A Clinical Comparative Study of Thoracoscopic Anatomical Lesion Resection and Lobectomy in the Treatment of Congenital Lung Malformations.

BACKGROUND: To explore the safety and feasibility of HuaXi thoracoscopic anatomical lesion resection (HX-TALR) in the treatment of congenital lung malformations (CLMs) in children. METHODS: A retrospective review of clinical data was conducted for patients who underwent HX-TALR and thoracoscopic lobectomy (TL) in our hospital from October 2017 to March 2023. Intraoperative and postoperative outcomes were compared between the HX-TALR and TL groups. RESULTS: There were 485 patients in this study, 267 of whom underwent HX-TALR and 218 of whom underwent TL. All patients underwent thoracoscopic surgery without conversion to open surgery. No patients had major complications, including bronchopleural fistula, hemorrhage, atelectasis, recurrence or reoperation. The operative time, intraoperative bleeding volume, cases with thoracic drainage tubes, postoperative hospital stay, and cases with postoperative fever in HX-TALR were greater than those in TL (P < 0.05). CONCLUSIONS: HX-TALR is safe, feasible, and retains all normal lung tissue while removing the lesion, which is expected to become the preferable operation for the treatment of CLMs. HX-TALR is a new and technically challenging procedure that needs to be carried out after training. LEVEL OF EVIDENCE: Level IV.

Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection.

BACKGROUND: Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD. AIM: To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD. METHODS: We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD. RESULTS: HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P < 0.001) and accounted for more 0-IIc (P < 0.001), atrophic gastritis was common (P < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P < 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P < 0.001), more abnormal folds and poorer mucosal peristalsis (P < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis. CONCLUSION: Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.

An Ultrasensitive Ti3 C2 Tx MXene-based Soft Contact Lens for Continuous and Nondestructive Intraocular Pressure Monitoring.

Wearable soft contact lens sensors for continuous and nondestructive intraocular pressure (IOP) monitoring are highly desired as glaucoma and postoperative myopia patients grow, especially as the eyestrain crowd increases. Herein, a smart closed-loop system is presented that combines a Ti3 C2 Tx MXene-based soft contact lens (MX-CLS) sensor, wireless data transmission units, display, and warning components to realize continuous and nondestructive IOP monitoring/real-time display. The fabricated MX-CLS device exhibits an extremely high sensitivity of 7.483 mV mmHg-1 , good linearity on silicone eyeballs, excellent stability under long-term pressure-release measurement, sufficient transparency with 67.8% transmittance under visible illumination, and superior biocompatibility with no discomfort when putting the MX-CLS sensor onto the Rabbit eyes. After integrating with the wireless module, users can realize real-time monitoring and warning of IOP via smartphones, the demonstrated MX-CLS device together with the IOP monitoring/display system opens up promising platforms for Ti3 C2 Tx materials as the base for multifunctional contact lens-based sensors and continuous and nondestructive IOP measurement system.

The role of cardiac remodeling associated with renal function in mediating cardiovascular event outcomes.

The potential impact of renal function-related cardiovascular remodeling on associated cardiovascular risk has not been previously investigated. Hence, we conducted multiple mediation analyses in the UK Biobank study to evaluate this association. Using multiple Cox models, we found lower renal function (estimated glomerular filtration rate based on cystatin C, eGFR-cysC) was independently related to increased risks of various cardiovascular events and mortalities. Multivariable linear regression revealed a progressive relationship between declining eGFR-cysC and adverse left ventricular (LV) remodeling and impaired systolic function. In Cox models, larger LV volume, mass, as well as decreased systolic function, were significantly correlated with adverse events, particularly in heart failure. Mediation analyses showed that undesirable LV remodeling and cardiometabolic diseases were independent mediators. Our study explores the connections between reduced renal function and poor cardiovascular phenotypes, as well as their significant independent role in mediating renal function-cardiovascular outcome relationships.

Self-supervised Self2Self denoising strategy for OCT speckle reduction with a single noisy image.

Optical coherence tomography (OCT) inevitably suffers from the influence of speckles originating from multiple scattered photons owing to its low-coherence interferometry property. Although various deep learning schemes have been proposed for OCT despeckling, they typically suffer from the requirement for ground-truth images, which are difficult to collect in clinical practice. To alleviate the influences of speckles without requiring ground-truth images, this paper presents a self-supervised deep learning scheme, namely, Self2Self strategy (S2Snet), for OCT despeckling using a single noisy image. Specifically, in this study, the main deep learning architecture is the Self2Self network, with its partial convolution being updated with a gated convolution layer. Specifically, both the input images and their Bernoulli sampling instances are adopted as network input first, and then, a devised loss function is integrated into the network to remove the background noise. Finally, the denoised output is estimated using the average of multiple predicted outputs. Experiments with various OCT datasets are conducted to verify the effectiveness of the proposed S2Snet scheme. Results compared with those of the existing methods demonstrate that S2Snet not only outperforms those existing self-supervised deep learning methods but also achieves better performances than those non-deep learning ones in different cases. Specifically, S2Snet achieves an improvement of 3.41% and 2.37% for PSNR and SSIM, respectively, as compared to the original Self2Self network, while such improvements become 19.9% and 22.7% as compared with the well-known non-deep learning NWSR method.

Integrated metabolome and transcriptome analysis of differences in quality of ripe Lycium barbarum L. fruits harvested at different periods.

BACKGROUND: Wolfberry is well-known for its high nutritional value and medicinal benefits. Due to the continuous ripening nature of Goji berries and the fact that they can be commercially harvested within a few weeks, their phytochemical composition may change during the harvesting process at different periods. RESULT: The involved molecular mechanisms of difference in fruit quality of ripe Lycium barbarum L. harvested at four different periods were investigated by transcriptomic and metabolomics analyses for the first time. According to the results we obtained, it was found that the appearance quality of L. barbarum fruits picked at the beginning of the harvesting season was superior, while the accumulation of sugar substances in L. barbarum fruits picked at the end of the harvesting season was better. At the same time the vitamin C and carotenoids content of wolfberry fruits picked during the summer harvesting season were richer. Ascorbic acid, succinic acid, glutamic acid, and phenolic acids have significant changes in transcription and metabolism levels. Through the network metabolic map, we found that ascorbic acid, glutamic acid, glutamine and related enzyme genes were differentially accumulated and expressed in wolfberry fruits at different harvesting periods. Nevertheless, these metabolites played important roles in the ascorbate-glutathione recycling system. Ascorbic acid, phenolic substances and the ascorbate-glutathione recycling system have antioxidant effects, which makes the L. barbarum fruits harvested in the summer more in line with market demand and health care concepts. CONCLUSION: This study laid the foundation for understanding the molecular regulatory mechanisms of quality differences of ripe wolfberry fruits harvested at different periods, and provides a theoretical basis for enhancing the quality of L. barbarum fruits.

High-fidelity source mask optimization for suppressing line-end shortening.

Source mask optimization (SMO) is a widely used computational lithography technique for compensating lithographic distortion. However, line-end shortening is still a key factor that cannot be easily corrected and affects the image fidelity of lithography at advanced nodes. This paper proposes a source mask optimization method that suppresses line-end shortening and improves lithography fidelity. An adaptive hybrid weight method is employed to increase the weights of the line end during the optimization, which adaptively updates the weights in each iteration according to the edge placement error (EPE). A cost function containing a penalty term based on the normalized image log slope (NILS) is established to ensure the fidelity of the overall feature when paying more attention to the line-end region. The scope of this penalty term is regulated by widening and extending the split contour to further reduce the line-end shortening. Simulation results show that the proposed method can effectively suppress the line-end shortening and improve the lithography fidelity compared with the traditional SMO method.

A foreign body that has been left for 20 years causes a pseudoaneurysm of the middle cerebral artery: a case report.

BACKGROUND: We report a patient with extensive subarachnoid hemorrhage caused by the rupture of a middle cerebral artery pseudoaneurysm from a foreign body that had been left for two decades. CASE PRESENTATION: A 74-year-old male patient from Han nationality was admitted to the emergency department of our hospital with impaired consciousness for 1 hour. Cranial computed tomography examination indicated a massive subarachnoid hemorrhage with intraventricular blood accumulation, and a high-density short strip dense shadow was seen in the M1 segment of the right middle cerebral artery, considering the possibility of a foreign body. Subsequently, a cerebral angiography was suggested; the foreign body was seen through the right middle cerebral artery, and the aneurysm was seen in the lower wall, so a pseudoaneurysm was considered. The emergent surgical intervention involved the clipping of the pseudoaneurysm and intracranial extraction of the foreign body. Unfortunately,the patient ultimately expired due to severe pulmonary infection. CONCLUSION: Intracranial pseudoaneurysm caused by foreign body has been rarely reported previously, and microsurgical treatment of an intracranial pseudoaneurysm caused by a foreign body is a good choice.

Percutaneous transthoracic catheter drainage prior to surgery in treating neonates with congenital macrocystic lung malformation presenting with respiratory distress.

Backgound: It is rarely seen that neonates with congenital macrocystic lung malformation (CMLM) presenting with respiratory distress require emergency intervention. No consensus has been achieved concerning the best policy facing such condition. This study aims to evaluate the efficacy and safety of our strategies in treating neonates with CMLM presenting with respiratory distress. Methods: We retrospectively reviewed the data of six neonates with CMLM presenting with respiratory distress from April 2020 to October 2022 for whom drainage-prior-to-surgery strategy were adopted and favorable outcomes were obtained. The relevant data was reviewed and analyzed. Results: All the patients were prenatally diagnosed with congenital lung malformation and postnatally as congenital macrocystic lung malformation via CT scan. Each neonate accepted percutaneous thoracic catheter drainage prior to surgery. The first and fifth neonates with macrocystic lung mass experienced prompt open lobectomy and delayed thoracoscopic surgery due to failure of air drainage, respectively. The other four patients obtained good drainage of the large air-filled cyst, thus gaining the opportunity for elective thoracoscopic surgery within median 45 days. Conclusions: For neonates with macrocystic lung malformation presenting with respiratory distress due to mediastinal compression, percutaneous thoracic catheter drainage is worth a shot for elective thoracoscopic surgery due to its feasibility and safety.

Pulmonary function after lobectomy in children: a systematic review and meta-analysis.

BACKGROUND: The influence of lobectomy on pulmonary function in children was still controversial. A systematic review and meta-analysis were essential to explore whether pulmonary function was impaired after lobectomy in children. METHODS: PubMed, Embase and Web of Science were searched from 1 January 1946 to 1 July 2022. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and total lung capacity were extracted from the studies as the primary analysis indicators. Subgroup analyses were performed between the congenital lung malformation (CLM) group and other diseases group, early surgery and late surgery group (1 year old as the dividing line). RESULTS: A total of 5302 articles were identified through the search strategy; finally, 10 studies met the inclusion criteria. Through the meta-analysis, we found a mild obstructive ventilatory disorder in children who underwent lobectomy. However, a normal pulmonary function could be found in young children with CLM who underwent lobectomy, and the time of operation had no significant influence on their pulmonary function. CONCLUSIONS: The overall result of pulmonary function after lobectomy in children was good. Surgeons may not need to be excessively concerned about the possibility of lung surgery affecting pulmonary function in children, particularly in patients with CLM. PROSPERO REGISTRATION NUMBER: CRD42022342243.

Absorbable Clips Applied in Thoracoscopic Anatomical Lung Resection in Younger Children.

OBJECTIVES: This study aims to evaluate the feasibility and safety of a 5-mm absorbable clips applied in thoracoscopic anatomical lung resection in younger children. METHODS: Demographic data and intra- and postoperative parameters of the two groups (Abs-o-lock® group and Hem-o-lok® group) were reviewed. In the Abs-o-lock® group, 5-mm absorbable clips were used in thoracoscopic anatomical lung resection on all patients from January 2020 to March 2021. In the Hem-o-lok® group, 5-mm Hem-o-lok® clips were used from January to December 2019. The primary outcomes were the one-time success rate of ligation, major bleeding rate, intraoperative dislodgement rate and operative time, which were compared between the two groups. RESULTS: There were 224 patients involved in this study, of whom 103 were in the Abs-o-lock® group and 121 were in the Hem-o-lok® group. The one-time success rate of ligation was 96.5% in the Abs-o-lock® group and 98.9% in the Hem-o-lok® group (p < 0.05). No major bleeding occurred in either group. The intraoperative dislodgement rate did not significantly differ between the two groups (p = 1.0). The operative time consumed in the Abs-o-lock® group was much longer than that in the Hem-o-lok® group for subgroups of resection of extralobar sequestration (p < 0.05), lobectomy (p < 0.05) and segmentectomy (p < 0.05). CONCLUSIONS: Compared to Hem-o-lok® clips, it is feasible and safe to apply 5-mm absorbable clips for vessel sealing during thoracoscopic anatomical lung resection in younger children.

Implicit function characterization of the curvilinear mask to realize parametric optical proximity correction with a neighborhood parallel tabu search.

The curvilinear mask structures provide significant benefits in improving lithographic resolution. Curvilinear masks, as opposed to rectilinear masks, have a wider range of structure types that can be used precisely to correct the contour of diffraction at sharp technological nodes. However, the curvilinear structure also makes the inverse design of mask in optical proximity correction (OPC) flow difficult. The current OPC of curvilinear masks uses pixel-based inverse optimization, which is extremely computationally intensive and takes up a lot of design data storage space. This paper proposes an implicit function to represent a large number of curve types with a small number of parameters to reduce computational complexity and the R&D cycle. Therefore, the ultra-high dimensional pixel-based OPC problem is transformed into a low-dimensional parameter search problem in the critical diffraction area of the mask pattern. The tabu search algorithm and neighborhood parallel computing strategy are then used to quickly search for optimal characterized parameters. The results of the simulation show that the parametric curvilinear OPC method achieves a higher image fidelity than that of rectilinear OPC. At the same time, it addresses the shortcomings of the traditional pixelated curvilinear mask OPC method, including high computational complexity, low manufacturability, and storage space occupancy.

CircFOXN2 alleviates glucocorticoid- and tacrolimus-induced dyslipidemia by reducing FASN mRNA stability by binding to PTBP1 during liver transplantation.

We aimed to examine impacts and functional mechanism of circular RNA forkhead box N2 (FOXN2) in tacrolimus (TAC)- and dexamethasone (Dex)-induced lipid metabolism disorders. RNA level and protein contents in TAC, Dex, or combined TAC- plus Dex-treated patients and Huh-7 cells were measured utilizing quantitative real-time (qRT)-PCR and western blotting assays measured the formation of lipid droplet. Total cholesterol (TC) and triglyceride (TG) levels were determined using corresponding commercial kits and Oil red O staining. RNA immunoprecipitation and RNA pull-down verified the binding relationship among circFOXN2, polypyrimidine tract binding protein 1 (PTBP1) and fatty acid synthase (FASN). Male C57BL/6 mice were used to establish a dyslipidemia mouse model to validate the discoveries at the cellular level. Dex treatment significantly promoted TAC-mediated increase of TC and TG in serum samples and Huh-7 cells. Moreover, circFOXN2 was reduced but FASN was elevated in TAC-treated Huh-7 cells, and these expression trends were markedly enhanced by Dex cotreatment. Overexpression of circFOXN2 could reverse the accumulation of TC and TG and the upregulation of FASN and sterol regulatory element binding transcription factor 2 (SREBP2) mediated by Dex and TAC cotreatment. Mechanistically, circFOXN2 reduced FASN mRNA stability by recruiting PTBP1. The protective roles of circFOXN2 overexpression on lipid metabolism disorders were weakened by FASN overexpression. In vivo finding also disclosed that circFOXN2 greatly alleviated the dysregulation of lipid metabolism triggered by TAC plus Dex. CircFOXN2 alleviated the dysregulation of lipid metabolism induced by the combination of TAC and Dex by modulating the PTBP1/FASN axis.NEW & NOTEWORTHY Collectively, our experiments revealed for the first time that circFOXN2 alleviated the Dex- and TAC-induced dysregulation of lipid metabolism by regulating the PTBP1/FASN axis. These findings suggested that circFOXN2 and FASN might be candidate targets for the treatment of Dex- and TAC-induced metabolic disorders.

Loss-balanced parallel decoding network for retinal fluid segmentation in OCT.

As a leading cause of blindness worldwide, macular edema (ME) is mainly determined by sub-retinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) accumulation, and therefore, the characterization of SRF, IRF, and PED, which is also known as ME segmentation, has become a crucial issue in ophthalmology. Due to the subjective and time-consuming nature of ME segmentation in retinal optical coherence tomography (OCT) images, automatic computer-aided systems are highly desired in clinical practice. This paper proposes a novel loss-balanced parallel decoding network, namely PadNet, for ME segmentation. Specifically, PadNet mainly consists of an encoder and three parallel decoder modules, which serve as segmentation, contour, and diffusion branches, and they are employed to extract the ME's characteristics, the contour area features, and to expand the ME area from the center to edge, respectively. A new loss-balanced joint-loss function with three components corresponding to each of the three parallel decoding branches is also devised for training. Experiments are conducted with three public datasets to verify the effectiveness of PadNet, and the performances of PadNet are compared with those of five state-of-the-art methods. Results show that PadNet improves ME segmentation accuracy by 8.1%, 11.1%, 0.6%, 1.4% and 8.3%, as compared with UNet, sASPP, MsTGANet, YNet, RetiFluidNet, respectively, which convincingly demonstrates that the proposed PadNet is robust and effective in ME segmentation in different cases.

Comparative transcriptomic analysis of transcription factors and hormones during flower bud differentiation in 'Red Globe' grape under red‒blue light.

Grape is a globally significant fruit-bearing crop, and the grape flower bud differentiation essential to fruit production is closely related to light quality. To investigate the regulatory mechanism of grape flower bud differentiation under red‒blue light, the transcriptome and hormone content were determined at four stages of flower bud differentiation. The levels of indole-3-acetic acid (IAA) and abscisic acid (ABA) in grape flower buds at all stages of differentiation under red‒blue light were higher than those in the control. However, the levels of cytokinins (CKs) and gibberellic acid (giberellins, GAs) fluctuated continuously over the course of flower bud differentiation. Moreover, many differentially expressed genes were involved in auxin, CK, GA, and the ABA signal transduction pathways. There were significant differences in the AUX/IAA, SAUR, A-RR, and ABF gene expression levels between the red‒blue light treatment and the control buds, especially in regard to the ABF genes, the expression levels of which were completely different between the two groups. The expression of GBF4 and AI5L2 in the control was always low, while the expression under red‒blue light increased. AI5L7 and AI5L5 expression levels showed an upwards trend in the control plant buds and gradually decreased in red‒blue light treatment plant buds. Through weighted gene coexpression network analysis, we determined that the transcription factors WRK48 (WRKY family), EF110 (ERF family), ABR1, CAMTA3 (CAMTA family), and HSFA3 (HSF family) may be involved in the regulation of the GBF4 gene. This study lays a foundation for further analysis of grape flower bud differentiation regulation under red‒blue light.

Optimization of ear electrodes for SSVEP-based BCI.

Objective.Current ear electrodes often require complex placing or long stimulation durations to achieve good detection of steady-state visual evoked potential (SSVEP). To improve the practicability of ear electrode-based SSVEP-BCI (brain-computer interface) system, we developed a high-performance ear electrode that can be easily placed.Approach.Hydrogel based disposable and replaceable semi-dry electrodes are developed to improve the contact impedance and wear feeling. The best combination of electrodes for SSVEP-BCI application around the ear is optimized by assessing the electrode on volunteers, and the performance of the electrode was compared with that of the occipital electrode.Main results.The developed ear hydrogel electrode can achieve an impedance close to that of the wet electrode. Three combinations of ear electrode groups demonstrate high information transfer rate (ITR) and accuracy in SSVEP-BCI applications. According to the rating of the comprehensive assessment and BCI performance in the online session, the behind-aural electrode is the best electrode combination for recording SSVEP in the ear region. The average preparation time is the shortest, and the average impedance is the lowest. The ITR of the behind-aural electrode based SSVEP-BCI system can reach 37.5 ± 18 bits min-1. The stimulus duration was as low as 3 s compared to 5 s or 10 s in other studies.Significance.The accuracy, ITR, and wear feeling can be improved by introducing a semi-dry ear electrode and optimizing the position and the combination of ear electrode. By providing a better trade-off between performance and convenience, the ear electrode-based SSVEP-BCI promises to be used in daily life.

Effective multi-objective inverse lithography technology at full-field and full-chip levels with a hybrid dynamic priority algorithm.

Inverse lithography technology (ILT), such as source mask optimization (SMO), is used to improve lithography performance. Usually, a single objective cost function is selected in ILT, and an optimal structure for one field point is achieved. The optimal structure is not the case for other images at full field points where the aberrations of the lithography system are different, even in high-quality lithography tools. The optimal structure that must match the high-performance images at the full field is urgently required for extreme ultraviolet lithography (EUVL). In contrast, multi-objective optimization algorithms (MOAs) limit the application of multi-objective ILT. Assigning target priority is incomplete in current MOAs, which results in the over-optimization of some targets and under-optimization of others. In this study, multi-objective ILT and a hybrid dynamic priority (HDP) algorithm were investigated and developed. High-performance images with high fidelity and high uniformity were obtained at multi-field and multi-clip areas across the die. A hybrid criterion was developed for the completion and reasonable prioritization of each target to ensure sufficient improvement. Compared to the current MOAs, the uniformity of images at full-field points was improved by up to 31.1% by the HDP algorithm in the case of multi-field wavefront error-aware SMO. The multi-clip source optimization (SO) problem showed the universality of the HDP algorithm to deal with different ILT problems. It acquired higher imaging uniformity than existing MOAs, which indicated that the HDP is more qualified for multi-objective ILT optimization than existing MOAs.

Self-supervised Blind2Unblind deep learning scheme for OCT speckle reductions.

As a low-coherence interferometry-based imaging modality, optical coherence tomography (OCT) inevitably suffers from the influence of speckles originating from multiply scattered photons. Speckles hide tissue microstructures and degrade the accuracy of disease diagnoses, which thus hinder OCT clinical applications. Various methods have been proposed to address such an issue, yet they suffer either from the heavy computational load, or the lack of high-quality clean images prior, or both. In this paper, a novel self-supervised deep learning scheme, namely, Blind2Unblind network with refinement strategy (B2Unet), is proposed for OCT speckle reduction with a single noisy image only. Specifically, the overall B2Unet network architecture is presented first, and then, a global-aware mask mapper together with a loss function are devised to improve image perception and optimize sampled mask mapper blind spots, respectively. To make the blind spots visible to B2Unet, a new re-visible loss is also designed, and its convergence is discussed with the speckle properties being considered. Extensive experiments with different OCT image datasets are finally conducted to compare B2Unet with those state-of-the-art existing methods. Both qualitative and quantitative results convincingly demonstrate that B2Unet outperforms the state-of-the-art model-based and fully supervised deep-learning methods, and it is robust and capable of effectively suppressing speckles while preserving the important tissue micro-structures in OCT images in different cases.

Previous pulmonary infection impacts thoracoscopic procedure outcomes in patients with congenital lung malformations: a retrospective cohort study.

BACKGROUND AND OBJECTIVES: Patients with congenital lung malformations (CLMs) are at high risk for developing pulmonary infection. Nonetheless, prophylactic surgical excision of asymptomatic CLMs is controversial and often delayed to symptoms occurring out of concern for potential operative risks. This study aims to evaluate the impact of previous pulmonary infection on the outcome of thoracoscopic procedures in CLMs patients. METHODS: This was a retrospective cohort study of CLMs patients who received an elective operation at a tertiary care center from 2015 to 2019. Patients were divided into pulmonary infection (PI) or non-infection of pulmonary (NPI) groups according to the history of pulmonary infection. Propensity score matching was used to minimize the bias between groups. The primary outcome was conversion to thoracotomy. Postoperative outcomes were compared between patients with and without PI. RESULTS: We identified 464 patients, of whom 101 had a history of PI. Propensity score matching yielded a well-balanced cohort of 174 patients. PI was associated with higher conversion to thoracotomy (adjusted odds ratio = 8.7, 95% confidence interval, CI, 1.1-71.2, p = 0.039), blood loss (p = 0.044), and longer operative time (p < 0.001), chest tube placement time (p < 0.001), length of stay (p < 0.001), and postsurgical length of stay (p < 0.001). CONCLUSIONS: Elective operation in CLMs patients with a history of PI was associated with an increased risk of conversion to thoracotomy, operative time, blood loss, chest tube placement time, length of stay, and postsurgical length of stay. Elective thoracoscopic procedures in asymptomatic CLMs patients are safe and effective, and earlier surgical intervention may be warranted.

Learning curve for total thoracoscopic segmentectomy in treating pediatric patients with congenital lung malformation.

BACKGROUND: Total thoracoscopic segmentectomy (TTS) is a technically challenging procedure in children but results in more parenchyma preservation, better pain control, better cosmetic results, and a shorter hospital stay. However, definitive data describing the learning curve of TTS has yet to be obtained. Here, we review the safety and efficiency of our initial experiences with pediatric TTS and evaluate our learning curve. METHODS: This was a retrospective study of all pediatric patients undergoing TTS between December 2016 and January 2020. Pediatric patients who underwent TTS were included, while those undergoing lobectomy or wedge resection were excluded. RESULTS: One hundred and twelve patients were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, the ascending phase (A), plateau phase (B) and descending phase (C), through cumulative summation (CUSUM) of the operative time (OT). Phases A, B, and C comprised 28, 51, and 33 cases, respectively. OT decreased significantly from phases A to B (p < 0.001) and from phase B to C (p = 0.076). No significant differences were observed in the demographic factors among the three phases. The conversion rate was zero, and the complication rate was 0.9%. Differences in technical parameters, such as length of stay and chest tube duration, were statistically insignificant between phases A and B or B and C. There were no mortalities. CONCLUSION: CUSUMOT indicates that the learning curve of at least 79 cases is required for TTS in our institute. We emphasize that the learning curve should be cautiously interpreted because many factors in different institutions may influence the exact parabola and actual learning curve.