Results Of Minimally Invasive Vats Thymectomy In Miastenia Gravis Patients Compared With More Invasive Approaches - 10-Year Experience In A Single Center.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.

Synthesis and toxicological study of chitosan-pirul (Schinus molle L.) essential oil nanoparticles on Aspergillus flavus.

In recent years, the study of essential oils as antifungal alternatives and their encapsulation to increase their properties for greater effects has been tested. In this work, nanoparticles of chitosan-Schinus molle L. essential oil (CS-PEO-Np) with a size of 260 ± 31.1 nm were obtained by ionic gelation and evaluated in some growth phases of Aspergillus flavus, a toxigenic fungus. At a concentration of 250 µg/mL of CS-PEO-Np, the A. flavus mycelial growth was inhibited at 97.1% with respect to control, at 96 h of incubation; the germination and viability of spores were inhibited at 74.8 and 40%, respectively, after exposure to 500 µg/mL of these nanomaterials, at 12 h of incubation. The fluorescence images of stained spores with DAPI showed the affectations caused by nanoparticles in the cell membrane, vacuoles and vacuolar content, cell wall, and nucleic acids. For both nanoparticles, CS-Np and CS-PEO-Np, no mutagenic effect was observed in Salmonella Typhimurium; also, the phytotoxic assay showed low-to-moderate toxicity toward seeds, which was dependent on the nanoparticle's concentration. The acute toxicity of CS-PEO-Np to A. salina nauplii was considered low in comparison to CS-Np (control), which indicates that the incorporation of Schinus molle essential oil into nanoparticles of chitosan is a strategy to reduce the toxicity commonly associated with nanostructured materials. The nanoparticulated systems of CS-PEO-Np represent an effective and non-toxic alternative for the control of toxigenic fungi such as A. flavus by delaying the initial growth stage.

Preparation and Characterization of Poly(lactic acid) Membranes and Films Coated with Polyaniline for Potential Use in Environmental Remediation.

This research outlines the fabrication of polymeric membranes and films of poly(lactic acid) (PLA), prepared via electrospinning and extrusion, respectively. These materials were subsequently coated with polyaniline (PANi) by using the in situ chemical polymerization technique. Scanning electron microscopy micrographs revealed that the best coatings were achieved when 3 and 30 min of contact time with the monomeric solution were used for the membrane and film, respectively. Additionally, Fourier transform infrared spectra, thermogravimetric studies, and contact angle measurements demonstrated proper interaction between PLA and PANi. The findings of these studies suggest that PLA membranes and films can serve as suitable substrates for the deposition of PANi, and the composite materials hold potential for use in environmental remediation applications.

Nanoparticles of Betalain-Gelatin with Antioxidant Properties by Coaxial Electrospraying: Preparation and Characterization.

Betalains are bioactive compounds with attractive antioxidant properties for the food industry, endowing them with potential application in food coatings to maintain quality and extend shelf life. However, they have low stability to factors such as light, temperature, and humidity. An alternative to protect bioactive compounds is nanoencapsulation; one of the most used techniques to produce an encapsulation is coaxial electrospraying. In this research, the preparation and characterization of gelatin-betalain nanoparticles were carried out using the coaxial electrospray technique. Betalains were extracted from pitaya (Stenocereus thurberi) and encapsulated in gelatin. The obtained material was evaluated by SEM, FTIR, TGA, and DSC techniques and for its antioxidant capacity. By SEM, nanoparticles with spherical and monodisperse morphologies were observed, with betalain concentrations of 1 and 3% w/v and average diameters of 864 and 832 µm, respectively. By FTIR, the interaction between betalain and gelatin was observed through amino groups and hydrogen bonds. Likewise, the antioxidant activity of the betalains was maintained at the time of encapsulation, increasing the antioxidant activity as the concentration increased. The results of the DPPH, ABTS, and total phenols methods were 645.4592 µM T/g, 832.8863 ± 0.0110 µM T/g, and 59.8642 ± 0.0279 mg GAE/g for coaxial nanoparticles with 3% betalains, respectively. Therefore, the coaxial electrospray technique was useful for obtaining nanoparticles with good antioxidant properties, and due to the origin of its components and since the use of toxic solvents is not necessary in the technique, the material obtained can be considered food grade with potential application as a coating on functional foods.

Active and Intelligent Packaging: A Review of the Possible Application of Cyclodextrins in Food Storage and Safety Indicators.

Natural cyclodextrins (CDs) can be formed by 6, 7, or 8 glucose molecules (α-, ß-, and γ-, respectively) linked in a ring, creating a cone shape. Its interior has an affinity for hydrophobic molecules, while the exterior is hydrophilic and can interact with water molecules. This feature has been used to develop active packaging applied to food, interacting with the product or its environment to improve one or more aspects of its quality or safety. It also provides monitoring information when food is optimal for consumption, as intelligent packaging is essential for the consumer and the merchant. Therefore, this review will focus on discerning which packaging is most appropriate for each situation, solubility and toxicological considerations, characterization techniques, effect on the guest properties, and other aspects related to forming the inclusion complex with bioactive molecules applied to packaging.

Effect of a Prolonged-Release System of Urea on Nitrogen Losses and Microbial Population Changes in Two Types of Agricultural Soil.

Urea is the nitrogen-containing fertilizer most used in agricultural fields; however, the nutrient given by the urea is lost into the environment. The aim of this research was to determine the effect of two soil textures by applying a prolonged-release system of urea (PRSU) on the N losses. This research shows an important decrease of the nitrate and ammonium losses from 24.91 to 87.94%. Also, the microbiological population increases after the application of the PRSU. It was concluded that both soil textures presented the same loss-reduction pattern, where the N from the nitrates and ammonium was reduced in the leachates, increasing the quality of the soil and the microbial population in both soil textures after the PRSU application.

Ultrasonography in rheumatology: time to learn from patient views.

OBJECTIVE: The objective of this observational, descriptive, cross-sectional, multicentre study was to assess the perceived quality and grade of satisfaction expressed by patients with chronic arthropathies regarding the use of musculoskeletal (MSK) ultrasonography by rheumatologists as an integrated clinical care tool. METHODS: All Spanish rheumatology departments with MSK ultrasonography incorporated in their healthcare services were invited to participate in the study. A Spanish-language survey was offered to fill out anonymously to all consecutive patients with chronic arthropathies under follow-up in the rheumatology outpatient clinics who attended their centre for a period of 3 months. The survey consisted of three sections. The first section contained patients' demographics, disease data, frequency of performing rheumatological ultrasound and information about who performed their ultrasound assessments. The second section consisted of 14 questions about patient's experience and opinion on different aspects of the management, performance and perceived usefulness of performing ultrasound, to be answered on a Likert scale 1-5. The third section of the survey was addressed to the rheumatologist ultrasonographers. RESULTS: Nine hundred and four patients from 16 university hospital rheumatology departments completed the survey. All questions reached an overall favourable response ≥ 80%. Patients who reported usual ultrasound examinations in their rheumatology care and those in which it was their attending rheumatologist who performed the ultrasound assessments responded more favourably. CONCLUSION: Our encouraging patient-centred results may be useful in facilitating the implementation of rheumatological ultrasound in rheumatology care worldwide. Key Points • This is the largest multicentre survey carried out in patients with chronic joint diseases designed to assess their experience and perceived benefits with the use of ultrasonography performed by rheumatologists in daily practice. • Musculoskeletal ultrasound incorporated into rheumatology care was very well accepted and valued by most patients. • The patients perceived that ultrasonography helps not only their rheumatologist but also themselves to better understand their condition. • The patients believed that ultrasonography helps them accept and comply with the proposed treatment.

Antioxidant and Antimicrobial Effect of Biodegradable Films Containing Pitaya (Stenocereus thurberi) Extracts during the Refrigerated Storage of Fish.

This study focused on the quality loss inhibition of fish muscle during refrigerated storage. Two parallel experiments were carried out that were focused on the employment of pitaya (Stenocereus thurberi) extracts in biodegradable packing films. On the one hand, a pitaya-gelatin film was employed for hake (Merluccius merluccius) muscle storage. On the other hand, a pitaya-polylactic acid (PLA) film was used for Atlantic mackerel (Scomber scombrus) muscle storage. In both experiments, fish-packing systems were stored at 4 °C for 8 days. Quality loss was determined by lipid damage and microbial activity development. The presence of the pitaya extract led to an inhibitory effect (p < 0.05) on peroxide, fluorescent compound, and free fatty acid (FFA) values in the gelatin-hake system and to a lower (p < 0.05) formation of thiobarbituric acid reactive substances, fluorescent compounds, and FFAs in the PLA-mackerel system. Additionally, the inclusion of pitaya extracts in the packing films slowed down (p < 0.05) the growth of aerobes, anaerobes, psychrotrophs, and proteolytic bacteria in the case of the pitaya-gelatin films and of aerobes, anaerobes, and proteolytic bacteria in the case of pitaya-PLA films. The current preservative effects are explained on the basis of the preservative compound presence (betalains and phenolic compounds) in the pitaya extracts.

Innovative 3d-Printed Prosthesis In A Rare Case Of A Huge Mass Of Anterior Thoracic Wall - Low Grade Fibromyxoid Sarcoma (Lgfms).

The need for complete resection of chest wall tumors creates a huge challenge in terms of reconstructing the complex dynamics of the thorax. We are reporting a case of a low-grade fibromyxoid sarcoma (LGFMS) diagnosed in a young male, where the complete resection of the mass, sternum and parcially the pericardium was performed. Subsequently, a composite porous high-density polyethylene StarPore® prosthesis of the sternum and costal arches was used and the latissimus dorsi muscle free flap with skin graft was implanted over the sternum.

An Unusual Location for a Lymph Node.

We report a case of a 67-years old non-smoking female diagnosed with hypertension when 24-years-old and complicated with chronic kidney and hypertensive heart diseases. On CT-Chest an incidental discovery of a lesion (16x14x23mm) adjacent to the abdominal aorta was made. Initially suspected to be paraganglioma, a hypothesis which the subsequent MRI did not exclude. Urine analysis showed normal Metanephrine with slightly elevated Chromogranin-A levels. During VATs-procedure "bulging" below the adventitial layer of the descending aorta at the level of the diaphragmatic gutter was identified. By opening the adventitia, a lipomatous lesion with a nodular, consistent center was identified and excised. Final histopathological report confirmed the diagnosis of lymph node not suggestive of neoplasia. Currently, 12 months after the surgery, the patient's condition is good being under surveillance in the Thoracosurgical Outpatient Clinic. Despite not having identified any neuroendocrine component, the patient had clinical signs of clear improvement of arterial hypertension.

Effect of Ionic Liquids in the Elaboration of Nanofibers of Cellulose Bagasse from Agave tequilana Weber var. azul by Electrospinning Technique.

The objective of this paper was to report the effect of ionic liquids (ILs) in the elaboration of nanofibers of cellulose bagasse from Agave tequilana Weber var. azul by the electrospinning method. The ILs used were 1-butyl-3-methylimidazolium chloride (BMIMCl), and DMSO was added as co-solvent. To observe the effect of ILs, this solvent was compared with the organic solvent TriFluorAcetic acid (TFA). The nanofibers were characterized by transmission electron microscopy (TEM), X-ray, Fourier transform-infrared using attenuated total reflection (FTIR-ATR) spectroscopy, and thermogravimetric analysis (TGA). TEM showed different diameters (ranging from 35 to 76 nm) of cellulose nanofibers with ILs (CN ILs). According to X-ray diffraction, a notable decrease of the crystalline structure of cellulose treated with ILs was observed, while FTIR-ATR showed two bands that exhibit the physical interaction between cellulose nanofibers and ILs. TGA revealed that CN ILs exhibit enhanced thermal properties due to low or null cellulose crystallinity. CN ILs showed better characteristics in all analyses than nanofibers elaborated with TFA organic solvent. Therefore, CN ILs provide new alternatives for cellulose bagasse. Due to their small particle size, CN ILs could have several applications, including in food, pharmaceutical, textile, and material areas, among others.

Nanoencapsulation of Eggplant (Solanum melongena L.) Peel Extract in Electrospun Gelatin Nanofiber: Preparation, Characterization, and In Vitro Release.

This study describes the preparation and characterization of eggplant peel extract-loaded electrospun gelatin nanofiber and study of its in vitro release. Results obtained by scanning electron microscopy (SEM) and transmission electronic microscopy (TEM) micrograph revealed that eggplant peel extract-loaded electrospun gelatin nanofiber is in nanometric range with an average diameter 606.7 ± 184.5 and 643.6 ± 186.7 nm for 20 and 33.3 mg mL-1 of extract addition, respectively. Moreover, the incorporation of extract improved morphology by being smooth, homogeneous, and without account formation compared to nanofibers without extract (control). Fourier transform-infrared (FT-IR) spectra indicated that interaction exists between electrospun gelatin nanofiber and eggplant peel extract by hydrogen bond interactions, mainly. Electrospun gelatin nanofibers showed encapsulation efficiency greater than 90% of extract and a maximum release of 95 and 80% for the medium at pH 1.5 and 7.5, respectively. Therefore, the electrospinning technique is a good alternative for the conservation of bioactive compounds present in the eggplant peel through electrospun gelatin nanofiber.

Rare case of low-grade fibromyxoid sarcoma of the thoracic wall with complete sternum reconstruction.

An 18-year-old boy presented with a giant midline mass with 9 years of evolution. The tumor was excised, and reconstruction made with a customized sternum implant and a free latissimus dorsi muscle flap with skin graft. Histological analysis was compatible with low-grade fibromyxoid sarcoma (LGFMS).

Beyond the skin - A rare case of primary pulmonary melanoma and endobronchial aspergilloma.

Melanoma is an aggressive skin tumor, but it may be present in other locations. Primary lung melanoma and endobronchial aspergilloma are rare entities. The authors report a case of a 72-year-old, asthmatic woman, with worsening of her respiratory complaints. Imaging revealed finger in glove sign at the left hemithorax. Bronchoscopy revealed an elongated mass with evidence of Aspergillus. Despite endoscopic mass removal, the patient maintained the nodular imaging at the left hemithorax. She underwent thoracic surgery, and the histological evaluation identified malignant melanoma. After undergoing a thorough evaluation, we excluded other melanocytic lesions, and assumed the diagnosis of primary malignant lung melanoma. This case demonstrates a rare association between endobronchial aspergilloma and primary lung melanoma, raising awareness of considering the co-existence of lung tumor in the presence of endobronchial aspergilloma, and showing endobronchial aspergilloma mimicking malignant lesions.

DESCENDING NECROTIZING MEDIASTINITIS - A MULTIDISCIPLINARY PATHOLOGY.

A 23-year-old man presented with fever and cervical swelling. Contrast-enhanced CT-scan with oblique sagittal planes reconstructions with extensive collection with gaseous areas, involving multiple cervical and mediastinal spaces is shown, reflecting a cervical-mediastinal necrotizing fasciitis. Note the circumference to the laryngotracheal axis. He underwent combined surgery by ENT and thoracic surgery and was discharged without sequelae after long hospitalization. This case demonstrates the importance of working in a multidisci- plinary team to treat complex pathologies.

LUNG RESECTION FOR NON-SMALL-CELL LUNG CANCER - A NEW RISK SCORE TO PREDICT MAJOR PERIOPERATIVE COMPLICATIONS.

OBJECTIVES: Identify risk factors for major perioperative complications (MPC) after anatomical lung resection for NonSmall-Cell Lung Cancer (NSCLC) and establish a scoring system. METHODS: Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). EXCLUSION CRITERIA: previous lung surgery, concomitant non-lung cancer related procedures, urgency surgery. STUDY POPULATION: 520 patients. PRIMARY END-POINT: MPC defined as a composite endpoint including at least one of the in-hospital complications. Univariable and Multivariable analyses were developed to identify predictors of perioperative complications and create a risk score. Discrimination was assessed using the C-statistic. Calibration was evaluated by Hosmer and Lemeshow test and internal validation was obtained by means of bootstrap replication. RESULTS: Mean age of 65 years and 327 (62.9%) were males. Mean hospital stay of 9 days after surgery. Overall MPC rate was 23.3%. Male gender, hypertension, FEV1<75%, thoracotomy, bilobectomy/pneumectomy and additional resection were independent predictors of MPC. A risk score based on the odds ratios was developed - Major Perioperative Complications of Lung Resection (MPCLR) scoring system - and ranged between 0 and 14 points. It was divided in 5 groups: 1-2 points (positive preditive value 15%); 3-4 (PPV 25%); 5-7 (PPV 35%); 8-9 (PPV 60%); >10 points (PPV 88%). The score showed rea- sonable discrimination (C-statistic=0.70), good calibration (P=.643) and it was internally validated (C-statistic=0,70 BCa95% CI,0.65-0.79). CONCLUSIONS: This study proposes a simple and daily-life risk score system that was able to predict the incidence of perioperative complications.

LYMPH NODE UPSTAGING AFTER SURGERY IN PATIENTS WITH NEGATIVE MEDIASTINAL STAGING BY EBUS.

INTRODUCTION: Mediastinal staging is a hot topic in thoracic oncology. According to the guidelines, and besides other criteria, in the presence of a primary lung cancer with increased mediastinal lymph node uptake on PET-CT, a negative result after lymph node sampling by Endobronchial Ultrasound (EBUS) is not enough to rule out mediastinal lymph node involve- ment, demanding a cervical mediastinoscopy to vouch for the results. METHODS AND OBJECTIVES: In order to study the percentage of lymph node surgical upstaging in patients with neg- ative mediastinal node staging by EBUS and evaluate the role of mediastinoscopy in these patients, we conducted a search in our department's database using the key-word EBUS in the period concerned between January 2014 and August 2020. A total of 302 patients were found. After applying defined criteria, we obtained 42 cases. RESULTS: Lymph node surgical upstaging occurred in 11 (26%) patients, of which 8 were upstaged to N2 and 3 to N1. Most of the cases were single station. Only in 5 (12% of the total) of the 11 patients, the upstaging was related to lymph node stations previously sampled by EBUS. Upstaging was more frequent among males and lower lobe tumours. DISCUSSION AND CONCLUSIONS: Regarding the 8 upstage cases for N2, 5 were single station. Of these 8 cases, only 5 would be approachable by cervical mediastinoscopy. Furthermore, 2 of them were single station, eligible for upfront surgery. Then, only in 3 (7%) of the 42 cases cervical mediastinoscopy would be of foremost importance.

Hemobilia and acute hemocolecyst as an unusual presentation of gallbladder cancer.

Gallbladder cancer that presents as acute cholecystitis associated with hemocholecyst and hemobilia is a rare entity. There are few cases reported in the literature. We present a case of gallbladder carcinoma diagnosed after emergency cholecystectomy, performed due to hemobilia and acute cholecystitis due to hemocholecyst.

El cáncer de vesícula biliar que se presenta como una colecistitis aguda asociada a hemocolecisto y hemobilia es muy infrecuente. Hasta la fecha hay pocos casos informados en la literatura. Presentamos un caso de carcinoma de vesícula biliar diagnosticado tras colecistectomía de urgencia, realizada por hemobilia y colecistitis aguda por hemocolecisto.

Combination of Sorbitol and Glycerol, as Plasticizers, and Oxidized Starch Improves the Physicochemical Characteristics of Films for Food Preservation.

The aim of this work was to use glycerol (Gly) and sorbitol (Sor) as plasticizers with oxidized starch potato (OS) to produce biodegradable and environmentally friendly films, and to demonstrate the resulting physicochemical and functional viability without subtracting the organoleptic characteristics of the food. Analyses by water vapor permeability (WVP), attenuated total reflection Fourier transform infrared spectra (ATR-FTIR), scanning electron microscopy (SEM), tensile strength (TS), and transparency (UV) showed that the best film result was with 1.5 g of Gly and 2.0 g of Sor, conferred shine, elasticity 19.42 ± 6.20%, and mechanical support. The starch oxidized to 2.5%, contributing a greater transparency of 0.33 ± 0.12 and solubility of 78.90 ± 0.94%, as well as less permeability to water vapor 6.22 ± 0.38 gmm-2 d-1 kPa-1. The films obtained provide an alternative for use in food due to their organic compounds, excellent visual presentation, and barrier characteristics that maintain their integrity and, therefore, their functionality.

Sustainable-green synthesis of silver nanoparticles using safflower (Carthamus tinctorius L.) waste extract and its antibacterial activity.

Silver nanoparticles have high potential for application in food industry, as they have the ability to inhibit a wide range of bacteria of pathogenic and spoilage origin. They can be obtained from different methods classified in physical and chemical and which are aggressive with the environment since they produce toxic waste. Nowadays, environmentally friendly methods such as green synthesis can be used, through the use of agri-food waste. The use of these wastes is a more sustainable method, because it reduces the environmental pollution, at the same time that silver nanoparticles are obtained. The aim of the present study is the green synthesis of silver nanoparticles using safflower (Carthamus tinctorius L.) aqueous extract from waste and its antibacterial activity on Staphylococcus aureus (Gram positive) and Pseudomonas fluorescens (Gram negative). The analyses by TEM showed that the as-synthesized silver nanoparticles were uniform and spherical particles with an average diameter of 8.67 ± 4.7 nm and confirmed by SEM. The electron diffraction and TEM analyses showed the characteristic crystallinity of silver nanoparticles. FTIR spectroscopy confirmed that various functional groups were responsible for reducing and stabilizing during the biosynthesis process. Nanoparticles inhibited the growth of both types of bacteria from the lowest concentration evaluated (0.9 µg/mL). We conclude that silver nanoparticles synthesized in the present study have potential application as antibacterial agents in food and medicine industry.