Journal of thoracic disease
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are serious clinical disease entities characterized by inflammatory pulmonary edema, which lead to acute hypoxic respiratory failure through various etiologies. According to the studies to date, ALI/ARDS has been recognized as a form of multiorgan failure related to overactive immune response, and overproduction of proinflammatory cytokines released from activated inflammatory cells are considered to play a key role in the development of ALI. Glycyrrhizin (GL) is an extractive component derived from Glycyrrhiza glabra (licorice), which has recently been reported to have various pharmacological effects like anti-inflammatory, anti-tumor, hepato-protective, and anti-viral activities. Nevertheless, the therapeutic effect of GL in ALI is still unclear. The aim of this study was to investigate therapeutic effects of GL on lipopolysaccharide (LPS)-induced ALI in a mouse model and to elucidate explicable mechanisms involved. ⋯ The results of this study indicate that GL may have anti-inflammatory and protective effects on LPS-induced ALI in mice. GL inhibited proinflammatory cytokines playing a key role in the initial phase of inflammatory response, which suggests that inhibition of the TLR-4/NF-κB signal pathway would be a possible mechanism underlying the action of GL. Thus, GL can be used as a novel therapeutic strategy for pulmonary inflammation.
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Pulmonary nodules (PNs) are increasingly detected by thoracic computed tomography (CT). Traditional diagnostic modalities have their drawbacks. Electromagnetic navigation bronchoscopy (ENB) is gaining popularity in diagnosing small PNs. This study describes the diagnostic yield and complication rate of ENB in diagnosing PNs in which other diagnostic methods are considered to have low yield. ⋯ For PNs not accessible by conventional FB/R-EBUS, ENB provides good diagnostic yield with low complication rate. It is a useful armamentarium to respiratory physicians and thoracic surgeons.
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Nodal upstaging occasionally occurs after curative resection in clinical N0 non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the prognosis of clinical N0 NSCLC (T1-2, tumor size 5 cm or smaller) after upstaging to pathologic N1 or N2. ⋯ Postoperative nodal upstaging from clinical T1-2N0 NSCLC was not a significant prognostic factor in the same stage. Therefore, surgical treatment of clinical T1-2N0 lung cancer diagnosed by imaging without preoperative pathologic lymph node staging can be a treatment option.
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Nutritional support for patients with esophagectomy is very important especially for patients with malnutrition. But there is significant variation in nutritional support between different hospitals. Traditionally, 5 to 7 days of nil by mouth is required to allow healing of the anastomosis after esophagectomy; a feeding tube (usually jejunostomy tube) placed before or during the operation provides enteral access for patients with esophagectomy. ⋯ However, evidence from large multicenter randomized controlled clinical trials is still lacking. In the future, the long-term outcomes, including body weight loss, quality of life (QOL), laboratory nutritional markers and survival, should be investigated in the field of EOF protocols. EOF after esophagectomy may require the application of the most recent knowledge and the perioperative practice of multi-disciplinary team medical care, according to the situation of each medical center.
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Review
Benchmark analyses in minimally invasive esophagectomy-impact on surgical quality improvement.
Over the last decades, benchmarking has become an established management tool to improve quality in commercial economics. It is a rather new concept in the healthcare industry, and a confusingly wide range of approaches referring to "benchmarking" have been employed in the field of minimally invasive esophageal cancer surgery. ⋯ Recently, we have introduced a standardized method of establishing valid benchmarks for surgical quality improvement including ideal outcome thresholds for total minimally invasive transthoracic esophagectomy (ttMIE). The present article aims at discussing the actual literature on benchmarking in minimally invasive esophagectomy (MIE) and at fueling the debate on how to further improve the current practice of surgical outcome research.