Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

Background: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown.Objectives: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events.Methods: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate.Results: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6-10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1-1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event.Conclusions: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.</p

Alexithymie et psychopathologie de patients atteints de cancer = Alexithymia and psychopathology of patients with cancer

Résumé Objectif : Décrire l'alexithymie chez des patientsnouvellement diagnostiqués de cancer.Méthode : Les données sociodémographiques, médicales etpsychométriques (HADS, SCL-90, EORTC-QLQ-C30 etTAS-20) ont été enregistrées chez des patients récemment(&lt; 4 mois) pris en charge pour un cancer.Résultats : Chez 70% des 419 patients inclus dans l'étude, unscore qualifiant pour un diagnostic d'alexithymie (TAS &gt; 56)a été observé avec une corrélation négative avec les symptômespsychiatriques, qui par ailleurs ne dépassaient pas lesseuils d'anxiété et de dépression mesurés avec le HADS,et une corrélation positive avec la qualité de vie.Conclusion : La haute prévalence de l'alexithymie, considéréecomme une protection, questionne la nécessité et letype d'éventuelles interventions psycho-oncologiques.Pour citer cette revue : Psycho-Oncol. 5 (2011)

Biallelic mutations in M1AP are associated with meiotic arrest, severely impaired spermatogenesis and male infertility

Male infertility affects ~7% of men, but its causes remain poorly understood. The most severe form is non-obstructive azoospermia (NOA), which is, in part, caused by an arrest at meiosis, but so far only few validated causal genes have been reported. To address this gap, we performed whole exome sequencing in 58 men with unexplained meiotic arrest and identified in three unrelated men the same homozygous frameshift variant c.676dup (p.Trp226LeufsTer4) in M1AP, encoding meiosis 1 arresting protein. This variant results in a truncated protein lacking 57% of its full-length as shown in vitro by heterologous expression of mutated M1AP. Next, we screened four large cohorts of 1904 infertile men from the International Male Infertility Genomics Consortium (IMIGC) and identified three additional cases carrying homozygous c.676dup and three carrying combinations of this and other likely causal variants in M1AP. Moreover, a homozygous missense variant p.(Pro389Leu) segregated with infertility in five men from a consanguineous Turkish family (LOD score = 3.28). The common phenotype between all affected men was NOA, but occasionally spermatids and rarely a few spermatozoa in the semen were observed. A similar phenotype was described for mice with disruption of M1ap. Collectively, these findings demonstrate that mutations in M1AP cause autosomal recessive severe spermatogenic failure and male infertility. In view of the evidences from several independent groups and populations, M1AP should be included in the growing list of validated male infertility genes.This work was supported by DFG Clinical Research Unit “Male Germ Cells: from Genes to Function” (CRU326).info:eu-repo/semantics/publishedVersio