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Adenocarcinoma (AC) is the number one pathological entity of lung cancer with approximately 30-40% of cases. It is known to be heterogeneous and has 5 histopathological growth patterns. We evaluated the long-term survival rates of patients with predominant subtypes.290 patients with AC underwent pulmonary resection between 2012 and 2017 at our institution. We excluded all patients with lymph node involvement and distant metastases. Hence, 163 patients were included for further analysis. Predominant growth pattern was defined if more than 10% of cells showed a growth pattern. 1, 3, and 5-year survival rates were evaluated. Survival was assessed by Kaplan-Meier curves and the Cox proportional hazards model was used to identify prognostic factors for overall survival.Predominant growth patterns10% were compared to10% growth patterns of the same subtype. 1-year, 3-year, and 5-year overall survival rates of patients with predominant solid tumor growth10% differed significantly from patients with10% (88.4% vs. 97.6%, p = 0.04; 65.8% vs. 87.4% p = 0.001, 36.4% vs. 65.9% p = 0.01). Survival rates did not differ between10% papillary and acinar growth compared to10%. Kaplan-Meier curves showed reduced overall survival for patients with solid tumor growth10% (log-rank 0.002). Solid tumor growth10% was an independent prognostic factor for worse long-term survival (Hazard ratio: 3.05, p = 0.01).Our study demonstrates that the presence of a predominant solid pattern in pulmonary adenocarcinoma is a factor for an unfavorable prognosis. This should be kept in mind in daily clinical practice.

BackgroundDespite meticulous investigation of bypass techniques for deep hypothermic circulatory arrest, unfavorable long-term neurologic deficits have been well documented. Our aim was to improve brain perfusion by reducing platelet plugging with a glycoprotein IIb/IIIa inhibitor (eptifibatide) in an experimental model of deep hypothermic circulatory arrest–reperfusion in pigs.MethodsTwo groups of 12 piglets each (eptifibatide group [eptifibatide + unfractionated heparin] vs UFH group [only unfractionated heparin]) underwent 10 minutes of normothermic bypass, 40 minutes of cooling during cardiopulmonary bypass (hematocrit, 30%; cardiopulmonary bypass flow, 100 mL·kg−1·min−1), 60 minutes of circulatory arrest at 15°C, and a 40-minute rewarming period. Intravital fluorescence microscopy of pial vessels at set intervals was performed.ResultsDuring the cooling period, there was a tendency toward reduced functional capillary density values without statistical significance in both groups. During reperfusion, the eptifibatide group demonstrated a significantly decreased platelet adhesion and aggregation (at 30 minutes of reperfusion: functional capillary density, 104% ± 3% vs 77% ± 4% relative to baseline, P = .02; red blood cell velocity, 0.65 vs 0.30 mm/s, P < .004). A more rapid recovery of tissue oxygenation (P < .001) was documented. Furthermore, a significant microvascular permeability reduction was achieved compared with that seen in the UFH group (P < .02). The use of eptifibatide resulted in fewer ultrastructural changes in hippocampal tissue, which is demonstrated by histologic examination.ConclusionsPlatelet plugging reduction with the glycoprotein IIb/IIIa inhibitor eptifibatide improves cerebral capillary blood flow and reduces cerebral ischemia in the setting of deep hypothermic circulatory arrest. Furthermore, significant endothelial cell injury and perivascular edema reduction can be achieved.

Background The purpose of this study was to develop a specific postoperative score for intensive care unit (ICU) cardiac surgical patients for assessment of organ dysfunction and survival. Methods This prospective study consisted of all consecutive adult patients admitted after cardiac surgery to our ICU over a period of 3 years. Evaluation of variables was performed using the first year patients who stayed in the ICU for at least 24 hours. The reproducibility was then tested in two validation sets using all patients. Performance was assessed with the Hosmer-Lemeshow (χ 2 statistics) goodness-of-fit test and receiver operating characteristic (ROC) curves and compared with the Acute Physiology and Chronic Health Evaluation (APACHE II) and Multiple Organ Dysfunction Score (MODS). Results A total of 3,230 patients were admitted to the ICU after cardiac surgery. Mean χ 2 values for the new score were 5.8 (APACHE II, 11.3; MODS, 9.7) for the construction set, 7.2 (APACHE II, 8.0; MODS, 4.5) for the validation set I, and 5.9 for the validation set II. The mean area under the ROC curve was 0.91 (APACHE II, 0.86; MODS, 0.84) for the new score in the construction set, 0.88 (APACHE II, 0.84; MODS, 0.84) in the validation set I, and 0.92 in the validation set II. Conclusions Our new 10-variable risk index performs very well, with calibration and discrimination very high, better than general severity systems; and it is an appropriate tool for daily risk stratification in ICU cardiac surgery patients. Thus, it may serve as an "expert system" for diagnosing organ failure, decision making, resource evaluation, and predicting mortality among ICU cardiac surgical patients.

In this study we investigated the postnatal developmental changes in sarcomeric protein expression in parallel with contractile parameters in myofibrils isolated from small resections from the right ventricular (RV) outflow tract in 25 patients with Tetralogy of Fallot and related congenital heart diseases (CHD). These CHDs are associated with RV hypertrophy and outflow tract obstruction. The age of the patients ranged from 4 days to 38 months. The resections were procured during surgical correction of the cardiac malformation and would have been otherwise discarded. In the neonate (4 days old), the expression of slow skeletal TnI (ssTnI) and atrial light chain (ALC-1) was ∼82% and ∼50% respectively and declined to respectively < ∼8% and ∼3% at the age of 38 months. This down-regulation in ssTnI and ALC-1 expression correlated (p

Implantable loop recorders have an important role in establishing symptom-rhythm correlation in adults with recurrent syncope or palpitations. The standard location of these devices is in a subcutaneous prepectoral pocket. As the device is bulky, this is not an ideal location in young patients. We report a technique of abdominal implantation of this device in 10 consecutive infants and children, achieving an excellent cosmetic result and diagnostic-quality electrograms at follow-up.