Successful thoracoscopic management of iatrogenic left subclavian arterial injury: a case report.

The subclavian artery at the thoracic outlet is in the deepest position of the thoracic cavity and is difficult to repair in this narrow space once injured, even if the surgery is converted to a thoracotomy. This article presents a successful left subclavian artery repair procedure at the thoracic outlet using a thoracoscopic approach, with a video demonstration, and describes its technical characteristics. The patient was planned for a left upper lobectomy through three-port thoracoscopic approach. Severe adhesions were found intraoperatively and an accidental left subclavian arterial injury occurred when dissecting the adhesions. We first clamped the proximal portion of the subclavian artery and then directly clamped the rupture site. Our first suture failed due to the limited suture angle and the mutual restriction between the needle holder and atraumatic vascular clamp. To freely control the needle holder, another assistant port was made in the seventh intercostal space (ICS). The arterial injury was finally successfully repaired using pledgetted suture. The operation time was 235 minutes and intraoperative blood loss was 800 mL. The pulsation of the left radial artery was normal postoperatively, and the patient was discharged on postoperative day 6. Appropriate strategies allow attempts to manage intraoperative hyperbaric arterial bleeding from the systemic circulation, such as bleeding caused by subclavian arterial injuries, by means of a thoracoscopic approach without conversion to thoracotomy

Chyle leakage in port incision after video-assisted thoracoscopic surgery: case report

A 26-year-old Asian male was found to have chyle leakage from the port incision after video-assisted thoracoscopic surgery (VATS) for excision of pulmonary bullae. The diagnosis was confirmed by oral intake of Sudan black and by lymphoscintigraphy. The leakage resolved after 5 days of restricted oral intake and total parenteral nutrition. No leakage recurred after return of oral intake. Possible explanations for the port incision chyle leakage are obstruction of the thoracic duct, which induced retrograde drainage of the lymphoid fluid, or an aberrant collateral branch of the thoracic duct in the chest wall

Mechanism of Balanced Strength and Ductility in High-Strength Low-Alloy Steel

A high-strength low-alloy steel with balanced strength and ductility was reported. A product of the strength and elongation (PSE) at a break of ~19 GPa% was obtained. The microstructure of the material was investigated by scanning electron microscopy, electron backscattered diffraction, and transmission electron microscopy methods. Phase transformation follows the K–S orientation relationships. Interconnecting structures generate due to the variant interactions within one prior austenite grain. The multi-phase microstructure containing both soft and hard phases contributes to good plasticity. The homogeneously distributed NbC nanoparticles make up the loss of strength ascribed to the soft retained austenite and keep the strength at an extremely high level

Mechanism of Balanced Strength and Ductility in High-Strength Low-Alloy Steel

A high-strength low-alloy steel with balanced strength and ductility was reported. A product of the strength and elongation (PSE) at a break of ~19 GPa% was obtained. The microstructure of the material was investigated by scanning electron microscopy, electron backscattered diffraction, and transmission electron microscopy methods. Phase transformation follows the K–S orientation relationships. Interconnecting structures generate due to the variant interactions within one prior austenite grain. The multi-phase microstructure containing both soft and hard phases contributes to good plasticity. The homogeneously distributed NbC nanoparticles make up the loss of strength ascribed to the soft retained austenite and keep the strength at an extremely high level

Job burnout is associated with slow improvement of quality of life in the employees after a first episode of acute coronary syndrome: A hospital-based longitudinal study in China

Objective This study investigated the association between job burnout and quality of life (QoL) after acute coronary syndrome (ACS) in a Chinese sample. Methods This was a one-year longitudinal study. Participants included patients with a first episode of ACS who were still employed. The Copenhagen Burnout Inventory (CBI) assessed job burnout before discharge, and QoL was assessed using the Medical Outcome Study 8-Items Short Form Health Survey (SF-8) and the Seattle Angina Questionnaire (SAQ) before discharge (baseline), at one month, six months and 12 months after discharge. Generalized estimating equations determined the association between job burnout and longitudinal changes of QoL. Results All participants were assigned to either a “low job burnout” group (n = 70) or a “high job burnout” group (n = 50), based on the upper quartile of job burnout scores. Longitudinally over 1-year follow-up period, the scores of the SF-8 and SAQ among patients with a high level of burnout were lower than those in the low job burnout group. Job burnout was significantly associated with lower physical and mental health (SF-8), as well as greater physical limitation and lower treatment satisfaction (SAQ) over time. Conclusion Job burnout at baseline predicted slow improvement of QoL after ACS in a Chinese working sample

The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial

Background: While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective: This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design: A prospective randomized double-blinded trial. Setting: The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants: Patients aged 18 – 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions: Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures: Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results: Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 – 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. Conclusion: Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registration: chictr.org.cn, ChiCTR2200059424