[Management of Malignant Pleural Effusion]. / Management des malignen Pleuraergusses.

Malignant pleural effusion is a common diagnosis in metastasized cancers. It is always of palliative character. Main symptoms are dyspnoea and reduced quality of life. Diagnosis is made by ultrasound-guided puncture of the pleural effusion (cytology) and often video-assisted thoracic surgery with biopsy of the pleural surface (histology). The goal of treatment is a fast, sustainable, minimally invasive, patient-centred therapy that increases quality of life. Besides systemic therapy and best supportive care the patient can be treated with local therapy including either pleurodesis (via drainage or VATS) or an indwelling-pleural catheter (IPC). Decision for one of these procedures is made upon performance index (ECOG), expandability of the lung, prognosis and the patient's wish. For the first technique, the lung must be expandable. The latter one (IPC) can be implanted both with expandable and trapped lung. Both are similarly effective in symptom control.

Priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery.

Background: Enhanced recovery after surgery (ERAS) is a perioperative care protocol, which was introduced several years ago and has gained increasing importance in thoracic surgery. The aim of this study was to provide guidance through clinical implementation and to identify factors for better compliance. Methods: This prospective cohort study collected data between July 2021 and June 2022 at the Department of Thoracic Surgery (University Hospital Regensburg, Germany). A modified enhanced recovery after thoracic surgery (ERATS) protocol with recommendations covering the pre-, intra- and postoperative phases was established and followed. The primary objective was to evaluate the implementation of the ERATS protocol. Secondary, specific and clinically relevant recommendations were analyzed regarding their compliance. Results: The study included 139 patients undergoing elective lung resections. Many ERATS recommendations were already part of standard perioperative care, including perioperative antibiotics, venous thromboembolism prophylaxis and intraoperative warming. Other measures such as anemia management, carbohydrate loading or chest drain management were updated or newly established and standardized according to our ERATS protocol. The recommendations emphasizing early postoperative mobilization were found to be crucial. We identified three groups with significantly different compliance rates: (I) patient-dependent measures which require active participation (49.3%); (II) treatment measures requiring interdisciplinary consensus (85.8%); and (III) surgical measures (88%). Conclusions: The implementation and continuous evaluation of our perioperative ERATS protocol led to a new categorization of targeted measures into three groups with actors of different competencies. The new grouping enables gradual implementation and a step-by-step targeted approach in order to achieve a higher compliance of ERATS in the future as well as long-term sustainability.

Content of amino acids and biogenic amines in stored meat as a result of a broiler diet supplemented with ß-alanine and garlic extract.

Poultry meat is a highly esteemed product among consumers. However, the emphasis on increasing body weight has led to a rise in the proportion of rapidly shrinking fibers, adversely affecting the quality and shelf life of poultry meat. With a growing awareness of dietetics among consumers, there is an increasing challenge to produce chicken meat that is not only free of antibiotics but also beneficial for dietary and health reasons. Biogenic amines (BA) can serve as indicators of meat freshness and quality. While they play vital roles in the body, excessive consumption of BA can have toxic and carcinogenic effects. The objective of this study was to examine the impact of supplementing feed with garlic extract and ß-alanine (ß-Ala) on the formation of BA and amino acid (AA) levels in the breast and leg muscles of chickens stored under aerobic chilling conditions. The muscles were obtained from chickens fed with garlic extract and ß-Ala in quantities of 0.5 and 2% for each additive, as well as 0.5 and 2% of their combination. Analyses were conducted on d 1, 3, 5, 7, and 10 of storage. ß-Ala supplementation increased the proportion of this AA in breast (P < 0.01) and leg muscles (P < 0.01), along with a rise in the proportion of nonessential AA (NEAA; sum of aspartic, aspartic acid, glutamic, glutamic acid, serine, ß-Ala, and proline) (P < 0.01). The levels of BA changed during storage in breast and leg muscles (P < 0.001). The applied diet significantly influenced the formation of putrescine (P = 0.030), phenylethylamine (P = 0.003), agmatine (P = 0.025), and total BA (P < 0.001) in breast muscles. On the 10 d of storage, the breast muscles exhibited the lowest BA index (BAI) in the group, with a diet supplemented with 0.5% garlic extract and 0.5% ß-Ala (P < 0.05). The leg muscles showed a similar BA trend as the breast muscles. These supplements may be utilized in production to augment the protein content of chicken muscles and potentially decrease the BAI index during meat storage.