Journal of thoracic disease
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Uniportal video-assisted thoracoscopic surgery (VATS) is probably the most successful single-incision approach worldwide, probably secondary to several specific circumstances: multiportal VATS was hardly getting his recognition in the thoracic surgeon's community; the extraordinary effort by his creators and believers for developing the technique and giving massive diffusion; the subjective feeling by surgeons who performed the approach about its benefits and advantages. Despite this, many efforts have focused on extending new indications and describing variations of the original intercostal uniportal VATS, but few quality papers have analyzed the real impact of the approach and its real advantages or disadvantages comparing to multiportal VATS. ⋯ With the aim of standardizing the approach and the technical aspects for non-experienced or beginners, the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgery (ESTS) decided to set the basis for homogenization of the technique to cement the development of high-level evidence works that shed light on the real outcomes of uniportal compared to multiportal VATS. This article describes the main specific technical aspects while performing lower lobectomies and lymphadenectomy, which were described as the most suitable cases for initiating the learning curve.
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To evaluate the implications of elevated cardiac troponin (cTn) in patients presenting with pulmonary embolism (PE). ⋯ Elevated cTn is independent predictor of short and long-term mortality. The predictive power of cTn increases when combined with the clinical probability score. Further, larger prospective studies are needed to confirm the findings of the present study.
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Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly used in lobectomy, bullectomy, wedge resection, lung volume reduction, sympathectomy and talc pleurodesis, which may reduce postoperative complications. However, the benefits of non-intubated and intubated methods of VATS remain controversial. ⋯ NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
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Numerous evidence-based guidelines (EBGs) pertaining to ventilator-associated pneumonia (VAP) have been published by domestic and international organizations, but their qualities have not been reported. ⋯ The overall quality of the identified EBGs pertaining to VAP was classified as moderate. The management of VAP varied by guideline. More high-quality evidence is needed to improve guideline recommendations.