Predictors of prolonged hospital stay after segmentectomy.

OBJECTIVE: Segmentectomy is becoming the standard of care for small, peripheral non-small cell lung cancer. To improve perioperative management in this population, this study aims to identify factors influencing hospital length of stay after segmentectomy. METHODS: Patients who underwent segmentectomy for any indication between January 2018 and May 2023 were identified using a prospectively maintained institutional database. Multivariable logistic regression models were used to estimate associations between clinical features and prolonged (≥3 days) hospital stay. A nomogram was designed to understand better and possibly calculate the individual risk of prolonged hospital stays. RESULTS: In total, 533 cases were included; 337 (63%) were female. Median age was 66 years (interquartile range [IQR], 63-75). The median size of resected lesions was 1.6 cm (IQR, 1.3-2.1 cm). Median hospital stay was 3 days (IQR, 2-4 days). Major adverse events occurred in 31 (5.8%) cases. The 30-day readmission rate was 5.8% (n = 31). There was no 30-day mortality; 90-day mortality was <1%. Patients older than 75 years (odds ratio [OR], 2.01, 95% confidence interval [CI], 1.15-3.57, P = .02), those with forced expiratory volume in 1 second <88% predicted (OR, 1.99; 95% CI, 1.38-2.89, P < .001), or positive smoking history (OR, 1.72; 95% CI, 1.15-2.60, P = .01) were more likely to have prolonged hospital stays after segmentectomy. A nomogram accounting for age, sex, forced expiratory volume in 1 second, body mass index, smoking history, and comorbidities was created to predict the probability of prolonged hospital stay with an area under the receiver operating characteristic curve of 0.66. CONCLUSIONS: Older patients, those with reduced pulmonary function, and current and past smokers have elevated risk for prolonged hospital stays after segmentectomy. Validation of our nomogram could improve perioperative risk stratification in patients who undergo segmentectomy.

Complete anatomic segmentectomy shows improved oncologic outcomes compared to incomplete anatomic segmentectomy.

OBJECTIVES: To compare oncologic outcomes after segmentectomy with division of segmental bronchus, artery and vein (complete anatomic segmentectomy) versus segmentectomy with division of <3 segmental structures (incomplete anatomic segmentectomy). METHODS: We conducted a single-centre, retrospective analysis of patients undergoing segmentectomy from March 2005 to May 2020. Operative reports were audited to classify procedures as complete or incomplete anatomic segmentectomy. Patients who underwent neoadjuvant therapy or pulmonary resection beyond indicated segments were excluded. Survival was estimated with Kaplan-Meier models and compared using log-rank tests. Cox proportional hazards models were used to estimate hazard ratios (HRs) for death. Cumulative incidence functions for loco-regional recurrence were compared with Gray's test, with death considered a competing event. Cox and Fine-Gray models were used to estimate cause-specific and subdistribution HRs, respectively, for loco-regional recurrence. RESULTS: Of 390 cases, 266 (68.2%) were complete and 124 were incomplete anatomic segmentectomy. Demographics, pulmonary function, tumour size, stage and perioperative outcomes did not significantly differ between groups. Surgical margins were negative in all but 1 case. Complete anatomic segmentectomy was associated with improved lymph node dissection (5 vs 2 median nodes sampled; P < 0.001). Multivariable analysis revealed reduced incidence of loco-regional recurrence (cause-specific HR = 0.42; 95% confidence interval 0.22-0.80; subdistribution HR = 0.43; 95% confidence interval 0.23-0.81), and non-significant improvement in overall survival (HR = 0.66; 95% confidence interval: 0.43-1.00) after complete versus incomplete anatomic segmentectomy. CONCLUSIONS: This single-centre experience suggests complete anatomic segmentectomy provides superior loco-regional control and may improve survival relative to incomplete anatomic segmentectomy. We recommend surgeons perform complete anatomic segmentectomy and lymph node dissection whenever possible.

Time between imaging and surgery is not a risk factor for upstaging of clinical stage IA non-small-cell lung cancer.

OBJECTIVES: The timing of preoperative imaging in patients with lung cancer is a debated topic, as there are limited data on cancer progression during the interval between clinical staging by imaging and pathological staging after resection. We quantified disease progression during this interval in patients with early stage non-small-cell lung cancer (NSCLC) to better understand if its length impacts upstaging. METHODS: We retrospectively reviewed our institutional database to identify patients who underwent surgery for clinically staged T1N0M0 NSCLC from January 2015 through September 2022. Tumour upstaging between chest computed tomography (CT) and surgery were analysed as a function of time (<30, 30-59, ≥60 days) for different nodule subtypes. We analysed data across 3 timeframes using Pearson's chi-squared and analysis of variance tests. RESULTS: During the study period, 622 patients underwent surgery for clinically staged T1N0M0 NSCLC. CT-to-surgery interval was <30 days in 228 (36.7%), 30-59 days in 242 (38.9%) and ≥60 days in 152 (24.4%) with no differences in patient or nodule characteristics observed between these groups. T-stage increased in 346 patients (55.6%) between CT imaging and surgery. Among these patients, 126 (36.4%) had ground-glass nodules, 147 (42.5%) had part-solid nodules and 73 (21.1%) had solid nodules. CT-to-surgery interval length was not associated with upstaging of any nodule subtype (full-cohort, P = 0.903; ground-glass, P = 0.880; part-solid, P = 0.858; solid, P = 0.959). CONCLUSIONS: This single-centre experience suggests no significant association between tumour upstaging and time from imaging to lung resection in patients with clinical stage IA NSCLC. Further studies are needed to better understand the risk factors for upstaging.

Participation of apoptotic markers in the process of maturation and elimination of spermatozoa in the epididymis of the Corynorhinus mexicanus bat.

The Corynorhinus mexicanus bat is characterized by a specific form of reproductive asynchrony between males and females. After mating, some sperm remain in the male's epididymis, the organ where the sperm had matured. It has not yet been determined if apoptotic markers participate in the process of the maturation and/or elimination of these cells, so studying this topic is essential for our understanding of this species. Male bats were collected during three stages: Before mating; during the Mating phase; After mating and the final phase, which we call, Storage. Their epididymides were removed, weighed and measured. Sperm were extracted and the following sperm parameters were evaluated: active caspases, phosphatidylserine externalization, and mitochondrial membrane potential. Sperm from the testes enter the epididymis during Before mating, causing the organ to grow. During Mating phase, spermatozoa present a large amount of active caspases with externalization of phosphatidyl serine, even while still alive. This suggests that these two markers could participate in maturation and elimination, respectively.

Toward High-Performance Metal-Organic-Framework-Based Quasi-Solid-State Electrolytes: Tunable Structures and Electrochemical Properties.

Metal-organic frameworks (MOFs) have been reported as promising materials for electrochemical applications owing to their tunable porous structures and ion-sieving capability. However, it remains challenging to rationally design MOF-based electrolytes for high-energy lithium batteries. In this work, by combining advanced characterization and modeling tools, a series of nanocrystalline MOFs is designed, and the effects of pore apertures and open metal sites on ion-transport properties and electrochemical stability of MOF quasi-solid-state electrolytes are systematically studied. It isdemonstrated that MOFs with non-redox-active metal centers can lead to a much wider electrochemical stability window than those with redox-active centers. Furthermore, the pore aperture of MOFs is found to be a dominating factor that determines the uptake of lithium salt and thus ionic conductivity. The ab initio molecular dynamics simulations further demonstrate that open metal sites of MOFs can facilitate the dissociation of lithium salt and immobilize anions via Lewis acid-base interaction, leading to good lithium-ion mobility and high transference number. The MOF quasi-solid-state electrolyte demonstrates great battery performance with commercial LiFePO4 and LiCoO2 cathodes at 30 °C. This work provides new insights into structure-property relationships between tunable structure and electrochemical properties of MOFs that can lead to the development of advanced quasi-solid-state electrolytes for high-energy lithium batteries.

Drug-Eluting, Bioresorbable Cardiovascular Stents─Challenges and Perspectives.

Globally, the leading causes of natural death are attributed to coronary heart disease and type 1 and type 2 diabetes. High blood pressure levels, high cholesterol levels, smoking, and poor eating habits lead to the agglomeration of plaque in the arteries, reducing the blood flow. The implantation of devices used to unclog vessels, known as stents, sometimes results in a lack of irrigation due to the excessive proliferation of endothelial tissue within the blood vessels and is known as restenosis. The use of drug-eluting stents (DESs) to deliver antiproliferative drugs has led to the development of different encapsulation techniques. However, due to the potency of the drugs used in the initial stent designs, a chronic inflammatory reaction of the arterial wall known as thrombosis can cause a myocardial infarction (MI). One of the most promising drugs to reduce this risk is everolimus, which can be encapsulated in lipid systems for controlled release directly into the artery. This review aims to discuss the current status of stent design, fabrication, and functionalization. Variables such as the mechanical properties, metals and their alloys, drug encapsulation and controlled elution, and stent degradation are also addressed. Additionally, this review covers the use of polymeric surface coatings on stents and the recent advances in layer-by-layer coating and drug delivery. The advances in nanoencapsulation techniques such as liposomes and micro- and nanoemulsions and their functionalization in bioresorbable, drug-eluting stents are also highlighted.

Spontaneous pneumomediastinum in COVID-19 patients. Case series.

Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.

El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.

Neumomediastino espontáneo en pacientes COVID-19. Serie de casos / Spontaneous pneumomediastinum in COVID-19 patients. Case series

Resumen El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.

Abstract Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.

Genotypes and phenotypes of resistance in Ecuadorian Plasmodium falciparum.

BACKGROUND: Malaria continues to be endemic in the coast and Amazon regions of Ecuador. Clarifying current Plasmodium falciparum resistance in the country will support malaria elimination efforts. In this study, Ecuadorian P. falciparum parasites were analysed to determine their drug resistance genotypes and phenotypes. METHODS: Molecular analyses were performed to search for mutations in known resistance markers (Pfcrt, Pfdhfr, Pfdhps, Pfmdr1, k13). Pfmdr1 copy number was determined by qPCR. PFMDR1 transporter activity was characterized in live parasites using live cell imaging in combination with the Fluo-4 transport assay. Chloroquine, quinine, lumefantrine, mefloquine, dihydroartemisinin, and artemether sensitivities were measured by in vitro assays. RESULTS: The majority of samples from this study presented the CVMNT genotype for Pfcrt (72-26), NEDF SDFD mutations in Pfmdr1 and wild type genotypes for Pfdhfr, Pfdhps and k13. The Ecuadorian P. falciparum strain ESM-2013 showed in vitro resistance to chloroquine, but sensitivity to quinine, lumefantrine, mefloquine, dihydroartemisinin and artemether. In addition, transport of the fluorochrome Fluo-4 from the cytosol into the digestive vacuole (DV) of the ESM-2013 strain was minimally detected in the DV. All analysed samples revealed one copy of Pfmdr1. CONCLUSION: This study indicates that Ecuadorian parasites presented the genotype and phenotype for chloroquine resistance and were found to be sensitive to SP, artemether-lumefantrine, quinine, mefloquine, and dihydroartemisinin. The results suggest that the current malaria treatment employed in the country remains effective. This study clarifies the status of anti-malarial resistance in Ecuador and informs the P. falciparum elimination campaigns in the country.

Absence of an Additional Metabolic Effect of Body Contour Surgery in Patients With Massive Weight Loss After Laparoscopic Roux-En-Y Gastric Bypass.

INTRODUCTION: Body contour surgery (BCS) is a combination of soft tissue resections that have proven to be an effective treatment for the aesthetic and functional problems related to massive weight loss (MWL). There are no studies analyzing the metabolic effect of large volume adipose tissue flap resection in patients with MWL after bariatric surgery. METHODS: This study was a retrospective review of adults who underwent BCS after gastric bypass. Preoperative clinical and laboratory data were compared with 1- and 2-year postoperative follow-up. RESULTS: A total of 62 patients with a mean age of 41 years were analyzed. Seventy-nine percent of them were women. Most procedures included abdominal flap resection alone or in combination with other areas. Mean resected tissue weight was 6.2 kg. We found that weight and body mass index (BMI) were lower 1 year after BCS (P < 0.05), but this was not maintained after 2 years. There were no differences for systolic or diastolic blood pressure, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, or fasting glucose after 1 and 2 years of the BCS. A subgroup analysis showed that the transient weight and BMI improvement was only apparent 1 year after BCS in those patients with flap resections more than 8 kg. CONCLUSIONS: There are no differences in blood pressure, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, or fasting glucose 1 and 2 years after BCS in patients who experienced MWL after gastric bypass. Although weight and BMI were transiently lower in those patients with tissue flap resections more than 8 kg, this effect disappeared after 2 years.

Clinical Characteristics and Mortality of Influenza A H1N1 and Influenza-Like Illness in Mexico City in the 2013-2014 Winter Season.

BACKGROUND: The 2013-2014 influenza season in Mexico City was severe and mainly due to influenza A H1N1, as was the 2009 pandemic. OBJECTIVE: To describe features of the outbreak and to compare the characteristics of patients with and without viral identification. METHODS: We reviewed the medical charts of all individuals with influenza or influenza-like illness admitted to a referral hospital for respiratory diseases in Mexico City from January 2013 to March 2014, whether influenza virus was identified or not. RESULTS: We included 233 patients with influenza-like illness, 99 of whom had laboratory confirmed influenza; one-half of all patients required mechanical ventilation and 25% were admitted to the intensive care unit. Patients with confirmed influenza had a more severe disease than those without confirmation. A total of 52 (22.3%) patients died in hospital; survival was greater among patients hospitalized in the intensive care unit compared with those who remained in regular wards. CONCLUSIONS: Influenza A H1N1 continues to cause significant outbreaks in Mexico City. Patients with influenza-like illness had a similar clinical course regardless of laboratory confirmation of influenza, suggesting that their illness likely belonged to the same outbreak. Mechanical ventilation in regular hospital wards may be lifesaving, although the outcome is worse than at an intensive care unit.

Variación de torque y angulación de brackets de prescripción MBTde cuatro casas comerciales / Variation of torque and angulation MBT brackets of prescriptionof four trade marks

Introducción y Objetivo: La exactitud de la información contenida en la ranura de los brackets preajustados permite obtener control y precisión de los movimientos dentarios; sin embargo losfabricantes no proveen el margen de error de los brackets. El objetivo fue determinar la variación enel torque y la angulación de brackets de la prescripción MBT de cuatro diferentes casas comerciales.Materiales y Métodos: Se midieron de 55 brackets de cuatro casas comerciales: 3M® Unitek, Monrovia, Calif: Gemini M.B.T; Dentaurum® Pforzheim, Germany: Equilibrium 2 M.B.T; Aditek® Grabilnhos, São Paulo Brazil: Vector M.B.T; Morelli® Perdizes São Paulo, SP: M.B.T system, entotal 220 brackets. El rango de tolerancia establecido fue de ±0.5º para el torque y de ±0.2º para la angulación. Para la medición se utilizó un proyector de perfiles Prazis® 50X. Resultados: Lospromedios de torque de las marcas Morelli® y Aditek® se desviaron del rango de tolerancia con diferencias estadisticamente significativas (p=0); Dentaurum® (p=0,31) y 3M Unitek® (p=0,30) estuvieron dentro del rango; las cuatro casas comerciales mostraron diferencias estadísticamentesignificativas entre sus promedios de torque (prueba ANOVA p<0.05). Los promedios de angulación sedesviaron del rango de tolerancia, excepto la marca Morelli® (p=0,11); 3M UNITEK® y DENTAURUM no presentaron diferencias estadísticamente significativas entre sus promedios de angulación (pruebaANOVA p=0,98). Conclusiones: Se presenta variación en torque y angulación de los brackets delas cuatro casas comerciales. Esta variación es menor para los brackets DENTAURUM® y 3M.

Introduction and Objective: Although it is important for orthodontists to know the accuracy of information contained in the pre-adjusted slot brackets for control and precision of tooth movement,manufacturers do not provide the margin of error built in the different values in these brackets. Theobjective of this study was to compare the torque and angle means of brackets of four different commercial brands with the original MBT prescription. Materials and Methods: A sample of 55brackets of each brand was taken: 3M® Unitek, Monrovia, Calif. : line Gemini M. B. T - Dentaurum® Pforzheim, Germany: line Equilibrium 2 M. B. T - Aditek® Grabilnhos, Sao Paulo Brazil: line Vector M. B. T - Morelli® Perdizes Sao Paulo, SP: line M. B. T system, for a total of 220 brackets. Theestablished range of tolerance was nominal value ±0.5 to the torque and ±0.2° to the angle. Bracketmeasurement was done with a Prazis ® 50X optical comparator. Results: Torque average values for the brand marks Morelli and Aditek were distant from the nominal value; 3M Unitek valueswere found within the range with no statistically significant differences. All four brands showed statistically significant differences between torque average values (test ANOVA (p<0,05)). With regards to angulations averages all were outside the range of tolerance except for Morelli (p=0,11).3M, UNITEK® and DENTAURUM® brackets showed no statistically significant differences betweenangle average values (ANOVA (p=0,985)). Conclusions: A large variability for both the torque andangulations values for all four brands. This variability was less for Equilibrium 2 MBT (Dentaurum)and Gemini MBT (3MUnitek) brackets.