Annals of Thoracic Medicine最新文献

Objectives: To explore the clinical value of three-dimensional (3D) reconstruction technology combined with 3D printing in the treatment of pectus excavatum (PE).

Methods: The clinical data of 10 patients with PE in our department from June 2018 to December 2020 were analyzed retrospectively. All patients underwent thin-layer computed tomography examination before the operation, and then 3D reconstruction was performed with Mimics 20.0 software. The radian and curvature of the pectus bar were designed according to the reconstructed images. Afterward, the images were imported into the light-curing 3D printer in STL format for slice printing. Hence that the personalized operation scheme, including the size of the pectus bar and the surgical approach, can be made according to the 3D printed model. The thoracoscopic-assisted Nuss operation was completed by bilateral incisions. The operation time, intraoperative blood loss, and postoperative hospitalization were counted and analyzed. The satisfaction of the surgery was evaluated according to the Haller index and the most posterior sternal compression sternovertebral distance.

Results: The surgeries were successfully completed in 10 patients without a transfer to open procedure. The average operation time was (56 ± 8.76) min, the intraoperative blood loss was (23.5 ± 11.07) mL, and the postoperative hospitalization was (7.2 ± 0.92) d. There were no serious complications or death during the perioperative period. Compared with the data before the operation, the most posterior sternal compression sternovertebral distance was larger, and the Haller index was lower, the differences were statistically significant (P < 0.05).

Conclusions: 3D reconstruction technology combined with 3D printing, which can be used before operation, contributes to the operator performing thoracoscopic-assisted Nuss operation safely and effectively, which has productive clinical application value for the treatment of pectus excavatum.

Background and aims: Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block.

Methods: All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal.

Results: There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (P = 0.001) and 12 h (P = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (P = 0.025).

Conclusion: The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.

Objective: This study aims to explore the diagnostic values of radial endobronchial ultrasound-guided transbronchial lung biopsy with distance (rEBUS-D-TBLB) measurement and with guide sheath (rEBUS-GS-TBLB) for peripheral pulmonary lesions (PPLs) with a diameter ≥3 cm by thin bronchoscope.

Patients and methods: Six hundred and three patients with PPL (diameter ≥3 cm) were enrolled in this study. The subjects were divided into the rEBUS-D-TBLB and rEBUS-GS-TBLB groups by the random number table method. Patients were assigned to undergo rEBUS-D-TBLB or rEBUS-GS-TBLB, respectively. The histopathology, positive diagnosis rates, duration of the procedure, and postoperative adverse effects between the two groups were examined.

Results: A total of 569 patients were included in this study according to the inclusion and exclusion criteria, with 282 cases in the rEBUS-D-TBLB group and 287 cases in the rEBUS-GS-TBLB group. For malignant diseases, the positive diagnosis rates of PPL in the outer/inner-middle lung bands and the right-upper/-lower lung lobes by rEBUS-D-TBLB were noninferior to those of rEBUS-GS-TBLB. The duration of the procedure of rEBUS-D-TBLB was longer than that of rEBUS-GS-TBLB. There were 14 cases of hemorrhage >50 mL, 1 case of postoperative chest pain in the rEBUS-D-TBLB group, and 3 cases of hemorrhage >50 mL in the rEBUS-GS-TBLB group.

Conclusion: REBUS-D-TBLB by thin bronchoscope has a high diagnostic value for PPL with a diameter ≥3 cm, which may be considered a useful alternative for rEBUS-GS-TBLB in the clinic.

Background: Venous thromboembolism (VTE) is associated with substantial mortality as well as morbidity and is largely preventable among hospitalized obstetric women. However, thromboprophylaxis is underutilized in most hospitalized patients.

Objectives: To evaluate VTE risk and adherence to local thromboprophylaxis protocol among hospitalized pre- and postnatal women.

Methods: This retrospective study was conducted at East Jeddah Hospital, Jeddah, Saudi Arabia, in 2020. The electronic record database of the hospitalized pregnant Saudi women during the years 2018 and 2019 was reviewed. Based on the local hospital protocol, the risk stratification was reassessed by researchers, and the hospital adherence to the prophylaxis was reviewed separately for antenatal and postnatal women.

Results: One thousand and ninety-five electronic records (539 antenatal and 556 postnatal) were reviewed. The postnatal group showed a significantly higher risk compared with an antenatal group (62.2% vs. 11.7%) (P = 0.000). There was a highly significant difference between risk categories assessment by the physicians and the researchers in both groups (P = 0.000). Thromboprophylaxis was overutilized in the low risk (5% heparin and 41.4% heparin and mechanical devices for antenatal and 17.08% heparin and 6.1% heparin and a mechanical device for the postnatal group) and underutilized in intermediate groups (50% no prophylaxis in antenatal and 51.5% mechanical devices in the postnatal group). There was less adherence to documentation in postnatal as compared to antenatal group (83.6% vs. 95%, P = 0.000) for risk documentation and 85.3% versus 91.5% for physician signature (P = 0.001). Thromboprophylaxis was ordered for 21.3% of antenatal (12.2 heparin, 3.5% mechanical, and 5.6% both) and 23.7% of postnatal patients (16.5 heparin, 2% mechanical, and 5.2% both). There were no reported VTE events or bleeding complications.

Conclusion: There was a considerable VTE risk among hospitalized obstetric patients which peaked during the postnatal period. Physicians showed good compliance to local VTE protocol with no reported VTE events or drug-induced bleeding. However, the implementation of prophylaxis is associated with both under and overutilization. There is a need for increasing the physicians' awareness of optimizing VTE risk assessment and documentation for hospitalized obstetric patients.

Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.

Objective: This review aimed to explore the pathophysiology and rehabilitation management of exercise intolerance in COVID-19 patients.

Methods: We reviewed articles published in 2019-2021 using PubMed, Google Scholar, and CINAHL databases as an electronic database. Data obtained were pathophysiology and rehabilitation management of exercise intolerance in COVID-19 survivors. Types of the article were original articles and systematic or narrative reviews, both published and preprint articles. Articles that were written in English and freely accessible in pdf or HTML format were included.

Results: There were 28 articles eligible for this review. Pathophysiology, rehabilitation management, and both pathophysiology and rehabilitation management were explained in 7, 24, and 4 articles, consecutively.

Discussion: Exercise intolerance is caused by some pathological processes in the respiratory, cardiovascular, and musculoskeletal systems as a result of systemic inflammation. Fatigue and shortness of breath during the activity were the most common symptom in the early phase of COVID-19 and persisted until the follow-up phase. Hospital admission, especially prolonged use of ventilators and immobilization worsen functional impairment resulting in persistent symptoms. Rehabilitation management begins with a functional assessment consisting of symptom assessment and physical examination of the body systems affected. The goals of rehabilitation management are to increase functional capacity, reduce symptoms, improve the ability to perform daily activities, facilitate social reintegration, and improve quality of life. Exercise is an effective intervention to reach these goals. Several studies recommend breathing, and aerobic exercises, as well as resistance exercises for peripheral and respiratory muscles, to improve symptoms and increase functional capacity.