratories that includes employment and equity or stock. Dr. Gary Stevens is with Dynastat which was paid by the sponsor On Target Laboratories for statistical analysis work related to the publication. Dr. Lopez is an employee of Moffitt Cancer Center which was paid by the sponsor On Target Laboratories for IHC and pathology related services. Dr Murthy and Dr. Sarkaria report a relationship with On Target Laboratories. Dr Reddy, Dr Rice, Dr Martin, and Dr. Singhal report no further relationship with On Target Laboratories. This report includes data generated from a multi-center phase 2 trial and a randomized multi-center Phase 3 trial sponsored by On Target Laboratories., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The implications of a lung malignancy in a lung transplant recipient are poorly understood. Here, we linked national transplant and cancer databases to determine how lung cancer impacted prognosis in lung transplant recipients with incidentally explanted lung cancers (IELCs). Records from the Scientific Registry of Transplant Recipients and National Cancer Database were linked to identify 186 patients who received a lung transplant and were subsequently diagnosed with lung cancer. These patients were determined to have IELC and were compared with control patients who received a lung transplant but were not diagnosed with IELC. Of the 186 patients, 144 had non-small cell lung cancer (NSCLC), 6 had small cell lung cancer, and 36 had neuroendocrine cancer. Patients with stage I/II NSCLC or any stage neuroendocrine cancer had overall survival and cancer-related mortality rates comparable with those of controls. Conversely, patients with stage III/IV NSCLC had worse overall survival, higher rates of cancer-related mortality, and infrequently received cancer-specific nonoperative treatment. Taken together, stage I/II NSCLC and neuroendocrine cancers should be reconsidered as an absolute contraindication to transplant. Conversely, patients with stage III/IV NSCLC had worse outcomes, and strategies are needed to increase the use of adjuvant therapy., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: eXtended Reality (XR) technology, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), is a growing field in healthcare. Each modality offers unique benefits and drawbacks for medical education, simulation, and clinical care. We review current studies to understand how XR technology uses medical imaging to enhance surgical diagnostics, planning, and performance. We also highlight current limitations and future directions., Approach: We reviewed the literature on immersive XR technologies for surgical planning and intraoperative augmentation, excluding studies on telemedicine and 2D video-based training. We cited publications highlighting XR's advantages and limitations in these categories., Results: A review of 556 papers on XR for medical imaging in surgery yielded 155 relevant papers reviewed utilizing the aid of chatGPT. XR technology may improve procedural times, reduce errors, and enhance surgical workflows. It aids in preoperative planning, surgical navigation, and real-time data integration, improving surgeon ergonomics and enabling remote collaboration. However, adoption faces challenges such as high costs, infrastructure needs, and regulatory hurdles. Despite these, XR shows significant potential in advancing surgical care., Conclusions: Immersive technologies in healthcare enhance visualization and understanding of medical conditions, promising better patient outcomes and innovative treatments but face adoption challenges such as cost, technological constraints, and regulatory hurdles. Addressing these requires strategic collaborations and improvements in image quality, hardware, integration, and training., (© 2024 Society of Photo-Optical Instrumentation Engineers (SPIE).)

The integration of the ORION digital signal processing-based MCA system coupled with a 3″ × 3″ NaI(Tl) detector assembly with a GM detector for counting beta (β) has eliminated the need for a standalone β-γ method in which U3O8 is determined by gross β and gross γ counting. Uraniferous and mixed U-Th samples were taken up for study and compared with the results obtained from Canberra p-type coaxial high resolution gamma ray spectrometry detector. In uraniferous samples, U3O8 values obtained are within ±10%, whereas in the case of mixed U-Th samples, U3O8 values are within ±15%. Regression graphs drawn between the outcomes from the two analytical systems indicate R2 > 0.95 for Ra(eU3O8) and ThO2. In uraniferous samples, the R2 value for U3O8 was found to be > 0.99, but in mixed U-Th samples, it is 0.92. The closeness of agreement between the results obtained from two methods at various concentrations over the analytical range shows that the integrated system is suitable for the quantitative determination of eU3O8, U3O8, Ra(eU3O8), ThO2 and K in geological rock samples., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Prognostic nutritional index (PNI) and systemic immune-inflammatory index (SII) are two novel markers that have emerged as potential candidates as an early indication of the severity of the disease in coronavirus disease 2019 (COVID-19) patients., Objective: The objective of the study is to assess the utility of the prognostic nutritional index (PNI) and systemic immune-inflammatory index (SII) as markers of severity among patients with COVID-19 infection., Methods: This is a retrospective study conducted in a tertiary care centre in South India. A total of 80 patients diagnosed with COVID-19 were included in the study. The patients were divided into mild, moderate, and severe groups based on the clinical parameters as per Indian Council of Medical Research guidelines. Lab values taken at admission were obtained from patient records, using which the PNI and SII were calculated using standard formulae. These markers were correlated with the severity of the COVID-19 illness., Results: PNI and SII were significantly elevated in the patients with severe COVID-19 illness as compared with mild COVID-19 illness. The mean PNI among subjects with mild COVID-19 and severe COVID-19 being 46.62 ± 6.51 and 34.09 ± 5.81, respectively. The mean SII among subjects with mild COVID-19 was 9,52,287.2 ± 1,42,113, and among subjects with severe COVID-19 was 15,39,461 ± 8,04,285. The cut-off value for PNI and SII for predicting severity of COVID-19 illness was 35.93 and 5,82,400, respectively. The sensitivity for PNI was 87.5, and the SII was 95., Conclusion: The present study showed a significant correlation between the SII and PNI as markers used to determine the severity of COVID-19. Based on these findings, it can be effectively used independently of other markers to predict critical illness among COVID-19 patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

The authors review the development and steps of the robotic-assisted minimally invasive transhiatal esophagectomy. Key goals of the robot-assisted approach have been to address some of the concerns raised about the technical challenges with the traditional open transhiatal esophagectomy while keeping most of the steps consistent with the open approach., Competing Interests: Disclosure R.M. Reddy, Intuitive Surgical, Medtronic, Genentech, Atricure, On Target Laboratories., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Most patients with thoracic endometriosis present with catamenial pneumothorax, a rare condition in which recurrent episodes occur within 72 h before or after the start of menstruation. We report a case of thoracic endometriosis presenting with recurrent bloody pleural effusions without pneumothorax diagnosed on pleural fluid cytology. We describe the cytomorphology and immunoprofile of thoracic endometriosis and discuss the differential diagnoses, including neoplastic processes. We also highlight the importance of communication with clinicians for timeliness of diagnosis and treatment, especially when thoracic endometriosis is not suspected., (© 2024 Wiley Periodicals LLC.)

Background: It has been postulated that a possible barrier to pursuing cardiothoracic surgery is a lack of exposure and mentorship during training. In 2006, The Society of Thoracic Surgeons began the Looking to the Future Scholarship to expand interest in the field. Undecided trainees with limited exposure were prioritized in the selection process. This report summarizes the career outcomes of general surgery resident and medical student recipients., Methods: Scholarship recipients and nonrecipients (control) were queried in a Google search. The percentage of those who were cardiothoracic surgeons or in cardiothoracic training (%CTS) was calculated, as well as the percentage of female surgeons in cardiothoracic surgery., Results: From 2006 to 2021, there were 669 awardees. The %CTS was 63.7% for resident recipients and 31.4% for students, respectively. There was no significant difference in %CTS between resident and student recipients compared to nonrecipients. Notably, the percentage of female cardiothoracic surgeons was significantly greater for both resident and student recipients., Conclusions: The majority of resident recipients are now in cardiothoracic surgery, comparable to nonrecipients. While there was no significant difference between the percentage of recipients and non-recipients in cardiothoracic surgery, these groups differed substantially as nonrecipients had greater exposure and commitment to the field at the time of application., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Our statewide thoracic quality collaborative has implemented multiple quality improvement initiatives to improve lung cancer nodal staging. We subsequently implemented a value-based reimbursement initiative to further incentivize quality improvement. We compare the impact of these programs to steer future quality improvement initiatives., Methods: Since 2016, our collaborative focused on improving lymph node staging for lung cancer by leveraging unblinded, hospital-level metrics and collaborative feedback. In 2021, a value-based reimbursement initiative was implemented with statewide yearly benchmark rates for (1) preoperative mediastinal staging for ≥T2N0 lung cancer, and (2) sampling ≥5 lymph node stations. Participating surgeons would receive additional reimbursement if either benchmark was met. We reviewed patients from January 2015 to March 2023 at the 21 participating hospitals to determine the differential effects on quality improvement., Results: We analyzed 6228 patients. In 2015, 212 (39%) patients had ≥5 nodal stations sampled, and 99 (51%) patients had appropriate preoperative mediastinal staging. During 2016 to 2020, this increased to 2253 (62%) patients and 739 (56%) patients, respectively. After 2020, 1602 (77%) patients had ≥5 nodal stations sampled, and 403 (73%) patients had appropriate preoperative mediastinal staging. Interrupted time-series analysis demonstrated significant increases in adequate nodal sampling and mediastinal staging before value-based reimbursement. Afterward, preoperative mediastinal staging rates briefly dropped but significantly increased while nodal sampling did not change., Conclusions: Collaborative quality improvement made significant progress before value-based reimbursement, which reinforces the effectiveness of leveraging unblinded data to a collaborative group of thoracic surgeons. Value-based reimbursement may still play a role within a quality collaborative to maintain infrastructure and incentivize participation., Competing Interests: Conflict of Interest Statement R.R. receives consulting fees from Intuitive, Genentech, AtriCure, Medtronic, and On Target Labs. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Gender and geographic access to care play a large role in health disparities in esophageal cancer care. The aim of our study was to evaluate disparities in peri-operative outcomes for patients undergoing esophagectomy based on gender and geographic location., Methods: A retrospective cohort of prospectively collected data from patients who underwent esophagectomy from 2003 to 2022 was identified and analyzed based on gender and county, which were aggregated into existing state-level "metropolitan" versus "rural" designations. The demographics, pre-operative treatment, surgical complications, post-operative outcomes, and length of stay (LOS) of each group were analyzed using chi-squared, paired t -tests and single-factor ANOVA., Results: Of the 1545 patients, men (83.6%) and women (16.4%) experienced similar rates of post-operative complications, but women experienced significantly longer hospital ( p = 0.002) and ICU ( p = 0.03) LOSs as compared with their male counterparts, with no differences in 30-day mortality. When separated by geographic criteria, rural women were further outliers, with significantly longer hospital LOSs ( p < 0.001) and higher rates of ICU admission ( p < 0.001)., Conclusions: Rural female patients undergoing esophagectomy were more likely to have a longer inpatient recovery process compared with their female metropolitan or male counterparts, suggesting a need for more targeted interventions in this population.

Objectives: Cryoablation is increasingly being utilized as an alternative to epidurals for patients undergoing thoracotomies. Current evidence suggests cryoablation may decrease postoperative analgesia utilization, but could increase operative times. We hypothesized that the adoption of intraoperative cryoablation to manage post-thoracotomy pain would result in reduced length of stay and reduced perioperative analgesia compared to routine epidural use., Methods: A retrospective analysis was performed from a single, quaternary referral centre, prospective database on patients receiving thoracotomies between January 2020 and March 2022. Patients undergoing transthoracic hiatal hernia repair, lung resection or double-lung transplant were divided between epidural and cryoablation cohorts. Primary outcomes were length of stay, intraoperative procedure time, crossover pain management and oral narcotic usage the day before discharge., Results: During the study period, 186 patients underwent a transthoracic hiatal hernia repair, lung resection or double-lung transplant with 94 receiving a preoperative epidural and 92 undergoing cryoablation. Subgroup analysis demonstrated no significant differences in demographics, operative length, length of stay or perioperative narcotic use. Notably, over a third of patients in each cryoablation subgroup received a postoperative epidural (45.5% transthoracic hiatal hernia repair, 38.5% lung resection and 45.0% double-lung transplant) for further pain management during their admission., Conclusions: Cryoablation use was not associated with an increase in procedure time, a decrease in narcotic use or length of stay. Surprisingly, many cryoablation patients received epidurals in the postoperative period for further pain control. Additional analysis is needed to fully understand the benefits and costs of epidural versus cryoablation strategies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)