Surgical repair for post-tuberculosis tracheobronchial stenosis.

AIM: Post-tuberculosis tracheobronchial stenosis is rare but one of the most dangerous complications of tracheobronchial tuberculosis. Balloon dilatation, stent insertion, laser photoresection, argon plasma coagulation, and cryotherapy are some of the initial treatments recommended for mild to moderate cases. Here, we report a case series of patients who underwent segmental resection and end-to-end anastomosis for bronchial stenosis and a sliding technique for severe and long-segment tracheal stenosis. METHODS: We retrospectively reviewed the medical records of patients with post-tuberculosis tracheobronchial stenosis operated on in our thoracic surgery department. Of the 7 cases that were treated, two had severe tracheal stenosis stretching over 50% of the tracheal length, one was operated on using resection and end-to-end anastomosis, and the other had sliding tracheoplasty. The other 5 cases of bronchial stem stenosis were treated with segmental resection and end-to-end anastomosis. RESULTS: All five patients with bronchial stenosis had a good outcome; the ipsilateral lung was well ventilated and respiratory function was good. One patient with tracheal stenosis, treated with segmental resection and end-to-end anastomosis, died after the surgery, and the other patient, treated with slide tracheoplasty, had a good recovery. CONCLUSION: The treatment plan for patients with post-tuberculosis tracheobronchial stenosis should be on a patient-by-patient basis. Sliding tracheoplasty can be a treatment option in patients with long-segment tracheal stenosis.

Initial Results of Management for Acute Ischemic Stroke due to Large Vessel Occlusion by a Direct Aspiration First Pass Technique at a Vietnamese Hospital.

BACKGROUND: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). OBJECTIVES: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. MATERIALS AND METHODS: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. RESULTS: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0-2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. CONCLUSIONS: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.

Efficacy of Microwave Ablation in the Treatment of Large (≥3 cm) Benign Thyroid Nodules.

BACKGROUND: Large (≥3 cm) benign thyroid nodules usually cause clinical symptoms or cosmetic concerns and therefore require treatment. Microwave ablation (MWA) is a potential valid non-surgical treatment alternative, but there is a lack of evidence. Thus, this study is to evaluate the safety and efficacy of MWA in the treatment of large benign thyroid nodules. METHODS: A retrospective study was conducted on 42 large benign thyroid nodules in 40 patients treated with MWA. We used the trans-isthmic approach and moving-shot technique to perform the procedure under ultrasound (US) guidance. Patients were followed by clinical and US examinations at 1, 3, 6, and 12 months after the MWA. Study outcomes were complications, volume reduction ratio (VRR), symptom and cosmetic scores, and the requirement of multiple MWA sessions. RESULTS: There were 31 females and 9 males, with a median age of 46 years. The medians of largest diameter and volume of the nodules were 40 mm and 22 ml. Four (10%) minor complications were observed. The mean VRR was 75.1, 85.2, and 96.4% after 3, 6, and 12 months. The mean symptom and cosmetic scores dropped from 8.0 and 3.8 (before treatment) to 2.8 and 2.3 (at 12 months), respectively. Thirteen nodules (31%) required two MWA sessions. CONCLUSIONS: MWA is safe, effective, and can be a good option to treat large benign thyroid nodules. More studies with large dataset and long follow-up are required to improve its safety and efficacy.

NT-proBNP incorporated in prediction rule of major peri-operative adverse cardiac event in non-cardiac surgery.

BACKGROUND: Patients undergoing non-cardiac surgery are at risk for peri-operative major cardiac events (PMCEs). The most common risk assessment tool is Revised Cardiac Risk Index (RCRI). N-terminal pro-brain natriuretic peptide (NT-proBNP) measured peri-operatively has prognostic information but the implication is uncertain. This study aimed to determine the accuracy of combining NT-proBNP and RCRI in predicting the PMCE in major non-cardiac surgery. METHODS: We performed a prospective cohort study to include non-cardiac surgical patients with moderate or high risk. PMCE included myocardial infarction, pulmonary edema, severe cardiac arrhythmias, and cardiac death occurring within 30 days post-operatively. Logistic regression models and the receiver operating characteristic (ROC) curves were used to determine the discriminative ability of NT-proBNP alone or incorporation with RCRI or its components in predicting PMCE. RESULTS: A total of 366 patients was included in the study with 48 PMCEs. When predicting PMCE, the area under the ROC curve (AUC) (95%-CI) of NT-proBNP alone and NT-proBNP incorporated with RCRI were 0.875 (0.819-0.932) and 0.882 (0.827-0.937), respectively. When incorporating NT-proBNP with the RCRI's components, the best four chosen models had the AUCs between 0.879 and 0.891. All these AUCs were not significantly different with the AUC of NT-proBNP alone. CONCLUSIONS: Higher preoperative NT-proBNP level leads to the increased risk of PMCE in patients undergoing non-cardiac surgery. Compared to NT-proBNP alone, the combination of NT-proBNP with the RCRI and other factors does not improve the accuracy in predicting PMCE. Future large studies are required to build a more accurate risk score.

Magnetic chitosan nanoparticles for removal of Cr(VI) from aqueous solution.

A simple method was introduced to prepare magnetic chitosan nanoparticles by co-precipitation via epichlorohydrin cross-linking reaction. The average size of magnetic chitosan nanoparticles is estimated at ca. 30 nm. It was found that the adsorption of Cr(VI) was highly pH-dependent and its kinetics follows the pseudo-second-order model. Maximum adsorption capacity (at pH 3, room temperature) was calculated as 55.80 mg·g(-1), according to Langmuir isotherm model. The nanoparticles were thoroughly characterized before and after Cr(VI) adsorption. From this result, it can be suggested that magnetic chitosan nanoparticles could serve as a promising adsorbent for Cr(VI) in wastewater treatment technology.