Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy.

Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.

Surgical treatment of breast cancer.

Surgical treatment of breast cancer has changed towards less invasive procedures as summarised in this review. Breast conserving surgery (BCS) and radiotherapy (RT) are now recommended as standard of care. Several flexible marking methods for removal of non-palpable tumours have gradually replaced wire-guided localisation. Neoadjuvant systemic treatment increases tumour shrinkage and BCS and may lead to omission of axillary clearance (AC). The prognostic significance of AC in patients with metastases to 1-2 sentinel nodes at primary surgery is questioned. Results from the SENOMAC trial are expected to change guidelines from AC to axillary RT.

The format of the cognitive map depends on the structure of the environment.

Humans and animals form cognitive maps that allow them to navigate through large-scale environments. Here we address a central unresolved question about these maps: whether they exhibit similar characteristics across all environments, or-alternatively-whether different environments yield different types of maps. To investigate this question, we examined spatial learning in three virtual environments: an open courtyard with patios connected by paths (open maze), a set of rooms connected by corridors (closed maze), and a set of isolated rooms connected only by teleporters (teleport maze). All three environments shared the same underlying topological graph structure. Postlearning tests showed that participants formed representations of the three environments that varied in accuracy, format, and individual variability. The open maze was most accurately remembered, followed by the closed maze, and then the teleport maze. In the open maze, most participants developed representations that reflected the Euclidean structure of the space, whereas in the teleport maze, most participants constructed representations that aligned more closely with a mental model of an interconnected graph. In the closed maze, substantial individual variability emerged, with some participants forming Euclidean representations and others forming graph-like representations. These results indicate that an environment's features shape the quality and nature of the spatial representations formed within it, determining whether spatial knowledge takes a Euclidean or graph-like format. Consequently, experimental findings obtained in any single environment may not generalize to others with different features. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Virtual reality and 3D printing in clinical anesthesia: a case series of two years' experience in a single tertiary medical centre.

PURPOSE: Anatomically correct patient-specific models made from medical imaging can be printed on a three-dimensional (3D) printer or turned into a virtual reality (VR) program. Until recently, use in anesthesia has been limited. In 2019, the anesthesia department at Tel Aviv Medical Center launched a 3D program with the aim of using 3D modelling to assist in preoperative anesthesia planning. METHODS: A retrospective review of all relevant patients between July 2019 and June 2021 referred for preoperative airway planning with 3D modelling. Patient files were reviewed for correlation between the model-based airway plan and the actual airway plan, the type of model used, and any anesthetic complications related to airway management. RESULTS: Twenty patients were referred for 3D modelling. Of these, 15 models were printed, including 12 children requiring one lung ventilation. Five patients had VR reconstructions, including three with mediastinal masses. One patient had both a 3D-printed model and a VR reconstruction. There were two cases (10%) where the model plan did not correlate with the final airway plan and one case where a model could not be created because of poor underlying imaging. For the remaining 17 cases, the plan devised on the model matched the final airway plan. There were no anesthetic complications. CONCLUSIONS: Three-dimensional modelling and subsequent printing or VR reconstruction are feasible in clinical anesthesia. Its routine use for patients with challenging airway anatomy correlated well with the final clinical outcome in most cases. High-quality imaging is essential.

RéSUMé: OBJECTIF: Des modèles anatomiquement corrects spécifiques à un·e patient·e réalisés à partir de l'imagerie médicale peuvent être imprimés sur une imprimante tridimensionnelle (3D) ou transformés en programme de réalité virtuelle (RV). Jusqu'à récemment, l'utilisation de cette modalité était limitée en anesthésie. En 2019, le service d'anesthésie du centre médical de Tel Aviv a lancé un programme 3D dans le but d'utiliser la modélisation 3D pour faciliter la planification préopératoire de l'anesthésie. MéTHODE: Nous avons réalisé un examen rétrospectif de toute la patientèle concernée référée pour une planification préopératoire des voies aériennes avec modélisation 3D entre juillet 2019 et juin 2021. Les dossiers des patient·es ont été examinés pour déterminer la corrélation entre le plan de prise en charge des voies aériennes fondé sur le modèle et le plan fondé sur les voies aériennes réelles, le type de modèle utilisé et toute complication anesthésique liée à la prise en charge des voies aériennes. RéSULTATS: Vingt patient·es ont été référé·es pour la modélisation 3D. À partir de cette cohorte, 15 modèles ont été imprimés, dont 12 pour des enfants nécessitant une ventilation pulmonaire. Cinq patient·es ont bénéficié de reconstructions en RV, dont trois avec des masses médiastinales. Un modèle imprimé en 3D et une reconstruction en RV ont été créés pour une personne. Il y a eu deux cas (10 %) où le plan modèle n'était pas corrélé avec le plan des voies aériennes final et un cas où il n'a pas été possible de créer un modèle en raison d'une mauvaise imagerie sous-jacente. Pour les 17 cas restants, le plan conçu sur le modèle correspondait au plan final de prise en charge des voies aériennes. Il n'y a pas eu de complications anesthésiques. CONCLUSION: La modélisation tridimensionnelle et l'impression ultérieure ou la reconstruction en RV sont réalisables en anesthésie clinique. Leur utilisation systématique pour les patient·es présentant une anatomie difficile au niveau des voies aériennes était bien corrélée avec le résultat clinique final dans la plupart des cas. Une imagerie de haute qualité est essentielle.

Evaluation of the cytotoxic and genotoxic potential of printer toner particles in a 3D air-liquid interface, primary cell-based nasal tissue model.

Printer toner particles (TPs) are a common, potentially hazardous substance, with an unclear toxicological impact on the respiratory mucosa. Most of the airways surface is covered by a ciliated respiratory mucosa, therefore appropriate tissue models of the respiratory epithelium with a high in vivo correlation are necessary for in vitro evaluation of airborne pollutants toxicology and the impact on the functional integrity. The aim of this study is the evaluation of TPs toxicology in a human primary cell-based air-liquid-interface (ALI) model of respiratory mucosa. The TPs were analyzed and characterized by scanning electron microscopy, pyrolysis and X-ray fluorescence spectrometry. ALI models of 10 patients were created using the epithelial cells and fibroblasts derived from nasal mucosa samples. TPs were applied to the ALI models via a modified Vitrocell® cloud and submerged in the dosing 0.89 - 892.96 µg/ cm2. Particle exposure and intracellular distribution were evaluated by electron microscopy. The MTT assay and the comet assay were used to investigate cytotoxicity and genotoxicity, respectively. The used TPs showed an average particle size of 3 - 8 µm. Mainly carbon, hydrogen, silicon, nitrogen, tin, benzene and benzene derivates were detected as chemical ingredients. By histomorphology and electron microscopy we observed the development of a highly functional, pseudostratified epithelium with a continuous layer of cilia. Using electron microscopy, TPs could be detected on the cilia surface and also intracellularly. Cytotoxicity was detected from 9 µg/ cm2 and higher, but no genotoxicity after ALI and submerged exposure. The ALI with primary nasal cells represents a highly functional model of the respiratory epithelium in terms of histomorphology and mucociliary differentiation. The toxicological results indicate a weak TP-concentration-dependent cytotoxicity. AVAILABILITY OF DATA AND MATERIALS: The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Data From a One-Stop-Shop Comprehensive Cancer Screening Center.

PURPOSE: Cancer is the second leading cause of death globally. However, by implementing evidence-based prevention strategies, 30%-50% of cancers can be detected early with improved outcomes. At the integrated cancer prevention center (ICPC), we aimed to increase early detection by screening for multiple cancers during one visit. METHODS: Self-referred asymptomatic individuals, age 20-80 years, were included prospectively. Clinical, laboratory, and epidemiological data were obtained by multiple specialists, and further testing was obtained based on symptoms, family history, individual risk factors, and abnormalities identified during the visit. Follow-up recommendations and diagnoses were given as appropriate. RESULTS: Between January 1, 2006, and December 31, 2019, 8,618 men and 8,486 women, average age 47.11 ± 11.71 years, were screened. Of 259 cancers detected through the ICPC, 49 (19.8%) were stage 0, 113 (45.6%) stage I, 30 (12.1%) stage II, 25 (10.1%) stage III, and 31(12.5%) stage IV. Seventeen cancers were missed, six of which were within the scope of the ICPC. Compared with the Israeli registry, at the ICPC, less cancers were diagnosed at a metastatic stage for breast (none v 3.7%), lung (6.7% v 11.4%), colon (20.0% v 46.2%), prostate (5.6% v 10.5%), and cervical/uterine (none v 8.5%) cancers. When compared with the average stage of detection in the United States, detection was earlier for breast, lung, prostate, and female reproductive cancers. Patient satisfaction rate was 8.35 ± 1.85 (scale 1-10). CONCLUSION: We present a proof of concept study for a one-stop-shop approach to cancer screening in a multidisciplinary outpatient clinic. We successfully detected cancers at an early stage, which has the potential to reduce morbidity and mortality as well as offer substantial cost savings.[Media: see text].

Bilateral hearing loss preceding rhomboencephalitis - a hint for Kelch-like 11 syndrome.

BACKGROUND: Paraneoplastic neurological syndromes have diverse clinical presentations and offer an opportunity for early diagnosis of malignancy and treatment. Recently, a new paraneoplastic syndrome associated with seminoma was described, consisting of rhombencephalitis with antibodies targeting the Kelch-like protein 11 (KLHL11). Questions were raised as to the spectrum of clinical symptoms and strength of association to seminoma. METHODS: We present a 45-year-old man with bilateral sensorineural hearing loss, vertigo, and progressive ataxia. An extensive diagnostic workup led to the diagnosis of anti-KLHL11 paraneoplastic syndrome based on an immunofluorescence assay showing a typical pattern and a confirmatory serological assay. As a result, the patient underwent a meticulous search for an underlying seminoma. RESULTS: Although initially, all images were interpreted as negative, a revision of the positron emission tomography-CT (PET-CT) examination identified a small mediastinal suspicious mass. The mass was resected, and pathological examination confirmed it to be an extra-testicular seminoma. CONCLUSIONS: Patients presenting with progressive sensorineural hearing loss, vertigo, and ataxia should be evaluated for KLHL11 paraneoplastic syndrome. Furthermore, we support a strong association between anti-KLH11 rhombencephalitis and an underlying seminoma and recommend a thorough search for an undiagnosed germ cell tumor in these patients.

Inhaled CD24-Enriched Exosomes (EXO-CD24) as a Novel Immune Modulator in Respiratory Disease.

Acute Respiratory Distress Syndrome (ARDS) is a major health concern with urgent unmet need for treatment options. There are three million new ARDS cases annually, and the disease's mortality rate is high (35-46%). Cluster of differentiation 24 (CD24), a long-known protein with multifaceted functions, is a small, heavily glycosylated, membrane-anchored protein which functions as an immune checkpoint control. CD24 allows for immune discrimination between Damage-Associated Molecular Patterns and Pathogen-Associated Molecular Patterns derived from pathogens. Exosomes are intraluminal vesicles which play an important role in intercellular communication. Exosomes offer the advantage of targeted delivery, which improves safety and efficacy. The safety and efficacy of EXO-CD24 is promising, as was shown in >180 ARDS patients in phase 1b/2a, phase 2b, and compassionate use. CD24 binds Damage-associated molecular patterns (DAMPs) and inhibits the activation of the NF-ĸB pathway, a pivotal mediator of inflammatory responses. In contrast to anti-inflammatory therapies that are cytokine-specific or steroids that shut down the entire immune system, EXO-CD24 acts upstream, reverting the immune system back to normal activity. Herein, the safety and efficacy of mEXO-CD24 is shown in murine models of several pulmonary diseases (sepsis, allergic asthma, Chronic Obstructive Pulmonary Disease(COPD), fibrosis). EXO CD24 can suppress the hyperinflammatory response in the lungs in several pulmonary diseases with a significant unmet need for treatment options.

Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis.

BACKGROUND: We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP). METHODS: Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates. RESULTS: There was no difference in age (26.7 ± 8 vs 27.4 ± 9 years), body mass index (19.7 ± 2.6 vs 20.6 ± 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p < 0.0001) and operative time (p < 0.0001), drainage time (p = 0.001), and hospital stay (p < 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding. CONCLUSION: Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted.

A novel platform for attenuating immune hyperactivity using EXO-CD24 in COVID-19 and beyond.

A small but significant proportion of COVID-19 patients develop life-threatening cytokine storm. We have developed a new anti-inflammatory drug, EXO-CD24, a combination of an immune checkpoint (CD24) and a delivery platform (exosomes). CD24 inhibits the NF-kB pathway and the production of cytokines/chemokines. EXO-CD24 discriminates damage-from pathogen-associated molecular patterns (DAMPs and PAMPs) therefore does not interfere with viral clearance. EXO-CD24 was produced and purified from CD24-expressing 293-TREx™ cells. Exosomes displaying murine CD24 (mCD24) were also created. EXO-CD24/mCD24 were characterized and examined, for safety and efficacy, in vitro and in vivo. In a phase Ib/IIa study, 35 patients with moderate-high severity COVID-19 were recruited and given escalating doses, 108 -1010 , of EXO-CD24 by inhalation, QD, for 5 days. No adverse events related to the drug were observed up to 443-575 days. EXO-CD24 effectively reduced inflammatory markers and cytokine/chemokine, although randomized studies are required. EXO-CD24 may be a treatment strategy to suppress the hyper-inflammatory response in the lungs of COVID-19 patients and further serve as a therapeutic platform for other pulmonary and systemic diseases characterized by cytokine storm.

"Bloodless" Major Pulmonary Resection in Two Jehovah's Witnesses Patients with Non-Small Cell Lung Carcinoma.

BACKGROUND: Blood transfusion rates during surgery and hospitalization for thoracic surgery vary from 16% to 55%. The religious beliefs of Jehovah's Witnesses (JW) permit medical and surgical procedures but exclude the use of blood and blood products. Performing major pulmonary resection without the possibility of compensating for blood loss is a daunting challenge that few surgeons are willing to meet. METHODS: The clinical and surgical data on two JW patients who underwent major pulmonary resections for non-small cell lung carcinoma (NSCLC) in Tel Aviv Medical Center between the years 2019 and 2020 were retrieved from the departmental databases and analyzed for the requirement and consumption of blood products. The patients were a 70-year-old female and a 49-year-old man that have underwent a completion right upper lobe lobectomy and a left lower lobe lobectomy, respectively. RESULTS: None required blood transfusions and the surgeries were successful, demonstrating that it is possible to successfully perform "bloodless" major pulmonary resection while respecting the limitations set by the patient's religious beliefs. CONCLUSION: This concept paves the way for the consideration of major pulmonary resection for patients who are currently denied such procedures due to religious restrictions or to their being high-risk surgical candidates, when resources are limited or lacking.

Thoracoscopic giant lung bullaectomy: our initial experience.

BACKGROUND: Giant lung bullae (GLB) are rare, and the only currently available management involves either an open surgical resection (thoracotomy) or the newer minimally invasive resection consisting of video-assisted thoracoscopic surgery (VATS). The aim of our study was to evaluate the possible influence of GLBs pulmonary attachment on patient's post-operative complications. METHODS: A retrospective analysis included all consecutive patients with GLBs who underwent bullae's surgical resection from 7/2007 to 12/2018. GLBs patient's individual characteristics, including demographics, comorbidities, and clinical pre-operative, surgical intra-operative and post-operative data were evaluated. RESULTS: 20 patients with GLBs, 15 males and 5 females with average age of 48.9 years (range, 22-67 years) underwent 21 surgical procedures. The GLBs were located in the right lung in 12 patients, in the left lung in seven patients, and in both lungs in one patient. Fifteen patients (75%) were symptomatic on admission and underwent urgent surgery. Five asymptomatic patients (25%) were operated on electively. Thirteen from 21 surgical procedures (61.9%) were VATS bullectomy, while the other eight were thoracotomies (38.1%). Complications included pneumonia successfully treated with intravenous antibacterial therapy in two thoracotomy patients and in one VATS patient (three patients, 14.2%) and a prolonged air leak in two thoracotomy and four VATS patients (six patients, 28.5%). Out of 21 GLBs, eight had a wide attachment with lung parenchyma (wide-based bullae's) and 13 had a short attachment (short-based bullae's). Two re-operated patients, with prolonged air leak complicated with empyema, had a wide-based GLBs. The median hospital stay was nine days. All patients completed the 24-month follow-up. CONCLUSIONS: Minimally invasive video-assisted thoracoscopic surgery as an open thoracotomy surgery is a safe and effective for giant lung bullae (GLB). Patients with wide-based GLBs were more likely to develop postoperative prolonged air leak that requiring re-operation.

Major Pulmonary Resection for Non-Small Cell Lung Carcinoma during the COVID-19 Pandemic-Single Israeli Center Cross-Sectional Study.

BACKGROUND: The highly contagious COVID-19 has created unprecedented challenges in providing care to patients with resectable non-small cell lung carcinoma (NSCLC). Surgical management now needs to consider the risks of malignant disease progression by delaying surgery, and those of COVID-19 transmission to patients and operating room staff. The goal of our study was to describe our experience in providing both emergent and elective surgical procedures for patients with NSCLC during the COVID-19 pandemic in Israel, and to present our point of view regarding the safety of performing lung cancer surgery. METHODS: This observational cross-sectional study included all consecutive patients with NSCLC who operated at Tel Aviv Medical Center, a large university-affiliated hospital, from February 2020 through December 2020, during the COVID-19 pandemic in Israel. The patients' demographics, COVID-19 preoperative screening results, type and side of surgery, pathology results, morbidity and mortality rates, postoperative complications, including pulmonary complications management, and hospital stay were evaluated. RESULTS: Included in the study were 113 patients, 68 males (60.2%) and 45 females (39.8%), with a median age of 68.2 years (range, 41-89). Of these 113 patients, 83 (73.5%) underwent video-assisted thoracic surgeries (VATS), and 30 (26.5%) underwent thoracotomies. Fifty-five patients (48.7%) were preoperatively screened for COVID-19 and received negative results. Fifty-six postoperative complications were reported in 35 patients (30.9%). A prolonged air leak was detected in 11 patients (9.7%), atrial fibrillation in 11 patients (9.7%), empyema in 5 patients (4.4%), pneumonia in 9 patients (7.9%) and lobar atelectasis in 7 patients (6.2%). Three patients (2.7%) with postoperative pulmonary complications required mechanical ventilation, and two of them (1.6%) underwent tracheostomy. Two patients (1.6%) were postoperatively diagnosed as positive for COVID-19. CONCLUSIONS: Our data demonstrate the feasibility and efficacy of implementing precautionary strategies to ensure the safety of lung cancer patients undergoing pulmonary resection during the COVID-19 pandemic. The strategy was equally effective in protecting the surgical staff and healthcare providers, and we recommend performing lung cancer surgery during the pandemic era.

Major pulmonary resection after neoadjuvant chemotherapy or chemoradiation in potentially resectable stage III non-small cell lung carcinoma.

The aim of this study was to identify predictors of postoperative outcome and survival of locally advanced non-small cell lung carcinoma (NSCLC) resections after neoadjuvant chemotherapy or chemoradiation. Medical records of all patients with clinical stage III potentially resectable NSCLC initially treated by neoadjuvant chemotherapy or chemoradiation followed by major pulmonary resections were retrieved from the databases of four Israeli Medical Centers between 1999 to 2019. The 124 suitable patients included, 86 males (69.4%) and 38 females (30.6%), with an average age of 64.2 years (range 37-82) and an average hospital stay of 12.6 days (range 5-123). Complete resection was achieved in 92.7% of the patients, while complete pathologic response was achieved in 35.5%. The overall readmission rate was 16.1%. The overall 5-year survival rate was 47.9%. One patient (0.8%) had local recurrence. Postoperative complications were reported in 49.2% of the patients, mainly atrial fibrillation (15.9%) and pneumonia (13.7%), empyema (10.3%), and early bronchopleural fistula (7.3%). The early in-hospital mortality rate was 6.5%, and the 6-month mortality rate was 5.6%. Pre-neoadjuvant bulky mediastinal disease (lymph nodes > 20 mm) (p = 0.034), persistent postoperative N2 disease (p = 0.016), R1 resection (p = 0.027), preoperative N2 multistation disease (p = 0.053) and postoperative stage IIIA (p = 0.001) emerged as negative predictive factors for survival. Our findings demonstrate that neoadjuvant chemotherapy or chemoradiation in locally advanced potentially resectable NSCLC, followed by major pulmonary resection, is a beneficial approach in selected cases.

The human brain uses spatial schemas to represent segmented environments.

Humans and animals use cognitive maps to represent the spatial structure of the environment. Although these maps are typically conceptualized as extending in an equipotential manner across known space, psychological evidence suggests that people mentally segment complex environments into subspaces. To understand the neurocognitive mechanisms behind this operation, we familiarized participants with a virtual courtyard that was divided into two halves by a river; we then used behavioral testing and fMRI to understand how spatial locations were encoded within this environment. Participants' spatial judgments and multivoxel activation patterns were affected by the division of the courtyard, indicating that the presence of a boundary can induce mental segmentation even when all parts of the environment are co-visible. In the hippocampus and occipital place area (OPA), the segmented organization of the environment manifested in schematic spatial codes that represented geometrically equivalent locations in the two subspaces as similar. In the retrosplenial complex (RSC), responses were more consistent with an integrated spatial map. These results demonstrate that people use both local spatial schemas and integrated spatial maps to represent segmented environment. We hypothesize that schematization may serve as a general mechanism for organizing complex knowledge structures in terms of their component elements.

Quasilobar minimalist lung volume reduction surgery.

OBJECTIVES: Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. METHODS: Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. RESULTS: Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). CONCLUSIONS: QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.

Brain Coding of Social Network Structure.

Humans have large social networks, with hundreds of interacting individuals. How does the brain represent the complex connectivity structure of these networks? Here we used social media (Facebook) data to objectively map participants' real-life social networks. We then used representational similarity analysis (RSA) of functional magnetic resonance imaging (fMRI) activity patterns to investigate the neural coding of these social networks as participants reflected on each individual. We found coding of social network distances in the default-mode network (medial prefrontal, medial parietal, and lateral parietal cortices). When using partial correlation RSA to control for other factors that can be correlated to social distance (personal affiliation, personality traits. and visual appearance, as subjectively rated by the participants), we found that social network distance information was uniquely coded in the retrosplenial complex, a region involved in spatial processing. In contrast, information on individuals' personal affiliation to the participants and personality traits was found in the medial parietal and prefrontal cortices, respectively. These findings demonstrate a cortical division between representations of non-self-referenced (allocentric) social network structure, self-referenced (egocentric) social distance, and trait-based social knowledge.SIGNIFICANCE STATEMENT Each of us has a social network composed of hundreds of individuals, with different characteristics and different relations among them. How does our brain represent this complexity? To find out, we mapped participants' social connections using Facebook data and then asked them to think about individuals from their network while undergoing functional MRI scanning. We found that the position of individuals within the social network, as well as their affiliation to the participant, are mapped in the retrosplenial complex, a region involved in spatial processing. Individuals' personality traits were coded in another region, the medial prefrontal cortex. Our findings demonstrate a neural dissociation among different aspects of social knowledge and suggest a link between spatial and social cognitive mapping.

Structuring Knowledge with Cognitive Maps and Cognitive Graphs.

Humans and animals use mental representations of the spatial structure of the world to navigate. The classical view is that these representations take the form of Euclidean cognitive maps, but alternative theories suggest that they are cognitive graphs consisting of locations connected by paths. We review evidence suggesting that both map-like and graph-like representations exist in the mind/brain that rely on partially overlapping neural systems. Maps and graphs can operate simultaneously or separately, and they may be applied to both spatial and nonspatial knowledge. By providing structural frameworks for complex information, cognitive maps and cognitive graphs may provide fundamental organizing schemata that allow us to navigate in physical, social, and conceptual spaces.

Fat fractions from high-resolution 3D radial Dixon MRI for predicting metastatic axillary lymph nodes in breast cancer patients.

PURPOSE: To assess diagnostic performance of fat fractions (FF) from high-resolution 3D radial Dixon MRI for differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer patients. METHOD: High-resolution 3D radial Dixon MRI was prospectively performed on 1.5 T in 70 biopsy-verified breast cancer patients. 35 patients were available for analysis with histopathologic and imaging data. FF images were calculated as fat / in-phase. Two radiologists measured lymph node FF and assessed morphological features in one ipsilateral and one contralateral lymph node in consensus. Diagnostic performance of lymph node FF and morphological criteria were compared using histopathology as reference. RESULTS: 22 patients had metastatic axillary lymph nodes. Mean lymph node FF were 0.20 ±â€¯0.073, 0.31 ±â€¯0.079, and 0.34 ±â€¯0.15 (metastatic, non-metastatic ipsi- and non-metastatic contralateral lymph nodes, respectively). Metastatic lymph node FF were significantly lower than non-metastatic ipsi- (p <  0.001) and contralateral lymph nodes (p <  0.001). Area under the receiver operating characteristics curve for lymph node FF was 0.80 compared to 0.76 for morphological criteria (p =  0.29). Lymph node FF yielded sensitivity 0.91, specificity 0.69, positive predictive value (PPV) 0.83, and negative predictive value (NPV) 0.82, while morphological criteria yielded sensitivity 0.91, specificity 0.62, PPV 0.80, and NPV 0.80 (p =  0.71). Combining lymph node FF and morphological criteria increased diagnostic performance with sensitivity 1.00, specificity 0.67, PPV 0.86, NPV 1.00, and AUC 0.83. CONCLUSIONS: Lymph node FF from high-resolution 3D Dixon images are a promising quantitative indicator of metastases in axillary lymph nodes.

Processing of Different Temporal Scales in the Human Brain.

While recalling life events, we reexperience events of different durations, ranging across varying temporal scales, from several minutes to years. However, the brain mechanisms underlying temporal cognition are usually investigated only in small-scale periods-milliseconds to minutes. Are the same neurocognitive systems used to organize memory at different temporal scales? Here, we asked participants to compare temporal distances (time elapsed) to personal events at four different temporal scales (hour, day, week, and month) under fMRI. Cortical activity showed temporal scale sensitivity at the medial and lateral parts of the parietal lobe, bilaterally. Activity at the medial parietal cortex also showed a gradual progression from large- to small-scale processing, along a posterior-anterior axis. Interestingly, no sensitivity was found along the hippocampal long axis. In the medial scale-sensitive region, most of the voxels were preferentially active for the larger scale (month), and in the lateral region, scale selectivity was higher for the smallest scale (hour). These results demonstrate how scale-selective activity characterizes autobiographical memory processing and may provide a basis for understanding how the human brain processes and integrates experiences across timescales in a hierarchical manner.