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Alonso A, de la Gala F, Vara E, Hortal J, Piñeiro P, Reyes A, Simón C, Garutti I. Lung and blood perioperative metalloproteinases in patients undergoing oncologic lung surgery: Prognostic implications. Thorac Cancer 2024; 15:307-315. [PMID: 38155459 PMCID: PMC10834222 DOI: 10.1111/1759-7714.15190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Metalloproteinases (MMPs) have been reported to be related to oncologic outcomes. The main goal of the study was to study the relationship between these proteins and the long-term prognosis of patients undergoing oncologic lung resection surgery. METHODS This was a substudy of the phase IV randomized control trial (NCT02168751). We analyzed MMP-2, -3, -7, and -9 in blood samples and bronchoalveolar lavage (LBA) and the relationship between MMPs and long postoperative outcomes (survival and disease-free time of oncologic recurrence). RESULTS Survival was longer in patients who had lower MMP-2 levels than those with higher MMP-2 in blood samples taken 6 h after surgery (6.8 vs. 5.22 years; p = 0.012) and MMP-3 (6.82 vs. 5.35 years; p = 0.03). In contrast, survival was longer when MMP-3 levels were higher in LBA from oncologic lung patients than those with lower MMP-3 (7.96 vs. 6.02 years; p = 0.005). Recurrence-free time was longer in patients who had lower MMP-3 levels in blood samples versus higher (5.97 vs. 4.23 years; p = 0.034) as well as lower MMP-7 (5.96 vs. 4.5 years; p = 0.041) or lower MMP-9 in LBA samples (6.21 vs. 4.18 years; p = 0.012). CONCLUSION MMPs were monitored during the perioperative period of oncologic lung resection surgery. These biomarkers were associated with mortality and recurrence-free time. The role of the different MMPs analyzed during the study do not have the same prognostic implications after this kind of surgery.
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Affiliation(s)
- Angel Alonso
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Francisco de la Gala
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Elena Vara
- Department of Biochemistry and Molecular Biology III, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Hortal
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Pharmacology, Faculty of Medicine complutense University of Madrid, Madrid, Spain
| | - Patricia Piñeiro
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Almudena Reyes
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
| | - Carlos Simón
- Department of Thoracic Surgery, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology, Gregorio Marañon University General Hospital, Madrid, Spain
- Department of Pharmacology, Faculty of Medicine complutense University of Madrid, Madrid, Spain
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Choong SM, Lee PY, Rashid AA. Prevalence of undiagnosed depression among patients with hypertension: A cross-sectional study of Malaysian primary care perspective. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:10. [PMID: 36992959 PMCID: PMC10042249 DOI: 10.51866/oa.2l4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. Method This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Results The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147-4.907), divorce (AOR: 3.5; CI: 1.243-9.860), singleness (AOR: 2.241; CI: 1.182-4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494-21.624), low physical activity level (AOR: 1.921; CI: 1.0932.274), low fibre intake (AOR: 1.836; CI: 1.061-3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134-2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053-5.185). Conclusion Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.
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Affiliation(s)
- Siaw Mei Choong
- MD (UPM), MMed Family Medicine (UPM) Klinik Kesihatan Pasir Panjang, Taman Pasir Panjang,Port Dickson, Negeri Sembilan, Malaysia.
| | - Ping Yein Lee
- MBBS (UM), DrFamMed (UM) E-Health Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- MBBCh BAO (NUI) (IRL), DrFamMed (UKM) Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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Chen T, Zhao W, Ji C, Luo J, Wang Y, Liu Y, Weder W, Fang W. Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching. Front Oncol 2023; 13:1099514. [PMID: 36816921 PMCID: PMC9929062 DOI: 10.3389/fonc.2023.1099514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background The safety, feasibility, and prognosis of sleeve lobectomy by minimally invasive surgery (MIS) remain to be validated. The purpose of this study was to investigate outcomes in real-world patients receiving minimally invasive sleeve lobectomy in a balanced large cohort. Methods Between January 2013 and December 2018, 578 consecutive patients undergoing sleeve resection at a high-volume center were retrospectively analyzed. Surgical and oncologic outcomes were compared between MIS and thoracotomy patients after propensity-score matching (PSM). Results MIS sleeve lobectomy was increasingly used as a time-trend in real-world. Before PSM, the MIS group had smaller tumor size, more T2-stage cases, and more right upper lobe sleeve lobectomies compared to the Open group. After 1:4 PSM by patient demographics and tumoral characteristics, 100 cases of MIS and 338 cases of Open sleeve lobectomy were further analyzed. Although median operation time was longer in the MIS group than in the Open group (170.5 minutes vs.149.5 minutes, P < 0.001), patients in MIS group had significantly less estimated intraoperative blood loss (100 ml vs. 200 ml, P = 0.003), shorter drainage duration (5 days vs. 6 days, P = 0.027) and less amount of drainage (1280 ml vs. 1640 ml, P < 0.001) after surgery. Complete resection rate, combined angioplasty, number of dissected lymph nodes, post-operative length of stay, postoperative morbidity and mortality rate, and application of adjuvant therapy were similar between the two matched groups. Conversion to open thoracotomy was necessary in 13.6% patients, but with similar perioperative outcomes compared to Open cases except for longer operation time. More lower lobe sleeve lobectomies were accomplished via robot-assisted thoracoscopic surgery than via video-assisted thoracoscopic surgery (40.0% vs. 12.0%, P = 0.017) in MIS patients. Five-year overall survivals (MIS vs. Open: 72.7% vs. 64.4%, P = 0.156) and five-year progression-free survivals (MIS vs. Open: 49.2% vs. 50.5%, P = 0.605) were similar between the two matched groups. Conclusions MIS sleeve lobectomy is associated with similar or even better perioperative results and oncologic outcomes to open thoracotomy. Conversion to thoracotomy does not compromise perioperative outcomes. Robot surgery may be preferable for more complex sleeve resections.
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Affiliation(s)
- Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Liu
- Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Wentao Fang,
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Chan KW. General and feasible tests with multiply-imputed datasets. Ann Stat 2022. [DOI: 10.1214/21-aos2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kin Wai Chan
- Department of Statistics, The Chinese University of Hong Kong
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Hsu PK, Lee YY, Chuang LC, Ting CK, Tsou MY. Nonintubated versus intubated “one-stage” preoperative localization and thoracoscopic lung resection. JTCVS Tech 2021; 10:517-525. [PMID: 34977800 PMCID: PMC8691827 DOI: 10.1016/j.xjtc.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Objective Nonintubated anesthesia, electromagnetic navigation (EMN)-guided preoperative localization, and uniportal video-assisted thoracic surgery (VATS) are recent innovations in minimally invasive thoracic surgery. This study aimed to explore the feasibility of applying nonintubated anesthesia in a “one-stage” localization and resection workflow. Methods Patients who underwent EMN-guided preoperative percutaneous localization with indocyanine green (ICG) and uniportal VATS were included. Perioperative data were compared between patients receiving nonintubated anesthesia and those receiving general anesthesia with endotracheal intubation. Results Forty-six patients with a total of 50 nodules were included in the study. Overall, finger palpation could be avoided in 94% of the nodules, whereas fluorescent green signals with a clear border on the pleural surface were noted in 91.3% (21 of 23) of nodules in the nonintubated group and 88.9% (24 of 27) of nodules in the intubated group. Intraoperatively, the nonintubated group had a lower median pH (7.33 [interquartile range (IQR), 7.28-7.40] vs 7.41 [IQR, 7.38-7.44]; P = .003), higher median arterial CO2 (45.5 [IQR, 41.1-58.7] mm Hg vs 38.4 [IQR, 35.3-40.6] mm Hg; P < .001), and lower arterial oxygen (322 [IQR, 211-433] mm Hg vs 426 [IQR, 355-471] mm Hg; P = .005) levels compared with the intubated group. The nonintubated group also had a shorter median registration time (2.0 [IQR, 1.0-3.0] minutes vs 3.0 [IQR, 2.0-8.0] minutes; P = .008) and total time in the operating room (150 [IQR, 130-175] minutes vs 170 [IQR, 135-203] minutes; P = .035), whereas no between-group differences were seen in localization and operative time. The duration of chest drainage, postoperative complications, pathologic diagnosis, and margins were similar in the 2 groups. Conclusions Nonintubated “one-stage” EMN-guided percutaneous ICG localization and uniportal VATS can be an option for selected patients undergoing treatment for small peripheral nodules.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Address for reprints: Po-Kuei Hsu, MD, PhD, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan.
| | - Yi-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chi Chuang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Kun Ting
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
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