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1.
Tetsutaro Sazuka Takashi Akai Masaya Uesato Daisuke Horibe Mari Kuboshima Hiroyuki Kitabayashi Akinao Matsunaga Akiko Kagaya Yorihiko Muto Nobuyoshi Takeshita Tetsuro Maruyama Yukimasa Miyazawa Kiyohiko Shuto Toru Shiratori Tsuguaki Kono Yasunori Akutsu Isamu Hoshino Hisahiro Matsubara 《Esophagus》2016,13(3):254-263
Background
We performed endoscopic ultrasound real-time tissue elastography to more accurately diagnose lymph node metastasis of esophageal cancer. The aim of this study was to evaluate the ability of EUS elastography to distinguish benign from malignant lymph nodes in esophageal cancer patients.Methods
The present study had two steps. As the first step (study 1), we developed diagnostic criteria for metastatic lymph nodes using elastography and verified the validity of the criteria. Three hundred and twenty-two lymph nodes from 35 patients treated by surgical resection were included in the study. As the second step (study 2), we preoperatively examined the lymph nodes of esophageal cancer patients with EUS elastography and compared its diagnostic performance with that of the conventional B-mode EUS images. A total of 115 lymph nodes from 31 patients were included.Results
In study 1, lymph nodes were considered malignant if 50 % or more of the node appeared blue, or if the peripheral part of the lesion was blue and the central part was red/yellow/green. The sensitivity and specificity of the elastography were 79.7 and 97.6 % with an accuracy of 93.8 %, which was significantly higher than the values for conventional B-mode imaging. In study 2, the sensitivity and specificity of the EUS elastography were 91.2 and 94.5 % with an accuracy of 93.9 %, which was also significantly higher than the values for conventional B-mode EUS imaging.Conclusions
The present study demonstrated that EUS elastography is useful for diagnosing lymph node metastasis of esophageal cancer.2.
Purpose
This study aimed to analyze and evaluate the feasibility of using carbon nanoparticles (CNs) to track lymph nodes (LNs) metastases in right colon tumors, especially for patients who underwent laparoscopic-assisted radical right hemicolectomy.Method
A total of 99 patients were enrolled in this retrospective study between November 2015 and September 2017 (control group n?=?47). One day before surgery, 1 ml of CNs suspension was injected into the submucosal layer around the site of the primary lesions by colonoscopy. Then complete mesocolic excision (CME) of laparoscopic right hemicolectomy was performed. CNs-stained LNs were identified and counted from all dissected LNs after surgery.Results
The dates showed that the number of total harvested LNs and the number of positive patients in the experimental group increased significantly compared with the control group (respectively, P?<?0.01 and P?<?0.05). The increase of positive percentage shifted some patients toward higher stage, although the total number of positive LNs changed a little bit. In addition, the duration for pathologist to dissect LNs became shorter (26.4 vs. 31.1 min, P?<?0.05).Conclusion
Therefore, the CNs are not only a good tattoo in laparoscopic-assisted operation, but could be regarded as a better pathological evaluating tool for tumor treatment.3.
Uma Kundu Brian Weston Jeffrey H. Lee Manoop S. Bhutani William A. Ross Wayne Hofstetter Roland L. Bassett Savitri Krishnamurthy 《Esophagus》2016,13(2):187-194
Background
Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (EUS-FNA) of lymph nodes (LN) are used for preoperative staging of patients with esophageal/gastroesophageal junction (E/GEJ) carcinomas. The recognition of sonographic features of LN can be variable in selecting LN for EUS-FNA. We evaluated the predictive value of sonographic features of LNs that correlate with the presence of metastatic carcinoma by EUS-FNA.Materials and methods
Patients with GIPB who underwent EUS/EUS-FNA for the preoperative staging of LNs over 29 months were studied. The EUS features including size, shape, borders, and echogenicity along with primary tumor stage were evaluated/correlated with the EUS-FNA result to determine features that predict positive EUS-FNA results.Results
86 LNs from 74 patients with E/GEJ carcinomas were studied. FNA yielded a positive/suspicious for carcinoma diagnosis in 42 cases and a negative result in 44 cases. The sonographic features of the LNs with and without metastatic carcinoma were average short axis measurement (1.02 vs 0.73), average long axis measurement (1.413 vs 1.348), average long:short axis ratio (1.45 vs 1.2), hypoechoic cortex (97.6 vs 72.8 %), round shape (71.4 vs 29.5 %), and well-circumscribed borders (40.5 vs 31.8 %). The features most strongly predictive of a positive result were short axis (p = 0.006), hypoechoic cortex (p = 0.01), and round shape (p = 0.0005) on univariate analysis. High-primary tumor stage (T3 and T4, p = 0.07 and p = 0.27, respectively) did not predict metastatic carcinoma on EUS-FNA. On multivariate analysis, short axis measurement alone was strongly predictive of a positive EUS-FNA (p = 0.04).Conclusions
Sonographic features of LNs including size, shape, echogenicity, and border characteristics can be useful in the selection of pertinent LNs for EUS-FNA sampling in preoperative staging of E/GEJ malignancies based on their ability to predict the presence of metastatic carcinoma. While hypoechoic cortex, round shape, and short axis measurement were independent factors that strongly predicted the presence of metastatic carcinoma on EUS-FNA, short axis alone was strongly predictive of metastatic carcinoma on multivariate analysis.4.
David G. Brauer Ryan C. Fields Benjamin R. Tan M.B. Majella Doyle Chet W. Hammill William G. Hawkins Graham A. Colditz William C. Chapman 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):470-476
Background
Lymph node (LN) status is an important predictor of overall survival for resected IHCC, yet guidelines for the extent of LN dissection are not evidence-based. We evaluated whether the number of LNs resected at the time of surgery is associated with overall survival for IHCC.Methods
Patients undergoing curative-intent (R0 or R1) resection for IHCC between 2004 and 2012 were identified within the US National Cancer Database. LN thresholds were evaluated using maximal chi-square testing and five-year overall survival was modeled using Kaplan–Meier and Cox regressions.Results
57% (n = 1,132) of 2,000 patients had one or more LNs resected and pathologically examined. In the 631 patients undergoing R0 resection with pN0 disease, maximal chi-square testing identified ≥3 LNs as the threshold most closely associated with overall survival. Only 39% of resections reached this threshold. On multivariable survival analysis, no threshold of LNs was associated with overall survival, including ≥3 LNs (p = 0.186) and the current American Joint Committee on Cancer recommendation of ≥6 LNs (p = 0.318).Conclusion
In determining the extent of lymphadenectomy at the time of curative-intent resection for IHCC, surgeons should carefully consider the prognostic yield in the absence of overall survival benefit. 相似文献5.
Atsushi Shiozaki Hitoshi Fujiwara Hirotaka Konishi Tomohiro Arita Toshiyuki Kosuga Ryo Morimura Yasutoshi Murayama Shuhei Komatsu Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Kazuma Okamoto Eigo Otsuji 《Esophagus》2017,14(2):138-145
Background
Hand-assisted laparoscopic surgery (HALS) is safe and useful in the management of gastric conduit reconstruction. By applying the HALS technique to mediastinal surgeries, we developed a novel technique for the en-bloc dissection of the middle and lower (M&L) mediastinal lymph nodes (LNs) using a laparoscopic transhiatal approach (LTHA). We describe our technique, with a focus on the roles of the operator’s left hand.Methods
In our procedure, the operator’s hand has several important roles, such as retraction, maintenance of the route for the laparoscope, and grasping the shaft of the energy device to stabilize operability. After the esophageal hiatus was opened, the pericardium was exposed. The posterior plane of the pericardium was extended, and the anterior side of the subcarinal, main bronchial, thoracic paraaortic, and pulmonary ligament LNs was separated. The posterior side of these LNs was then separated. While lifting these LNs like a membrane, they were resected from the bilateral mediastinal pleura, main bronchi, and tracheal bifurcation. The treatment outcomes of 84 patients with esophageal cancer who underwent M&L mediastinal LN dissection by LTHA were compared with those of 75 patients who underwent their dissection by right thoracotomy.Results
The total operative time and bleeding were significantly decreased by LTHA. The number of resected M&L mediastinal LNs in the two groups was not significantly different. Postoperative respiratory complications occurred in 14.3 % of patients treated with LTHA and 25.3 % of those treated without it.Conclusions
In our surgical procedure, a specific technique of the operator’s left hand was essential and resulted in a good surgical view of the mediastinum, and en-bloc dissection of M&L mediastinal LNs was performed safely.6.
Xiaohui Ning Xuerui Ye Yanhua Si Zihe Yang Yunzi Zhao Qi Sun Ruohan Chen Min Tang Keping Chen Xiaoli Zhang Shu Zhang 《Journal of electrocardiology》2018,51(4):742-746
Background
We investigated the prevalence of ventricular tachycardia/ventricular fibrillation (VT/VF) in Post-infarction left ventricular aneurysm (PI-LVA) patients and analyze clinical outcomes in patients presenting with VT/VF.Methods
575 PI-LVA patients were enrolled and investigated by logistic regression analysis. Patients with VT/VF were followed up, the composite primary endpoint was cardiac death and appropriate ICD/external shocks.Results
The incidence of sustained VT/VF was 11%. Logistical regression analysis showed male gender, enlarged LV end diastolic diameter (LVEDD) and higher NYHA class were correlated with VT/VF development. During follow up of 46?±?15?months, 19 out of 62(31%) patients reached study end point. Multivariate Cox regression analysis revealed that enlarged LVEDD and moderate/severe mitral regurgitation (MR) were independently predictive of clinical outcome.Conclusions
Male gender, enlarged LVEDD and higher NYHA class associated with risk of sustained VT/VF in PI-LVA patients. Among VT/VF positive patients, enlarged LVEDD and moderate/severe MR independently predicted poor clinical prognosis. 相似文献7.
8.
Gianfranco Sanson Yuliya Khlopenyuk Sara Milocco Massimiliano Sartori Lorella Dreas Adam Fabiani 《Heart & lung : the journal of critical care》2018,47(4):408-417
Background
In cardiac surgical patients little is known about different phenotypes of delirium and how the symptoms fluctuate over time.Objectives
Evaluate risk factors, incidence, fluctuations, phenotypic characteristics and impact on patients' outcomes of delirium.Methods
Prospective longitudinal study. In postoperative intensive care unit 199 patient were assessed three-times a day through an adapted versions of the Intensive Care Delirium Screening Checklist.Results
Delirium and subsyndromal delirium incidence were 30.7% and 31.2%, respectively. Delirium manifested mostly in the hypoactive form and showed a fluctuating trend for several days.Atrial fibrillation, benzodiazepine/opioids dosages, hearing impairment, extracorporeal circulation length, SAPS-II and mean arterial pressure were independent predictors for delirium. Delirium was a statistically significant predictor of chemical/physical restraint use and hospital length of stay.Conclusions
Given the fluctuating and phenotypic characteristics, delirium screening should be a systematic/intentional activity. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors. 相似文献9.
Purpose
The recurrence of T1 colorectal cancers is relatively rare, and the prognostic factors still remain obscure. This study aimed to clarify the risk factors for recurrence in patients with T1 colorectal cancers treated by endoscopic resection (ER) alone or surgical resection (SR) with lymph node dissection, respectively.Methods
We reviewed 930 patients with resected T1 colorectal cancers (mean follow-up, 52.3 months). Patients were divided into two groups: those who underwent ER alone (298 cases), and those who underwent initial or additional SR with lymph node dissection (632 cases). Group differences in recurrence-free survival were evaluated using the Kaplan–Meier method and log-rank test. Associations between recurrence and clinicopathological features were evaluated in Cox regression analyses; hazard ratios (HRs) were calculated for the total population and each group.Results
Recurrence occurred in four cases (1.34%) in the ER group and six cases (0.95%) in the SR group (p?=?0.32). Endoscopic resection, rectal location, and poor or mucinous (Por/Muc) differentiation were prognostic factors for recurrence in the total population. Por/Muc differentiation was prognostic factor in both groups. Female sex, depressed-type morphology, and lymphatic invasion were also prognostic factors in the ER group, but not in the SR group.Conclusions
Endoscopic resection, rectal location, and Por/Muc differentiation are prognostic factors in the total population. For patients who undergo ER alone, female sex, depressed-type morphology, and lymphatic invasion are also risk factors for recurrence. For such patients, regional en-bloc surgery with lymph node dissection could reduce the risk of recurrence.10.
Vladimira Timkova Iveta Nagyova Sijmen A. Reijneveld Ruzena Tkacova Jitse P. van Dijk Ute Bültmann 《Heart & lung : the journal of critical care》2018,47(4):371-379
Background
Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear.Objectives
The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients.Methods
All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data.Results
Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index–AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%.Conclusions
Supporting OSA patients' sense of mastery may significantly contribute to better disease management. 相似文献11.
Jengyuan Wu Chienming Liu Shangsen Lee Yuhung Kuo Tengfu Hsieh 《Heart & lung : the journal of critical care》2018,47(2):157-161
Background
Patients with thoracic empyema have an increased risk of mortality, but their absolute rate of mortality depends on age and comorbidities.Objective
This study seeks to assess the predictive value of the Charlson Comorbidity Index score (CCIS), CHADS2 and CHA2DS2-VASc scores for mortality risk in patients with empyema thoracis.Methods
From Taiwan's National Health Insurance Research Database we identified a total of 484 participants diagnosed with thoracic empyema. The CCIS, CHADS2 and CHA2DS2-VASc scores were used to stratify mortality risk.Results
The incidence rate of mortality in the present study was 20.39 per 1000 person-months. A strong correlation was found between thoracic empyema and CCIS score.Conclusions
Our results show that patients with thoracic empyema have a significantly high incidence rate of mortality and that CCIS can be used as an indicator of risk for mortality. 相似文献12.
13.
James M. Walter Chitaru Kurihara Thomas C. Corbridge Ankit Bharat 《Heart & lung : the journal of critical care》2018,47(4):398-400
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.Objectives
To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.Methods
We use a clinical case to illustrate chugging and discuss potential management strategies.Results
Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.Conclusions
Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS. 相似文献14.
Brian C. Bucca David M. Maahs Janet K. Snell-Bergeon John Hokanson Sean Rinella Franziska Bishop Alexis Boufard Joanna Homann Carol Y. Cheung Tien Y. Wong 《Journal of diabetes and its complications》2018,32(2):234-239
Aims
To investigate changes in retinal vessel diameter during acute hyperglycemia in patients with type 1 diabetes.Methods
We conducted a study on 11 subjects with type 1 diabetes. Euglycemia was maintained for 3 h followed by induction of hyperglycemia and simultaneous bolus of rapid acting insulin. Two fundus photos were captured during euglycemia and five fundus photos, blood glucose and blood pressure were taken every 30 min for 2.5 h post-prandial. Central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) were measured over the study visit and examined using generalized linear mixed models.Results
In a multivariate mixed model, mean CRAE and CRVE were reduced at 90 min post-prandial in both zones B and C. In repeated measures analysis, arterioles exhibited a significant association with change in vessel caliber per change in blood glucose. Inconsistent effects of blood pressure on vessel diameter were also measured.Conclusions
We document a change in retinal vessel diameter during acute hyperglycemia in persons with type 1 diabetes. Larger controlled studies are required to further investigate this phenomenon and to more accurately assess if hyperglycemia has direct effects on retinal vessel diameter. 相似文献15.
Oronzo Chialà Ercole Vellone Leonie Klompstra Giorgio Alberto Ortali Anna Strömberg Tiny Jaarsma 《Heart & lung : the journal of critical care》2018,47(5):465-470
Background
Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.Objectives
The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.Methods
This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.Results
The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.Conclusions
The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. 相似文献16.
Ann F. Jacobson Veronica Sumodi Nancy M. Albert Robert S. Butler Lori DeJohn Donna Walker Kelly Dion Hua-Li Lin Tai Donna M. Ross 《Heart & lung : the journal of critical care》2018,47(5):447-451
Background
More evidence is needed about factors that influence self-management behaviors in persons with heart failure.Objective
To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors.Methods
The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. Results: Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge.Conclusions
Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes. 相似文献17.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86
Rationale
Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.Objective
This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.Methods
This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.Results
91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.Conclusions
The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support. 相似文献18.
Yicheng K. Bao Maamoun Salam Deborah Parks Janet B. McGill Jing Hughes 《Journal of diabetes and its complications》2018,32(8):737-739
Background
The prevalence of systemic rheumatic diseases (SRDs) in T1DM has not been described.Method
This observational study compares SRD prevalence across age, race, and gender in 1,212 adults with T1DM.Findings
There is an age-dependent enrichment of SRDs in women with T1DM: 9.2% prevalence in women overall and 14% in women over age 50.Conclusion
Clinicians taking care of older women with T1DM should monitor for these SRDs. 相似文献19.
20.