A case report of using gauze packing to treat postoperative chest bleeding after left pneumonectomy for secondary rifampicin-resistant tuberculosis.

One patient with rifampin-resistant tuberculosis underwent emergency left pneumonectomy and thoracic gauze packing for hemoptysis due to recurrent hemoptysis after transcatheter arterial embolization. Vital signs were maintained by mechanical ventilation and medication. Tracheotomy and anti-tuberculosis treatment were performed. After half a year of follow-up, the patient's condition was stable.

The safety and efficacy of decortication for stage III drug-resistant tuberculous empyema.

OBJECTIVES: The goal of this study was to evaluate the safety and efficacy of decortication for stage III drug-resistant tuberculous empyema (TE). METHODS: We analysed all patients with stage III TE who underwent decortication between March 2015 and October 2019 at Wuhan Pulmonary Hospital. The patients were divided into 2 groups according to drug-susceptibility testing of bronchoscopy lavage fluid, pleural effusion and tissue specimens, including a drug-resistant group and a drug-sensitive group. We collected and compared the preoperative, perioperative and postoperative data from the 2 groups to evaluate the safety and efficacy of decortication for stage III drug-resistant TE. RESULTS: In total, 135 cases met the inclusion criteria and were enrolled, including 30 cases in the drug-resistant group and 105 cases in the drug-sensitive group. No deaths were recorded for the entire study population. Compared to the drug-sensitive group, the drug-resistant group had longer operation times (259.8 ± 78.4 min vs 187.2 ± 56.0 min, P = 0.00), a larger volume of intraoperative blood loss [300 (200,400) ml vs 200 (130, 300) ml, P = 0.00] and a higher intraoperative transfusion rate (5/30, 16.7% vs 4/105, 3.8%, P = 0.04). The rate of complications was significantly higher in the drug-resistant group (23; 76.7%) than in the drug-sensitive group (53; 50.5%) (P = 0.01). Recurrence was not reported in any of the patients. Twenty-three (76.7%) patients in the drug-resistant group and 90 (85.7%) patients in the drug-sensitive group recovered to an "excellent" level, and 3 cases in each group recovered to a "poor" level; there was no significant difference between the 2 groups in surgical effects (P = 0.21). CONCLUSIONS: Decortication is a safe, effective and feasible option for patients with stage III drug-resistant TE, although the operation is difficult and risky.

Lymph node dissection effectively shortens the course of anti-tuberculosis treatment.

Objective: To evaluate the clinical efficacy of postoperative ultra-short-course chemotherapy in treating cervical lymph node tuberculosis in the Wuhan region. Methods: Follow-up of patients in the surgery and non-surgery group after discharge, evaluating the number of cervical lymph nodes during the administration of antituberculosis drugs. Results: The age of the patients in the surgical therapy group ranged from 6 to 83 years old with an average age of 45 and a standard deviation of 20. The number of cervical lymph nodes in the patients ranged from 1.61 to 8.15. The average antituberculosis treatment duration before surgery for patients in the surgical group was 98.02 days, while for patients in the non-surgical group it was 96.13 days. The average length of hospital stay for patients receiving surgical treatment was 12.76 days, while for patients receiving non-surgical treatment it was 8.74 days. The average antituberculosis treatment duration after discharge for patients in the surgical group was 205 days, with a standard deviation of 42.39, while for patients in the non-surgical group it was 372 days, with a standard deviation of 71.54. The T-test results for antituberculosis treatment during hospitalization and after discharge were 98.3x10-10 and 5.02x10-67, respectively. Conclusion: After surgical treatment of cervical lymph node tuberculosis, the effectiveness of a 4-6 month short-course chemotherapy in Wuhan region is not weaker than the effectiveness of a conventional 6-9 month drug treatment.

Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis.

Surgery plays a crucial role in the treatment of patients with chronic pulmonary aspergillosis (CPA). However, there is currently limited information available regarding the use of uniportal thoracoscopy (Uni-VATS) in CPA patients. To address this gap, we conducted a retrospective analysis of surgical procedures performed at a single center, aiming to demonstrate the feasibility and safety of Uni-VATS for patients with CPA. We collected basic information and surgical data from patients who underwent surgery for CPA at our hospital between January 2018 and June 2022. All patients received voriconazole antifungal medication for 3-6 months post-surgery and were monitored for a minimum of 6 months. A total of 110 patients, comprising 59 cases in the traditional open chest incision group and 51 cases in the Uni-VATS group, met the inclusion criteria. Among those who underwent surgery, 70% were male (77/110). The median age (IQR) of all enrolled patients was 55 (46-62) years. There were no statistically significant differences in general information, such as age, sex, comorbidities, BMI, FEV1, FVC, clinical symptoms, location of the disease, and duration of voriconazole antifungal medication, between the OS group and the Uni-VATS group (p > 0.05). The postoperative complication rates were 40.7% (24/59) for the traditional open chest incision group and 17.6% (9/51) for the Uni-VATS group. Through univariate analysis, we identified sex and operative approach as risk factors for postoperative complications. Multivariate logistic analysis confirmed that male and OS procedures were the independent risk factors for postoperative complications. There were statistically significant differences in operative time, intraoperative blood loss volume, postoperative drainage volume, pain scores, postoperative drainage tube removal time, postoperative hospital stay time between the OS group and the Uni-VATS group (p < 0.05). Uni-VATS is a feasible and safe surgical procedure for patients with CPA, and we recommend it as a preferred option for selected patients with CPA.

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging.

To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

Is VATS suitable for lung diseases with hemoptysis? Experience from a hemoptysis treatment center in China.

BACKGROUND: Surgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis. METHODS: We collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022. RESULTS: Sixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195-665) ml, which was 250 (130-500) ml of the VATS group, significantly less than the 550 (460-820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4-9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6-17) days for all patients, and it was 7 (5-14) days for the VATS group, which was less than 15 (9-20) days for the OS group. CONCLUSION: VATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.

Successful surgical treatment of bronchopleural fistula caused by severe pulmonary tuberculosis: A case report and review of literature.

BACKGROUND: Bronchopleural fistula (BPF) is a relatively rare, but severe complication of pulmonary tuberculosis. It is associated with significant mortality; however, its management remains a major therapeutic challenge. CASE SUMMARY: We present a 24-year-old man with BPF resulting from severe pulmonary tuberculosis combined with mixed infections. The damaged right upper lobe and concomitant empyema were demonstrated via computed tomography. After undergoing open-window thoracostomy and tuberculosis treatment for 4 mo, decortication and right upper lobectomy were subsequently performed, leading to the resolution of tuberculosis and other concurrent pulmonary infections. Follow-up, 6 mo after surgery, failed to reveal any evidence of infection recurrence resulting in a good prognosis. CONCLUSION: The disease course of tuberculous BPF is particularly challenging. Surgical intervention serves as an effective and safe therapeutic strategy for BPF.

Uniportal video-assisted thoracoscopic (VATS) subtotal parietal pleurectomy for refractory tuberculous pneumothorax: Five case-reports.

OBJECTIVE: This study explored the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) paretal pleurectomy in patients suffering from complex tuberculous pneumothorax. These cases were reported and summarized to present the experience of the authors with this procedure. METHODS: The clinical data of a total of 5 patients with refractory tuberculous pneumothorax having undergone subtotal parietal pleurectomy by uniportal VATS in our institution were hereby collected from November 2021 to February 2022, and regular follow-up was conducted after surgery. RESULTS: Parietal pleurectomy via VATS was successfully performed in all these 5 patients, among which, 4 received bullectomy at the same time, with no conversion to open surgery. Among the 4 cases of full lung expansion who were suffering from recurrent tuberculous pneumothorax, the preoperative chest drain duration ranged from 6 days to 12 days; the operation time, from 120 minutes to 165 minutes; intraoperative blood loss, from 100 mL to 200 mL; the drainage volume, from 570 mL to 2000 mL 72 hours after operation; and chest tube duration, from 5 days to 10 days. One rifampicin-resistant case had satisfactory postoperative lung expansion, but left a cavity, the operation time of which was 225 minutes; intraoperative blood loss, 300 mL; the drainage volume, 1820 mL 72 hours after operation; and chest tube duration, 40 days. The follow-up time ranged from 6 months to 9 months, and no recurrence was noted. CONCLUSION: Parietal pleurectomy with preservation of the top pleura via VATS is a safe and satisfactorily effective procedure for patients with refractory tuberculous pneumothorax.

Cortical thickness and intrinsic activity changes in middle-aged men with alcohol use disorder.

BACKGROUND: Previous studies reported the alterations of brain structure or function in people with alcohol use disorder (AUD). However, a multi-modal approach combining structural and functional studies is essential to understanding the neural mechanisms of AUD. Hence, we examined regional differences in cortical thickness (CT) and amplitude of low-frequency fluctuation (ALFF) in patients with AUD. METHODS: Thirty male patients with AUD and thirty age- and education-matched healthy male controls were recruited. High-resolution anatomical and resting-state functional MRI (rs-fMRI) data were collected, and the CT and ALFF were computed. RESULTS: Behaviorally, males with AUD showed a cognitive decline in multiple domains. Structurally, they presented prominent reductions in CT in the bilateral temporal, insular, precentral, and dorsolateral prefrontal gyri (p < 0.05, voxel-wise family-wise error [FWE]). Functionally, a significant decrease in ALFF in the bilateral temporal, dorsolateral prefrontal, insular, putamen, cerebellum, right precuneus, mid-cingulate, and precentral gyri were observed (p < 0.05, FWE). CONCLUSIONS: Our findings demonstrate the dual alterations of alcohol-related brain structure and function in male patients with AUD. These results may be useful in understanding the neural mechanisms in AUD.

The association of cytokine gene polymorphisms with tuberculosis susceptibility in several regional populations.

PURPOSE: By collecting the data of all relevant articles, the goal of this study was to better understand the relationship between the IL-6/IL-18 polymorphism and susceptibility to tuberculosis in several regional populations. METHODS: Pubmed, Embase, WOS and CNKI were used to find relevant literature. The findings of separate research were merged using Review Manager. RESULTS: A total of 25 studies were included in this study. IL-6 rs1800795 (dominant. comparison: p-value < 0.0001, OR 1.43, 95 % CI 1.23-1.67; recessive comparison: p-value < 0.0001, OR 0.48, 95 % CI 0.35-0.65; allele comparison: p-value < 0.0001, OR 1.43, 95 % CI 1.27-1.62), IL-18 rs1946518 (dominant comparison: p-value = 0.01, OR 1.19, 95 % CI 1.04-1.35; recessive comparison: p-value = 0.01, OR 0.82, 95 % CI 0.71-0.96; allele comparison: p-value = 0.002, OR 1.14, 95 % CI 1.05-1.24), IL-18 rs187238 (dominant comparison: p-value = 0.0002, OR 1.35, 95 % CI 1.15-1.58; allele comparison: p-value < 0.0001, OR 1.31, 95 % CI 1.14-1.50). All gene polymorphisms were shown to be substantially linked to tuberculosis in the general population. Positive findings of rs187238 and rs1800795 polymorphisms were primarily driven by several regional populations, according to subgroup analyses. CONCLUSION: This meta-analysis found that the the IL-6 rs1800795and IL-18 rs187238 polymorphisms may have a role in TB susceptibility.

Analysis of efficacy and safety of linezolid-based chemotherapeutic regimens for patients with postoperative multidrug-resistant spinal tuberculosis.

OBJECTIVES: The study aimed to explore the efficacy and safety of linezolid-based chemotherapeutic regimens for patients with postoperative multidrug-resistant spinal tuberculosis. METHODS: The randomized controlled study included 50 Mycobacterium tuberculosis culture or pathological-confirmed multidrug resistant tuberculosis patients who received spinal surgery from January 2018 to February 2020. Twenty-five patients were assigned to the control group and the study group, respectively. Random number method was used for patient allocation and they were treated with levofloxacin, pyrazinamide, thioisonicotinamide enteric-coated tablet, amikacin sulfate injection, and sodium p-amino salicylate injection, accompanied by linezolid or not. RESULTS: The overall effective rate of the study group was higher than that of the control group (88.00% vs 64.00%, P<0.05). The severity of pain at 3 and 6 months postoperatively was lower in the study group than that in the control group (P<0.05). Postoperatively, the study group had higher bone graft fusion rate, shorter mean bone graft fusion time, and higher paraspinal cyst absorption rate than the control group (P<0.05). Postoperatively, the study group had lower levels of PCT, ESR, and CRP than the control group (P <0.05). All patients had normal hepatic and renal function, and no statistical difference of adverse effects between 2 groups were found. CONCLUSIONS: Linezolid-based chemotherapeutic regimens can effectively treat patients with postoperative multidrug-resistant spinal tuberculosis but have higher rates of adverse reactions.

A combination of support vector machine and voxel-based morphometry in adult male alcohol use disorder patients with cognitive deficits.

Cognitive performance deteriorates with drinking. However, the neural basis of cognitive deficits in alcohol use disorder (AUD) is still incompletely understood. Here we examined the relationship between overall drinking, brain structural alterations and cognitive deficits in AUD. A total of 40 middle-aged AUD males and 40 healthy controls (HC) underwent high-resolution anatomical imaging scans, and the data were analyzed using voxel-based morphometry, support vector machine (SVM) classification and mediation analysis. The AUD patients demonstrated reduced gray matter (GM) volumes that included left amygdala, thalamus, hippocampus, precentral gyrus, cerebellum, calcarine, right supplementary motor area and bilateral superior temporal gyri (voxel-wise p < 0.05, FWE corrected). The SVM results could distinguish AUD from HC with satisfactory classification results (0.8275). GM volumes in the bilateral cerebellum and thalamus, left anterior medial temporal lobe, left nucleus ambiguus + parahippocampus gyrus, left fusiform gyrus, left lingual gyrus, left hippocampus, and right nucleus accumbens had positive correlations with the Montreal Cognitive Assessment (MoCA) scores. Further mediation analysis showed that left cerebellum crus 1 partially mediated the relationship between overall drinking and MoCA scores (standardized beta coefficient = -0.0973, SE = 0.0002, 95% CI = (-0.0006, 0.0000)). Our findings showed widespread GM atrophies and many of these atrophies also mirrored cognitive deficits and were robustly distinguishable. Critically, the left cerebellum crus 1 partially mediated the relationship betweem overall drinking and MoCA scores, suggesting a pathway by which alcohol abuse impairs cognition and accelerates brain ageing in middle-aged AUD males.

Comparative analysis of five inspection techniques for the application in the diagnosis and treatment of osteoarticular tuberculosis.

OBJECTIVE: To evaluate five examination techniques in the diagnosis and treatment of osteoarticular tuberculosis (TB). METHODS: Microbiological samples were collected from a total of 284 patients during the period August 2017 to December 2019 in Wuhan Pulmonary Hospital. The specimens were examined by acid-fast bacillus (AFB) smear microscopy, mycobacterial culture, PCR, T-SPOT.TB, and X-pert MTB/RIF rapid molecular detection. RESULTS: The diagnostic sensitivity of the Xpert technology was 96.8% (116/120), specificity was 96.8% (58/60), the Youden index was 0.936, and the area under the receiver operating characteristic (ROC) curve was 0.967. The sensitivity and specificity of PCR were 84.2% (104/128) and 95.2% (76/80), respectively; the area under the ROC curve was 0.881. T-SPOT.TB had a detection sensitivity of 75.0% (12/16) and specificity of 85.0% (17/20). AFB smear microscopy had a sensitivity of 60.0% (75/125) and specificity of 95.8% (152/159). TB culture sensitivity was 58.1% (72/124) and specificity was 96.2% (73/76). The sensitivity and specificity of Xpert MTB/RIF for detecting rifampicin resistance were 100% (2/2) and 97.3% (73/75), respectively. CONCLUSIONS: The Xpert MTB/RIF technique was found to have a good diagnostic value. With an additional diagnosis of Rifampicin resistance, it was also useful in tuberculosis therapy.

Prediction of the Complication Risk in Drug-Resistant Tuberculosis After Surgery: Development and Assessment of a Novel Nomogram.

Background: Surgery is increasingly accepted as an adjunctive approach to treat multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB). However, a model that includes all factors to predict the risk of postoperative complications is lacking. Methods: We developed a prediction model based on 138 patients who had undergone surgery as treatment for drug-resistant tuberculosis (DR-TB) after 24 months. Clinical features on the lesion type (L), treatment history (T), physiologic status of the body (B), and surgical approach (S) were evaluated. Multivariable logistic regression analysis was conducted by clinical features selected in the least absolute shrinkage and selection operator (LASSO) to build a nomogram. The discrimination, calibration, and clinical usefulness of the nomogram were assessed using the C-Index, calibration plots, and decision curves. Internal validation was assessed using bootstrapping. Results: The nomogram contained the features L, B, T, cavitary, recurrent chest infection (RCI) and MDR-TB/XDR-TB. The model displayed good discrimination with a C-Index of 0.879 (95% CI: 0.799-0.967). A high C-Index of 0.824 was achieved in the interval validation. Decision-curve analysis showed that the nomogram was clinically useful if intervention was decided at the non-adherence possibility threshold of 4%. Conclusion: Our novel nomogram could be used conveniently to predict postoperative complication risk in DR-TB patients.

Intrinsic dialogues between the two hemispheres in middle-aged male alcoholics: a resting-state functional MRI study.

BACKGROUND: The purpose of this study was to investigate the interhemispheric intrinsic connectivity measured by resting-state functional MRI (R-fMRI) in middle-aged male alcoholics. METHODS: Thirty male alcoholics (47.33 ± 8.30 years) and 30 healthy males (47.20 ± 6.17 years) were recruited and obtained R-fMRI data. Inter- and intrahemispheric coordination was performed by using voxel-mirrored homotopic connectivity (VMHC) and seed-based functional connectivity analysis. RESULTS: We found significantly decreased VMHC in a set of regions in male alcoholics patients, including lateral temporal, inferior frontal gyrus, insular/insulae operculum, precuneus/posterior cingulate gyrus, and pars triangularis (P < 0.05, corrected). Subsequent seed-based functional connectivity analysis demonstrated disrupted functional connectivity between the regions of local homotopic connectivity deficits and other areas of the brain, particularly the areas subserving the default, salience, primary somatomotor, and language systems. CONCLUSIONS: Middle-aged male alcoholic subjects demonstrated prominent reductions in inter- and intrahemispheric functional coherence. These abnormal changes may reflect degeneration of system/network integration, particularly the domains subserving default, linguistic processing, and salience integration.

A web visualization tool using T cell subsets as the predictor to evaluate COVID-19 patient's severity.

Wuhan, China was the epicenter of the 2019 coronavirus outbreak. As a designated hospital for COVID-19, Wuhan Pulmonary Hospital has received over 700 COVID-19 patients. With the COVID-19 becoming a pandemic all over the world, we aim to share our epidemiological and clinical findings with the global community. We studied 340 confirmed COVID-19 patients with clear clinical outcomes from Wuhan Pulmonary Hospital, including 310 discharged cases and 30 death cases. We analyzed their demographic, epidemiological, clinical and laboratory data and implemented our findings into an interactive, free access web application to evaluate COVID-19 patient's severity level. Our results show that baseline T cell subsets results differed significantly between the discharged cases and the death cases in Mann Whitney U test: Total T cells (p < 0.001), Helper T cells (p <0.001), Suppressor T cells (p <0.001), and TH/TSC (Helper/Suppressor ratio, p<0.001). Multivariate logistic regression model with death or discharge as the outcome resulted in the following significant predictors: age (OR 1.05, 95% CI, 1.00 to 1.10), underlying disease status (OR 3.42, 95% CI, 1.30 to 9.95), Helper T cells on the log scale (OR 0.22, 95% CI, 0.12 to 0.40), and TH/TSC on the log scale (OR 4.80, 95% CI, 2.12 to 11.86). The AUC for the logistic regression model is 0.90 (95% CI, 0.84 to 0.95), suggesting the model has a very good predictive power. Our findings suggest that while age and underlying diseases are known risk factors for poor prognosis, patients with a less damaged immune system at the time of hospitalization had higher chance of recovery. Close monitoring of the T cell subsets might provide valuable information of the patient's condition change during the treatment process. Our web visualization application can be used as a supplementary tool for the evaluation.