Severity-onset prediction of COVID-19 via artificial-intelligence analysis of multivariate factors.

Progression to a severe condition remains a major risk factor for the COVID-19 mortality. Robust models that predict the onset of severe COVID-19 are urgently required to support sensitive decisions regarding patients and their treatments. In this study, we developed a multivariate survival model based on early-stage CT images and other physiological indicators and biomarkers using artificial-intelligence analysis to assess the risk of severe COVID-19 onset. We retrospectively enrolled 338 adult patients admitted to a hospital in China (severity rate, 31.9%; mortality rate, 0.9%). The physiological and pathological characteristics of the patients with severe and non-severe outcomes were compared. Age, body mass index, fever symptoms upon admission, coexisting hypertension, and diabetes were the risk factors for severe progression. Compared with the non-severe group, the severe group demonstrated abnormalities in biomarkers indicating organ function, inflammatory responses, blood oxygen, and coagulation function at an early stage. In addition, by integrating the intuitive CT images, the multivariable survival model showed significantly improved performance in predicting the onset of severe disease (mean time-dependent area under the curve = 0.880). Multivariate survival models based on early-stage CT images and other physiological indicators and biomarkers have shown high potential for predicting the onset of severe COVID-19.

Uniportal versus triportal video-assisted thoracic surgery in the treatment of tuberculous empyema.

OBJECTIVE: To examine the effectiveness of decortication to treat chronic tuberculous empyema (TE) using uniport video-assisted thoracoscopic surgery (VATS) versus conventional triport VATS. METHODS: Data from consecutive patients with stage II or III TE who underwent decortication with either uniport VATS (uniportal group) between July and December 2017, or triport VATS between January and July 2018 (triportal group), were retrospectively analysed. VATS procedures were performed under general anaesthesia with double lumen endotracheal intubation and clinical outcomes were compared between the two groups. RESULTS: Clinical data were comparable between the groups (20 patients in each) regarding demographic and baseline characteristics, operative and postoperative characteristics, surgical procedure-related complications, and postoperative adverse events. No surgical procedure-related complications occurred during the perioperative period in either group. Threshold values for mechanical pain at 8 h postoperatively were significantly higher in the triportal group versus the uniportal group. Furthermore, the incidence of nausea and vomiting was significantly lower in the uniportal versus triportal group. In the triportal group, one patient required readmission and further intervention due to recurrence. CONCLUSIONS: Uniport VATS decortication for stages II and III TE may be a feasible and safe procedure in selected patients. Moreover, uniport VATS may be less painful than triport VATS.

The short-term outcomes for the early removal of pigtail catheter drainage within 24 hours of uniportal video-assisted anatomic surgery in patients with lung cancer.

Background: Early removal of the chest tube has advantages of reducing postoperative pain and speed recovery. This study aimed to confirm its safety and feasibility of early removal of a pigtail catheter used as a chest drain in patients undergoing anatomical surgery. Methods: This retrospective cohort study included 126 patients who removed pigtail catheter ≤24 h after surgery, and 56 patients >24 h who underwent uniportal video-assisted thoracic surgery (u-VATS) between January 2020 and April 2022. All patients had stage I lung cancer and underwent anatomical surgery (lobectomy or segmentectomy). The clinical characteristics, perioperative data, and postoperative complications of both groups were analyzed and compared. Results: The >24 h group had more patients with a higher body mass index (BMI) (P<0.001), a lower forced expiratory volume in the first second (FEV1) (P<0.001), Chronic obstructive pulmonary disease (COPD) (P<0.001), and current smokers (P=0.006) than the ≤24 h group. There were no significant differences in terms of age, sex, type of resection, operation time, and bleeding loss between the two groups (P>0.05). The pain of patients in the ≤24 h group was significantly less than that in the >24 h group only on the third postoperative day (P=0.035). There were no significant differences in the postoperative visual analogue scale (VAS) at postoperative day 0, day 1, day 7, and 1 month between the two groups (P>0.05). With the exception of a higher occurrence of subcutaneous emphysema in the >24 h group (71.7% vs. 100%, P=0.001), there were no statistically significant differences in the postoperative complications (e.g., pneumonia, atrial fibrillation, atelectasis, pleural effusion, and wound infection) between the 2 groups (P>0.05). During the 30-day follow-up period, none of the patients required tube reinsertion for pneumothorax. A total of 8 patients in the ≤24 h group and 4 in the >24 h group required tube reinsertion (6.7% vs. 7.1%, P>0.99) due to pleural effusion. Conclusions: In stage I lung cancer patients who underwent u-VATS anatomic surgery, the pigtail catheter used as a thoracic drainage tube removed with 24 h after was safe and feasible.

Two case reports of preoperative selective artery embolization with robotic-assisted thoracoscopic lobectomy for chronic cavitary pulmonary aspergillosis: technology, safety and short-term outcomes.

Background: Minimally invasive surgical resection is a possible radical treatment for pulmonary aspergillosis; however, it is difficult and can be accompanied by a variety of complications, especially in chronic cavitary pulmonary aspergillosis (CCPA). Selective artery embolization is usually conducted as palliative management or emergent control of hemoptysis in CCPA. In this report, we share our experience of 2 CCPA patients who underwent preoperative selective artery embolization followed by robotic-assisted thoracoscopic lobectomy. Case Description: Two male patients with post-tuberculosis CCPA had recurrent hemoptysis. They underwent preoperative selective artery embolization and robotic-assisted thoracoscopic lobectomy in July-August 2022. The intraoperative blood loss volumes for the 2 patients were 160 and 200 mL, respectively. Both patients had good short-term outcomes, and the post-operative stays for each patient were 15 and 9 days, respectively. Conclusions: Robotic-assisted thoracoscopic lobectomy following selective artery embolization is a potential safe and effective treatment for CCPA. Robotic resection has a number of advantages, including the dexterity, the sharp, 3-dimensional, and magnified vision, and a minimally invasive procedure. Selective preoperative feeding artery embolization can reduce intraoperative bleeding and provide a clearer surgical vision, thus facilitating minimally invasive approaches. We expect further systematic clinical researches to validate the conclusion.

Uniportal Thoracoscopic Wedge Resection of Lung Nodules: Paravertebral Blocks Are Better Than Intercostal Blocks.

Background. Regional analgesia for tubeless, uniport, thoracoscopic wedge resection of benign peripheral nodules is generally performed by intercostal nerve block (INB). We examined the effectiveness of thoracic paravertebral block (PVB), in comparison to the traditional intercostal blocks, for the procedure. Methods. Between July 2016 and December 2016, 20 consecutive patients with solitary benign peripheral lung nodules underwent tubeless uniport thoracoscopic wedge resection using thoracic PVB (PVB group). The clinical outcomes were compared with those of 20 other consecutive patients who underwent the same procedure under the conventional INB, between January 2016 and July 2016 (INB group). In both groups, the procedures were performed without endotracheal intubation, urinary catheterization, or chest tube drainage. Results. The clinical data of patients in both groups were comparable in terms of demographic and baseline characteristics, operative and anesthetic characteristics, puncture-related complications, and postoperative anesthetic adverse events. No puncture-related complications occurred during the perioperative period in either group. The threshold values for mechanical pain at postoperative hours 4 and 8 were significantly higher in the PVB group than in the INB group. Furthermore, the incidence of nausea or vomiting in the PVB group was significantly less than that in the INB group. None of the patients required reintervention or readmission to our hospital. Conclusions. Tubeless uniportal thoracoscopic wedge resection for solitary benign peripheral lung nodules using thoracic PVB for regional analgesia is a feasible and safe procedure. Moreover, we found that thoracic PVB is less painful than INB.

Early enteral feeding on esophageal cancer patients after esophageal resection and reconstruction.

BACKGROUND: In patients under esophagectomy, early postoperative oral feeding has traditionally been contraindicated to minimize the risk of anastomotic leaks. Because early oral feeding preserves the integrity and function of gut mucosa, the aim of this study was to investigate the impact of postoperative early oral feeding on esophagectomy. METHODS: Between Oct 2013 and Jan 2016, 41 consecutive patients with esophageal carcinoma (stages I- III), who had undergone minimally invasive Ivor-Lewis surgery, were enrolled in this study. The patients were randomly arranged into the early oral feeding (EOF) group (21 cases) and the simple tube feeding (STF) group (20 cases). The nutritional goal for both groups was 25 kcal/(kg·day). The patients in the EOF group were tube-fed with enteral nutrition and orally fed with 5% glucose in normal saline during the first 4 postoperative days, after that the patients were placed on a liquid diet. The patients in the STF group were postoperatively tube-fed with enteral nutrition for 7 days before being switched to liquid diet. The length of the postoperative hospital stay, rate of perioperative complications, and overall mortality were recorded. Preoperative and postoperative levels of serum albumin (ALB), prealbumin (PA), transferrin (TP), and C reactive protein (CRP) were also monitored. RESULTS: There were no significant differences of the incidence of postoperative complications and overall mortality between the EOF group and the STF group, but the duration of hospital stay, interval until the first liquid food, and time of ambulation in the EOF group were lower than those of the STF group (P<0.05). EOF patients also showed significantly lower CRP levels compared with the STF group (P<0.05). CONCLUSIONS: EOF might reduce the duration of hospital stays and CRP levels in esophageal cancer patients who underwent esophagectomy while the mortality and complications were not affected.