Kardiochirurgia I Torakochirurgia Polska最新文献

Lung cancer remains a major health challenge despite recent advances in diagnostics and treatment. Surgical resection, particularly in early stages, offers the best chance for cure. Enhanced Recovery After Surgery (ERAS) programs have been shown to improve outcomes in various surgical areas. This narrative review summarizes current evidence on the role of prehabilitation within ERAS for lung cancer surgery and presents the organizational model from a high-volume academic thoracic surgery center. Key elements of prehabilitation include smoking cessation, nutritional optimization, physical activity enhancement, and patient education, all delivered by a multidisciplinary team. Despite organizational challenges, preoperative ERAS programs demonstrate benefits for patients and hospitals, supporting their broader implementation in thoracic surgery.

A goiter is defined as an enlargement of the thyroid gland, typically resulting in a doubling in size or a weight exceeding 40 g. It affects approximately 5% of the global population. Diving, or substernal, goiters occur when more than 50% of the thyroid extends into the mediastinum, with an incidence ranging from 5% to 15.7% across various studies. An alternative definition describes diving goiters as those extending more than 3 cm below the sternal notch on chest computed tomography with the neck in hyperextension, or beyond the fourth thoracic vertebra. In this review, we outline the key clinical and radiological criteria that indicate when sternotomy is required for the surgical management of diving goiters.

Introduction: Pulmonary contusion leads to alveolar damage and inflammation, which can progress to acute lung injury and acute respiratory distress syndrome. Glutamine and L-arginine play critical roles in immune regulation and inflammation control, showing potential protective effects in lung injury models.

Aim: This study aimed to investigate the effects of glutamine and/or arginine, which play significant roles in the immuno-inflammatory response, on mitigating inflammation in an experimentally induced pulmonary contusion model.

Material and methods: Thirty male Wistar Albino rats from the same colony were randomly divided into five groups (n = 6 per group). Group I (sham) received no trauma or treatment. Bilateral pulmonary contusion was induced in Groups II-V. Group II received 0.9% saline; Group III received 200 mg/kg/day intraperitoneal glutamine; Group IV received 200 mg/kg/day intraperitoneal arginine; and Group V received both glutamine (200 mg/kg/day) and arginine (150 mg/kg/day). All treatments were administered for 3 consecutive days. Rats were sacrificed three days after the procedure, and histopathologic evaluation was performed afterwards. Three different parameters were scored: inflammation intensity, intraalveolar hemorrhage, and alveolar congestion. Statistical analysis was performed using the Mann-Whitney U test.

Results: Compared to the untreated trauma group, all treatment groups showed significant histopathological improvement (p < 0.05). The arginine-only group demonstrated greater effectiveness across all parameters compared to the combined treatment group (p < 0.05). No significant difference was observed between the glutamine-only and arginine-only groups (p > 0.05).

Conclusions: Both glutamine and arginine treatments were effective in reducing inflammation following pulmonary contusion. However, combined treatment was less effective than arginine alone.

This position paper, jointly authored by the Polish Society of Cardiothoracic Surgeons and the Heart Rhythm Association of the Polish Society of Cardiology, defines the role of hybrid approaches in the treatment of cardiac arrhythmias, particularly atrial fibrillation. We present a rationale for integrating epicardial and endocardial ablation strategies, summarize current evidence, and advocate for multidisciplinary planning, including arrhythmia treatment during cardiac surgery for other indications and atrial fibrillation treatment as a stand-alone procedure. The paper highlights the importance of minimally invasive approaches, the need for heart team-based planning, structured curricula, and postoperative referral pathways for comprehensive management of atrial fibrillation and non-atrial fibrillation arrhythmias.

This article reviews the progress of nanoparticles as drug carriers in the treatment of cardiovascular diseases, and how nanoparticles can deliver anti-inflammatory, anti-proliferative, and anticoagulant drugs directly to the surgical site in surgical procedures. For this, 45 articles published between 2005 and 2024 with keywords including "Artificial intelligence Nanoparticle", "Emergency Medicine Unit", and "Therapeutic for the treatment of cardiovascular diseases" in Scopus, Elsevier, Web of Science and ScienceDirect were reviewed. Nanoparticle-based drug delivery systems have demonstrated several noteworthy therapeutic benefits in the treatment of cardiovascular disorders since they were first used in the cancer field to deliver safer and more effective chemotherapeutics. By delivering targeted and site-specific medications with controlled release, nanoparticle-based drug delivery systems modify the biodistribution of therapeutic agents. An optimal material for cardiovascular therapeutics would be a nanoparticle based on metal, lipid, or polymer.

Introduction: Hybrid coronary revascularization (HCR) is a combined approach for multivessel coronary artery disease (MVD), integrating surgical grafting of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) for non-LAD lesions. It aims to reduce invasiveness while maintaining effectiveness.

Aim: To summarize current evidence on the safety, effectiveness, and clinical outcomes of HCR compared to coronary artery bypass grafting (CABG), PCI, and off-pump coronary artery bypass (OPCAB).

Methods: A review of current literature including clinical trials, meta-analyses, and observational studies was conducted. Focus was placed on procedural techniques, patient selection, and outcomes.

Results: HCR is associated with shorter hospital stays, reduced bleeding, and faster recovery compared to CABG. Compared to PCI, it shows improved LAD patency and fewer repeat interventions. Outcomes are similar to OPCAB, with lower myocardial injury. Despite its benefits, HCR remains underused due to technical demands and limited availability of hybrid facilities.

Conclusions: Further randomized trials are needed to confirm its long-term safety, effectiveness, and cost-efficiency.

Introduction: The incredibly rapid development of artificial intelligence (AI) in recent years has created new opportunities for its application in medical advancements. This raises questions about the reliability and limitations of AI.

Aim: The aim of the present study was to evaluate the effectiveness of the ChatGPT-3.5 language model in solving the test component of the National Specialist Examination (PES) in the field of thoracic surgery.

Material and methods: A total of 120 test questions from 2015 PES examination were analyzed. They were grouped according to subject matter, clinical character, and cognitive requirements. In independent sessions, each question was submitted five times. The following statistical tests were applied: χ², Kruskal-Wallis, Mann-Whitney and Spearman's rank correlation. The consistency of the answers was assessed using Fleiss' k coefficient.

Results: The AI tool achieved a score of 42.2% correct answers, with the passing threshold set at 60%. A statistically significant difference was found between clinical and non-clinical questions (p = 0.041). Correct answers were characterized by a higher confidence coefficient (p < 0.001). No correlation was observed between confidence and psychometric indicators. The response consistency was assessed as moderate (k = 0.341).

Conclusions: The result obtained by ChatGPT-3.5 is equivalent to a failing score on the examination. The confidence of responses correlated with their correctness, whereas limitations in clinical knowledge and consistency indicate the need for caution when using this model to assess specialized knowledge.