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Laverty RB, Ivins-O'Keefe KM, Adams AM, Flatley MJ, Sobieszczyk MJ, Mason PE, Sams VG. Tube Thoracostomy Complications in Patients With ARDS Requiring ECMO: Worse in COVID-19 Patients? Mil Med 2024; 189:e1016-e1022. [PMID: 38079460 DOI: 10.1093/milmed/usad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO. MATERIALS AND METHODS This study is a single institution, retrospective cohort study of patients with COVID-19 ARDS requiring V-V ECMO. The control cohort consisted of patients who required V-V ECMO for ARDS-related diagnoses from January 2018 to January 2021. The primary outcome was any complication following initial tube thoracostomy placement. Study approval was obtained from the Brooke Army Medical Center Institutional Review Board (C.2017.152d). RESULTS Twenty-five COVID-19 patients and 38 controls were included. Demographic parameters did not differ between the groups. The incidence of pneumothorax was not significantly different between the two groups (44% COVID-19 vs. 22% control, OR 2.8, 95% CI 0.95-7.9, P = 0.09). Patients with COVID-19 were as likely to receive tube thoracostomy as controls (36% vs. 24%, OR 1.8, 95% CI 0.55-5.7). Complications, however, were more likely to occur in the COVID-19 group (89% vs. 33%, OR 16, 95% CI, 1.6-201, P = 0.0498). CONCLUSIONS Tube thoracostomy placement in COVID-19 patients with ARDS requiring V-V ECMO is common, as are complications following initial placement. Clinicians should anticipate the need for re-intervention in this patient population. Small-bore (14Fr and smaller) pigtail catheters appeared to be safe and efficacious in this setting, but further study on tube thoracostomy management in ECMO patients is needed.
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Affiliation(s)
- Robert B Laverty
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Kelly M Ivins-O'Keefe
- Department of Anesthesiology, US Army Institute of Surgical Research Burn Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Meaghan J Flatley
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michal J Sobieszczyk
- Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Phillip E Mason
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Valerie G Sams
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
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Wang Y, Wang H, Zhang L, Zhang J, Liu N, Zhao P. A novel identified circular RNA, circSnap47, promotes heart failure progression via regulation of miR-223-3p/MAPK axis. Mol Cell Biochem 2023; 478:459-469. [PMID: 35900666 DOI: 10.1007/s11010-022-04523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the effect of circSnap47 on heart failure (HF) and its potential mechanisms. Quantitative real-time PCR (qRT-PCR) was performed to detect the mRNA expression levels of circSnap47 and miR-233-3p. The viability and apoptosis of H9C2 cells were assessed using CCK-8 and TUNEL assays. The expressions of interleukin (IL)-6, IL-1β, IL-18, and tumor necrosis factor-alpha were determined using ELISA and qRT-PCR. In addition, the expression of apoptosis-related proteins and mitogen-activated protein kinase (MAPK) signaling pathway-related proteins was analyzed using western blot. Moreover, HF-related circRNAs and miRNAs were predicted via bioinformatics analysis. The relationship between circSnap47 and miR-233-3p was further confirmed using a dual-luciferase reporter gene assay. In HF tissues and H9C2 cells treated with oxygen-glucose deprivation (OGD), circSnap47 was upregulated. Silencing circSnap47 increased cell viability and inhibited apoptosis. Besides, silencing circSnap47 alleviated OGD-induced inflammation in H9C2 cells. Moreover, we found that miR-233-3p was the downstream target gene of circSnap47. Our results also revealed that silencing circSnap47 relieved OGD-induced H9C2 cell damage by inactivating the miR-223-3p/MAPK axis. We confirmed that circSnap47 silencing inhibited HF progression via regulation of miR-223/MAPK axis, which will provide for a new therapeutic direction for the treatment of HF.
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Affiliation(s)
- Yunkai Wang
- Department of Cardiac Surgery ICU, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, People's Republic of China
| | - Hongqiang Wang
- Department of Cardiac Surgery II, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, People's Republic of China
| | - Luping Zhang
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, People's Republic of China
| | - Jinhua Zhang
- Department of Physical Examination, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, People's Republic of China
| | - Ning Liu
- Department I of Obstetrics, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, People's Republic of China
| | - Peng Zhao
- Department of Cardiac Surgery I, Yantai Yuhuangding Hospital, No.20 Yuhuangding East Road, Zhifu District, Yantai, 264000, Shandong, People's Republic of China.
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Raveglia F, Scarci M, Rimessi A, Orlandi R, Rebora P, Cioffi U, Guttadauro A, Ruffini E, Benvenuti M, Cardillo G, Patrini D, Vannucci F, Yusuf N, Jindal P, Cerfolio R. The Role of Surgery in Patients with COVID-19-Related Thoracic Complications. Front Surg 2022; 9:867252. [PMID: 35686209 PMCID: PMC9170983 DOI: 10.3389/fsurg.2022.867252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Patients with several thoracic complications induced by SARS-CoV-2 infection may benefit from surgery, but its role in this condition is largely unknown, and many surgeons’ advice against any surgical referrals. Our aim is to investigate the efficacy and safety of surgery in COVID-19 patients with thoracic complications requiring surgery. Methods We designed a multicenter observational study, involving nine thoracic surgery departments, evaluating patients who developed thoracic complications in hospital, surgically managed from March 1, 2020, to May 31, 2021. An overall 30-day mortality was obtained by using the Kaplan–Meier method. Multivariable Cox regression model and logistic models were applied to identify the variables associated with mortality and postoperative complications. Results Among 83 patients, 33 (40%) underwent surgery for complicated pneumothorax, 17 (20.5%) for pleural empyema, 13 (15.5%) for hemothorax, 8 (9.5%) for hemoptysis, 5 patients (6%) for lung abscess, 4 (5%) for infected pneumatoceles, and 3 (3.5%) for other causes. Within 30 days of surgery, 60 patients (72%) survived. At multivariable analysis, age (HR 1.05 [95% CI, 1.01, 1.09], p = 0.022), pulmonary hypertension (HR 3.98 [95% CI, 1.09, 14.5], p = 0.036), renal failure (HR 2.91 [95% CI, 1.19, 7.10], p-value 0.019), thoracotomy (HR 4.90 [95% CI, 1.84, 13.1], p-value 0.001) and infective affections (HR 0.17 [95% CI, 0.05, 0.58], p-value 0.004) were found to be independent prognostic risk factors for 30-day mortality. Age (OR 1.05 [95% CI, 1.01, 1.10], p = 0.023) and thoracotomy (OR 3.85 [95% CI, 1.35, 12.0] p = 0.014) became significant predictors for 30-day morbidity. Conclusion Surgical management of COVID-19-related thoracic complications is affected by high mortality and morbidity rates, but a 72% survival rate still seems to be satisfactory with a rescue intent. Younger patients without pulmonary hypertension, without renal insufficiency and undergoing surgery for infectious complications appear to have a better prognosis.
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Affiliation(s)
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre – B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | | | - Enrico Ruffini
- Thoracic Surgery, San Giovanni Battista Molinette Hospital, Turin, Italy
| | | | | | - Davide Patrini
- Thoracic Surgery, University College London Hospitals, London, United Kingdom
| | - Fernando Vannucci
- Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brasil
| | - Nasser Yusuf
- Thoracic Surgery, Chest Hospital, Calicut, India/Sunrise Hospital, Kochi, India
| | - Pramoj Jindal
- Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Robert Cerfolio
- Thoracic Surgery, NYU Langone Health, New York, NY, United States
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Kalenchic TI, Kabak SL, Primak SV, Melnichenko YM, Kudelich OA. Bilateral parapneumonic pleural effusion with pneumothorax in a patient with covid 19 pneumonia: case report. Radiol Case Rep 2022; 17:869-874. [PMID: 35035651 PMCID: PMC8743860 DOI: 10.1016/j.radcr.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
Recurrent pyogenic effusion combined with bilateral pneumothorax is a rare complication associated with the COVID−19 infection. Current article presents the case report of a 68-year-old male with the severe community-acquired bilateral polysegmental viral COVID−19 pneumonia. Chest radiography on the 15th day after admission to the hospital showed the presence of air and pleural effusion in the right pleural cavity with collapse of the right lung. Thoracentesis and thoracostomy in the sixth intercostal space on the mid-axillary line were performed. About 1400 ml of a yellowish opaque liquid were evacuated from the pleural cavity. Pleural fluid analysis confirmed an exudative lymphocytic-rich effusion with no growth of acid-fast bacteria (AFB). In the pleural fluid such gram-negative bacteria as Acinetobacter baumannii and Pseudomonas aeruginosa were cultured. Chest computed tomography obtained on the third day after thoracentesis showed radiological sings of bilateral hydropneumothorax. Needle thoracocentesis and new pleural drainage in the second intercostal space on the right midclavicular line were established. Five days later after the second drainage of the pleural space was initiated the patient was diagnosed with pleural empyema and transferred to the Surgical Clinic. This case report highlights that in patients with COVID-19 recurrent pyogenic effusion combined with bilateral pneumothorax may occur.
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Affiliation(s)
- Tamara I Kalenchic
- Department of Medical Rehabilitation and Physiotherapy, Belarusian State Medical University, Dzerzhinsky Ave., 83, Minsk, Belarus. 220116
| | - Sergey L Kabak
- Head of the Human Morphology Department, Belarusian State Medical University, Dzerzhinsky Ave., 83, Minsk, Belarus. 220116
| | - Sergey V Primak
- Pulmonologist of the Pulmonary department no.1 of the 6th City Clinical Hospital, Uralskaya Str. 5, Minsk, Belarus. 220037
| | - Yuliya M Melnichenko
- Human Morphology Department, Belarusian State Medical University, Dzerzhinsky Ave., 83, Minsk, Belarus. 220116
| | - O A Kudelich
- Department of Surgical Diseases, Belarusian State Medical University, Dzerzhinsky Ave., 83, Minsk, Belarus. 220116
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Reshetnikov MN, Plotkin DV, Zuban ON, Bogorodskaya EM. Emergency surgical care for patients with COVID-19 and tuberculosis coinfection at multispecialty hospital. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The double burden of the novel coronavirus infection and tuberculosis (TB) is a global challenge. The aspects of emergency surgical care for patients with COVID-19 and TB coinfection remain understudied. The aim of this study was to assess treatment outcomes in acute surgical patients with COVID-19 and preexisting TB coinfection. In 2020, our Center delivered surgical care to 465 patients with COVID-19 and preexisting TB; a total of 64 emergency surgeries were performed on 36 (5.6%) patients, of whom 16 had HIV. Thirteen patients (36.1%) were diagnosed with pulmonary TB; 23 patients (63.9%) had disseminated TB. Chest CT scans showed >25% lung involvement in 61.9% of the patients with COVID-19 pneumonia, 25–50% lung involvement in 30.6% of the patients, and 50–75% lung involvement in 5.6% of the patients. By performing abdominal CT, we were able to detect abdominal TB complications, including perforated tuberculous ulcers of the intestine, intestinal obstruction and tuberculous peritonitis, as well as tuberculous spondylitis complicated by psoas abscess. Of all surgical interventions, 28.2% were abdominal, 23.2% were thoracic, 15.6% were surgeries for soft tissue infection, and 32.8% were other types of surgery. Postoperative mortality was 22.2%. We conclude that COVID-19 did not contribute significantly to postoperative mortality among acute surgical patients with TB.
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Affiliation(s)
- MN Reshetnikov
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - DV Plotkin
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - ON Zuban
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
| | - EM Bogorodskaya
- Moscow Research and Clinical Center for TB Control, Moscow, Russia
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