Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic sympathectomy in selected patients with primary palmar hyperhidrosis.

BACKGROUND: To assess the feasibility and safety of tubeless video-assisted thoracoscopic sympathectomy (VATS) with a single 5 mm port under nonintubated, intravenous anesthesia with spontaneous ventilation in selected patients with primary palmar hyperhidrosis (PPH). METHODS: Adults (aged between 18 and 60 years) with moderate or severe PPH symptoms were enrolled. Demographic information and clinical data were obtained from 172 consecutive patients undergoing thoracoscopic surgery for PPH from March 2014 to December 2020. The primary outcomes were the rate of complications, including death, and the intraoperative conversion rate to 3-port VATS. The secondary outcomes were the conversion rate to intubated anesthesia during the operation and the surgical duration and pain score of postoperative day 0. RESULTS: In total, 172 patients were included with 88 males and 84 females. The median age was was 25 years (IQR:21-30 years). No mortalities or major morbidities occurred in any patient. The overall median surgical duration was 53 min (IQR:37-72 min). The median length of postoperative hospital stay was one day (IQR:one-one day). The median pain score of POD0 was 2 (IQR:2-2). Intraoperative conversion to 3-port VATS followed by drainage tube insertion occurred in one (0.6%) patient due to extensive pleural adhesions. No patients required conversion to intubated anesthesia during surgery. No postoperative mechanical ventilation was noted in any patient. CONCLUSIONS: For selected patients with PPH, tubeless VATS with a single 5 mm port using spontaneous ventilation anesthesia can be considered a feasible and safe operation. The surgical wound is extremely small and the operation time is shorter than the conventional technique. Trial registration This study was in conformity with the Declaration of Helsinki, and was approved by the National Ethics Committee of the University of the Hong Kong-Shenzhen Hospital (Approval number: [2020]70). We registered the study in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100049063) in 2021.Informed consent was collected from all the participants of this study. URL for this clinical trial registration is: https://www.chictr.org.cn/index.aspx .

[Effects of Different Water Stratification on the Vertical Distribution of Nitrogen in Sediment Interstitial Waters: A Case Study of the Three Gorges Reservoir and Xiaowan Reservoir].

To determine the reasons for the variation in the vertical distribution of nitrogen in sediment interstitial waters between different stratified reservoirs, the characteristics of overlying water-interstitial water in Xiangxi Bay, Yangtze River mainstream, and Xiaowan Reservoir were monitored. The vertical distribution of nitrogen in sediment interstitial waters in these different stratified waters were then analyzed, and the reasons for the variation in this distribution were assessed. The results showed:① the ρ(TN) in the sediment interstitial waters of the Yangtze River mainstream and Xiangxi Bay gradually increased with depth, while that of Xiaowan Reservoir reached its maximum at 12 cm and the bottom layer presented a "C" distribution. The ρ(NH4+) in the sediment interstitial waters of the Yangtze River mainstream and Xiangxi Bay exhibited an increasing trend with depth, while that of Xiaowan Reservoir was slightly higher in the bottom layer than in the surface layer, although the change with depth was not significant. Overall, the ρ(NH4+) in the sediment interstitial waters of the Yangtze River mainstream and Xiangxi Bay was higher than that of Xiaowan Reservoir, and the concentration ranges were as follows:0.512-8.289 mg·L-1, 0.968-9.307 mg·L-1, and 0.950-1.450 mg·L-1. The vertical distribution of the ρ(NO3-) in the sediment interstitial waters of all three waterbodies were opposite to that of ρ(NH4+). Moreover, the ρ(NO3-) in the sediment interstitial waters of Xiangxi Bay and the Yangtze River mainstream was higher than that of Xiaowan Reservoir. The concentration ranges were as follows:0.143-0.674 mg·L-1, 0.107-0.647 mg·L-1, and 0.050-0.051 mg·L-1. ② There were also significant differences in the vertical distribution of physical and chemical indices in the three water bodies. There was no significant change in the vertical distribution of the water temperature in the Yangtze River mainstream and the N2 value was <5×10-5 s-2; hence, the water was well mixed, and the vertical range of the dissolved oxygen content was 6.180-6.318 mg·L-1. The water temperature in the upper and middle reaches of Xiangxi Bay decreased vertically, while the water temperature in the lower reach presented a ladder-like distribution and the N2 values were all>5×10-5 s-2; thus, the water was in a stable stratified state and the dissolved oxygen content presented a "C" distribution. There was obvious stratification at the depths of 5-15 m and 54-70 m in Xiaowan Reservoir. The dissolved oxygen content decreased significantly at higher water temperature gradients, and there was no significant change along the water depth below 80 m. ③ The main reasons for the variation in the vertical distribution of nitrogen in the sediment interstitial waters of the three waterbodies were the differences in the overlying water hydrodynamics, dissolved oxygen distribution, and sediment environment. The ρ(NH4+) and ρ(NO3-) were higher in Xiangxi Bay, which may have increased the denitrification rate and subsequently have helped to remove nitrogen and reduce the nitrogen load in these waters.