Medicine
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Randomized Controlled Trial
Application of CO2 waveform in the alveolar recruitment maneuvers of hypoxemic patients during one-lung ventilation.
Deterioration of gas exchange during one-lung ventilation (OLV) is caused by both total collapse of the nondependent lung and partial collapse of the dependent lung. Alveolar recruitment maneuver improves lung function during general anesthesia. The objective of this study was to investigate whether there is an indirect relationship between the changes of CO2 expirogram and the selective lung recruitment. ⋯ After OLV-AP, the phase III slopes of CO2 expirogram and SpO2 were similar to those during TLV. During OLV, however, parameters of ventilation setting in both OLV-PP and OLV-AP are obviously different. This study indicates that alveolar recruitment by utilizing CO2 expirogram probably improves SpO2 level during one-lung ventilation.
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Randomized Controlled Trial Multicenter Study
Local microwave ablation with continued EGFR tyrosine kinase inhibitor as a treatment strategy in advanced non-small cell lung cancers that developed extra-central nervous system oligoprogressive disease during EGFR tyrosine kinase inhibitor treatment: A pilot study.
The non-small cell lung cancer (NSCLC) patients that experienced good clinical response to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) will ultimately develop acquired resistance. This retrospective study was performed to explore the potential survival benefit of microwave ablation (MWA) therapy in epidermal growth factor receptor (EGFR)-mutant NSCLC that developed extra-central nervous system (CNS) oligoprogressive disease during TKI treatment. We retrospectively analyzed 54 NSCLC patients with EGFR mutations who showed a clinical benefit from initial EGFR-TKI therapy and developed extra-CNS oligoprogressive disease at our institutions. ⋯ In the MWA group, the median PFS2 for complete ablation was significantly longer than that for incomplete ablation (11 vs. 4.2 months, HR 0.29, P < 0.05). MWA with continued EGFR inhibition might be associated with favorable progression-free survival (PFS) and OS in patients with extra-CNS oligometastatic disease. MWA as a local therapy for extra-CNS oligometastatic disease should be considered for NSCLC with acquired resistance to EGFR-TKIs.
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Review Case Reports
Pyogenic arthritis of native joints due to Bacteroides fragilis: Case report and review of the literature.
Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity. In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. ⋯ Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%. Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.
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Review Case Reports
Multiorgan resection with inferior vena cava reconstruction for hepatic alveolar echinococcosis: A case report and literature review.
Alveolar echinococcosis (AE) is a life-threatening parasitic disease characterized by its tumor-like growth. Radical operation is deemed the curable method for AE treatment if R0-resection is achievable. ⋯ This patient had an uneventful postoperative recovery and a good prognosis. Multiorgan resection is justified and unavoidable in selected patients when AE lesions invade different organs and the main vascular structures.
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Multicenter Study Observational Study
The anatomy of clinical decision-making in multidisciplinary cancer meetings: A cross-sectional observational study of teams in a natural context.
In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable. The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision. ⋯ Hawthorne effect is the main limitation of the study. The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core disciplines. Evidence of dual-task interference was observed in relation to the meeting chairs' input and their corresponding surgical input into case reviews.