Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study

BACKGROUND: At present only few studies directly compare the diagnostic yield of endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) and transcervical video-assisted mediastinoscopy (TM) for mediastinal lymph node staging in patients with NSCLC. If and when EBUS-FNA may replace TM as Gold Standard remains controversial. METHODS: From April 2008 to December 2009, 36 patients with mediastinal lymphadenopathy underwent simultaneous EBUS-FNA/ TM at our institution. Among them were 26 patients with confirmed or suspected NSCLC. RESULTS: A total of 133 samples were obtained by EBUS-FNA and 157 samples by TM. EBUS-FNA achieved significantly less conclusive, but more indeterminate pathological results in comparison to TM (78.7% vs. 98.6%, p < 0.001; 14.9% vs. 1.4%, p = 0.007). Less paratracheal nodes were sampled by EBUS-FNA (right: 46.2% vs. 88.5%, p = 0.003; left: 23.1% vs. 65.4%, p = 0.005), while sampling rates in the subcarinal localisation were comparable (96.2% vs. 80.8%, p = NS). Among patients with confirmed NSCLC and conclusive EBUS-FNA/ TM findings (n = 18), the prevalence of N2/N3 disease was 66.7% (n = 12) according to TM findings. Diverging nodal stages were found in five patients (27.8%). Three patients who were N2 negative in EBUS-FNA were upstaged to N2 or N3 by TM, two patients with N2 status in EBUS-FNA were upstaged to N3 by TM. CONCLUSIONS: Compared to TM, EBUS-FNA had a lower diagnostic yield and resulted in systematic mediastinal nodal understaging. At this point we suggest corroborating negative EBUS-FNA results by transcervical mediastinoscopy

Low-Charge-Noise Nitrogen-Vacancy Centers in Diamond Created Using Laser Writing with a Solid-Immersion Lens

We report on pulsed-laser-induced generation of nitrogen-vacancy (NV) centers in diamond facilitated by a solid-immersion lens (SIL). The SIL enables laser writing at energies as low as 5.8 nJ per pulse and allows vacancies to be formed close to a diamond surface without inducing surface graphitization. We operate in the previously unexplored regime, where lattice vacancies are created following tunneling breakdown rather than multiphoton ionization. We present three samples in which NV center arrays were laser-written at distances between similar to 1 and 40 mu m from a diamond surface, all presenting narrow distributions of optical linewidths with means between 62.1 and 74.5 MHz. The linewidths include the effect of long-term spectral diffusion induced by a 532 nm repump laser for charge-state stabilization, thereby emphasizing the particularly low-charge-noise environment of the created color centers. Such high-quality NV centers are excellent candidates for practical applications employing two-photon quantum interference with separate NV centers. Finally, we propose a model for disentangling power broadening from inhomogeneous broadening in the NV center optical linewidth

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Background: Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods: We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results: Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions: U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach

Efetividade do tratamento não farmacológico na abordagem da doença do Refluxo Gastroesofágico : Effectiveness of non-pharmacological treatment in addressing Gastroesophageal Reflux disease

Objetivo: Analisar e verificar a efetividade do tratamento não farmacológico na abordagem inicial da DRGE. Método: Este trabalho será realizado no ambulatório de gastroenterologia do Hospital da Santa Casa de Misericórdia de Vitória (HSCMV), serão selecionados pacientes diagnosticados com DRGE em abordagem inicial não farmacológica para a doença. Será observado após um período de um mês, o resultado dessa intervenção, de modo que, possa ser analisado e correlacionado o grau de dedicação do paciente com o resultado obtido com a terapia não farmacológica e a necessidade de utilizar Inibidores da Bomba de Prótons (IBP) para episódios sintomáticos da DRGE. Resultado: É esperado uma melhora nos sintomas da DRGE nos pacientes em fase inicial do tratamento, realizando apenas mudanças no estilo de vida do paciente, sem que haja a necessidade da terapia farmacológica com IBP. Conclusão: Pacientes que realizam todas as mudanças no estilo de vida tendem a utilizar menos inibidor de bomba de prótons. No entanto, novos trabalhos precisam ser realizados para confirmar tais achados.Objetivo: Analisar e verificar a efetividade do tratamento não farmacológico na abordagem inicial da DRGE. Método: Este trabalho será realizado no ambulatório de gastroenterologia do Hospital da Santa Casa de Misericórdia de Vitória (HSCMV), serão selecionados pacientes diagnosticados com DRGE em abordagem inicial não farmacológica para a doença. Será observado após um período de um mês, o resultado dessa intervenção, de modo que, possa ser analisado e correlacionado o grau de dedicação do paciente com o resultado obtido com a terapia não farmacológica e a necessidade de utilizar Inibidores da Bomba de Prótons (IBP) para episódios sintomáticos da DRGE. Resultado: É esperado uma melhora nos sintomas da DRGE nos pacientes em fase inicial do tratamento, realizando apenas mudanças no estilo de vida do paciente, sem que haja a necessidade da terapia farmacológica com IBP. Conclusão: Pacientes que realizam todas as mudanças no estilo de vida tendem a utilizar menos inibidor de bomba de prótons. No entanto, novos trabalhos precisam ser realizados para confirmar tais achados

Additional file 1: of Improved application technique of albumin-glutaraldehyde glue for repair of superficial lung defects

Results of individual tests. (XLS 63 kb

Biosynthetic Nanostructured Cellulose Patch for Chest Wall Reconstruction: Five-Month Follow-up in a Porcine Model

Purpose: Ideal approaches and materials for reconstruction of large chest wall defects remain a topic of debate. We sought to explore the suitability of a reinforced nanostructured cellulose (NC) patch for chest wall reconstruction in an animal model. Materials and Methods: In four domestic pigs, a standardized 10 × 10 cm chest wall defect was created by resecting three rib segments. Subsequently the defect was reconstructed via a biosynthetic NC patch (16 × 12 cm) reinforced by polytetrafluoroethylene mesh. After 1, 2, 4, and 5 months respectively, gross examination of NC patches was performed following sacrifice of the animals. Specimens of NC patches and surrounding connective tissue underwent histological examinations after staining with Hematoxylin-eosin and Elastica van Gieson. Results: All animals survived their observation period without encountering major adverse events. On gross examination all NC patches were intact and well integrated into the surrounding tissue. Histological examination showed clearly demarked zones of foreign body reaction at the patch/host-tissue interface. After 5 months a slight increase in foreign body reaction, fibrous capsule formation and cellular infiltration were observed. No signs of fibroblast proliferation or neovascularization were seen within NC patches at any point. Conclusions: Our findings suggest a quick healing process and good overall biocompatibility following NC patch implantation.NC might prove an efficient and suitable biomaterial for complex chest wall reconstruction

Nauczanie chirurgii na Uniwersytecie Ottona von Guericke w Magdeburgu - podstawowy opis koncepcyjny

Nauczanie chirurgii jako jednej z klasycznych, rozległych dyscyplin klinicznych oraz głównych dziedzin obok medycyny chorób wewnętrznych powinno otrzymywać należytą uwagę w kontekście możliwości uzyskania wysokiego wyniku końcowego na zakończenie studiów medycznych. Chirurgia jest nie tylko przedmiotem wielu wykładów, lecz także stanowi również jedną trzecią (cztery miesiące) obowiązkowego stażu (rok praktyczny – w języku niemieckim Praktisches Jahr) na koniec studiów medycznych. Dlatego też nauczanie medyczne studentów powinno zawsze stanowić część rzetelnych i stałych prób optymalizacji programu nauczania i treści jako elementu przewodnich działań, które koncentrują się na znacznej poprawie studiów medycznych. Co więcej, klasyczny i tradycyjnie ustanowiony format nauczania, tj. wykład (ustny), wymaga dalszego rozwoju i racjonalnego uzupełnienia poprzez liczne formy nauczania interakcyjnego, zorientowanego na praktykę, metody przekazywania wiedzy i egzaminowania (obligatoryjne lub fakultatywne seminaria/kursy, szkolenia w małych grupach uczniów, nauczanie przy łóżku pacjenta, indywidualne ćwiczenia praktyczne w ramach SkillsLab, grupy młodych badaczy, projekty badawcze w toku nauczania, publikacje naukowe na wszelkie tematy i cenne doświadczenia związane z nauczaniem, w których mogą uczestniczyć studenci, metoda „Nauczaj nauczyciela”, projekty itp.). Chociaż zainicjowanych zostało wiele nowatorskich koncepcji i dokonano znacznych postępów, istnieje ciągła potrzeba dalszej poprawy. W prezentowanym ogólnym zarysie specyficznym dla indywidualnych uczelni, mającym charakter reprezentacyjny, obecna złożona koncepcja nauczania chirurgicznego, która w ostatnich latach podlegała nieustannej optymalizacji na Uniwersytecie Ottona von Guerickego w Magdeburgu ze Szpitalem Uniwersyteckim (Niemcy), opisana jest jako dokument naukowy i systematyzujący, a także jako manuskrypt związany z ciągłym przygotowywaniem instytucjonalnego „Podręcznika nauczania” na temat rozwijania wiedzy o chirurgii i szkolenia studentów medycyny. Na koniec temat powinien stanowić podstawę do publicznej dyskusji, która, miejmy nadzieję, może doprowadzić do dalszych reform strukturalnych nauczania (chirurgii) w najbliższej przyszłości

Surgical teaching at the Medical School Otto-von-Guericke University of Magdeburg – basic conceptual description

Teaching in surgery, one of the classical big clinical and main disciplines beside internal medicine, needs to be also associated with great attention in regard to a valuable final result at the end of the study of human medicine. In particular, surgery is not only the subject to a large number of lectures it also represents one third (four months) of the compulsory internship (practical year – in German, “Praktisches Jahr”) at the end of the study of medicine. Therefore, medical teaching of students should be always part of serious and steady attempts to optimize course und contents as a component of guiding activities focussing onto the substantial improvement of the study of medicine. In detail, the classical and traditionally established type of teaching, the (oral) lecture, has to be further developed and reasonably completed by numerous interactive and practice-oriented teaching, learning and examining modalities (obligatory or facultative seminars / courses, training in [very] small groups of students, bed-side teaching, individual practical exercises within the SkillsLab, groups of young researchers, research projects in teaching, scientific publications on topics and recommendable experiences ot teaching including students, ”Teach-the-teacher“ projects etc.). Although many novel concepts have been inaugurated and considerable advances have been achieved, there is a steady need for further improvement. In the presented representative but medical school-specific overview, the current complex surgical teaching concept, which has been continuously optimized over the last couple of years, at the Otto-von-Guericke University Medical School with University Hospital of Magdeburg (Germany) is described as a scientific and systematizing document as well as a manuscript associated with the ongoing preparation of an institutional “Teaching Manual” on surgical teaching and training for medical students. It should – last but not least – provide the basis for a public discussion, which vice versa might hopefully and possibly result in further structural reforms of (surgical) teaching in the near future