Human dystrophin expressing chimeric (DEC) cell therapy ameliorates cardiac, respiratory, and skeletal muscle's function in Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a progressive and lethal disease, caused by X‐linked mutations of the dystrophin encoding gene. The lack of dystrophin leads to muscle weakness, degeneration, fibrosis, and progressive loss of skeletal, cardiac, and respiratory muscle function resulting in premature death due to the cardiac and respiratory failure. There is no cure for DMD and current therapies neither cure nor arrest disease progression. Thus, there is an urgent need to develop new approaches and safer therapies for DMD patients. We have previously reported functional improvements which correlated with increased dystrophin expression following transplantation of dystrophin expressing chimeric (DEC) cells of myoblast origin to the mdx mouse models of DMD. In this study, we demonstrated that systemic‐intraosseous transplantation of DEC human cells derived from myoblasts of normal and DMD‐affected donors, increased dystrophin expression in cardiac, respiratory, and skeletal muscles of the mdx/scid mouse model of DMD. DEC transplant correlated with preservation of ejection fraction and fractional shortening on echocardiography, improved respiratory function on plethysmography, and improved strength and function of the limb skeletal muscles. Enhanced function was associated with improved muscle histopathology, revealing reduced mdx pathology, fibrosis, decreased inflammation, and preserved muscle morphology and architecture. Our findings confirm that DECs generate a systemic protective effect in DMD‐affected target organs. Therefore, DECs represents a novel therapeutic approach with the potential to preserve or enhance multiorgan function of the skeletal, cardiac, and respiratory muscles critical for the well‐being of DMD patients.

Autologous Blood Patch Pleurodesis: A Large Retrospective Multicenter Cohort Study

BACKGROUND

Prolonged air leaks (PAL) complicate 10% to 15% of lung resections, delaying chest tube removal and prolonging length of hospital stay. No consensus exists for managing this common complication, despite favorable results for autologous blood patch pleurodesis (ABPP) in the literature. The aim of this study was to evaluate the effectiveness and safety of ABPP.

METHODS

We retrospectively reviewed medical records of 510 patients with PAL after lobectomy in four centers between January 2010 and December 2019. They were divided into two groups: group A consisted of patients who received ABPP for PAL of more than 5 days; and group B was patients for whom no ABPP or other procedure was performed for PAL unless strictly necessary. Propensity score matched analysis was performed, and 109 patients were included in each group. Time to cessation of air leak and chest tube removal, length of hospital stay, reoperation, and complications rate were examined.

RESULTS

After the propensity score matching, ABPP significantly reduced the number of days before chest tube removal (8.12 vs 9.30, P = .004), and length of hospital stay (10 vs 11 days, P = .045) with fewer perioperative complications (6 vs 17, P = .015). Furthermore, ABPP was related to lower incidence of any additional invasive procedures (0 vs 9, P = .002) and reoperation (0 vs 4, P = .044). No patient in the ABPP group had long-term complications related to pleurodesis.

CONCLUSIONS

Autologous blood patch pleurodesis is safe and effective in reducing length of hospital stay and leads to earlier chest tube removal without increasing complications.

Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data

The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.

Impact of Pulmonary Ligament Resection in Upper Lobectomies: A Multicenter Matched Cohort Study

Background: Division of the pulmonary ligament is standard in lower lobectomies, but its application in upper lobectomies remains controversial due to potential complications like atelectasis and bronchial kinking. This retrospective matched cohort study aimed to evaluate the efficacy and safety of ligament resection in upper lobectomies for oncological purposes. Methods: From January 2015 to December 2020, 988 patients who underwent minimally invasive upper lobectomies across multiple centers were identified. They were categorized into ligament resection and no ligament resection groups, with propensity score matching (PSM) to minimize confounding factors. Endpoints included operative time, pleural effusion, complications (frequency and Clavien-Dindo scores), chest drainage removal, length of stay, pleural space, collapse rate, and bronchial kinking. Results: Following PSM, 276 patients were included in each group, with no significant differences in baseline characteristics. Ligament resection correlated with longer operative times, increased lymphadenectomy sampling at station #9 (p < 0.001), and a bigger change in the bronchial angle (p < 0.001). No statistically significant differences were observed for the other endpoints. Conclusions: Ligament resection during upper lobectomy may impact the bronchial angle without immediate postoperative outcome changes. Further research is necessary to comprehensively assess the risks and benefits of ligament resection in upper lobectomies for neoplastic disease.

Does needle-type increase the diagnostic yield of malignancies in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)?—a prospective comparative study

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed minimally invasive technique for diagnosing mediastinal pathologies. Currently, many needle types are being developed to improve the accuracy of the final diagnosis. Our study aimed to assess the possible advantages and disadvantages between the 22-gauge ProCore^® needle and the standard 22-gauge needles.

Methods

In this prospective study, we enrolled a group of 363 EBUS-TBNA patients. For each patient, we used either the ProCore^® needle or the standard one. We used the ProCore^® needle in 51 patients and the standard needle in 312 patients. When a diagnosis could not be made, it was subsequently established with a surgical biopsy. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the biopsy for both needle types.

Results

By using EBUS-TBNA, a diagnosis was established in 306 patients (84.3%). The rates of the final diagnoses in ProCore^® and standard needle groups were 92.2% and 83.0% (P=0.14), respectively. The sensitivity, specificity, PPV, and NPV for ProCore^®vs. standard needles did not differ and were 89.2% vs. 79.3%, 100.0% vs. 95.7%, 100.0% vs. 98.5%, and 77.8% vs. 57.3%, respectively. A total of 57 patients required mediastinoscopy or surgical biopsy to obtain a final pathology. However, this number was not significantly different between the needles [ProCore^® (7.8%) vs. standard (17%), P=0.26].

Conclusions

Both types of needles demonstrated very high diagnostic efficiency for malignancy, and there was no significant advantage of the ProCore^® over the standard needle.

Epidemiology and clinical impact of EGFR mutation in patients with lung cancer after radical surgical treatment

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Background: The epidemiology of epidermal growth factor receptor (EGFR) mutation in lung adenocarcinoma and its clinical impact are well-known. However, most studies have focused on advanced-stage inoperable cancer. Data on the frequency of EGFR mutation in surgically resected lung cancer are limited. Recent studies have shown a promising effect of Osimertinib in adjuvant settings. Hence, the need to estimate the target population in the real-world data. This study aimed to assess the occurrence of EGFR mutation in patients after radical surgical treatment of lung adenocarcinoma and explore its prognostic impact compared to EGFR negative group. Methods: This single-center retrospective analysis included the group of 732 consecutive Caucasian patients with histopathologically confirmed lung adenocarcinoma, evaluated for EGFR mutations expression, who underwent anatomical resection between January 2016, and December 2020. EGFR status was assessed by cobas EGFR mutation test v2. The frequency of EGFR mutations, disease-free survival (DFS) and overall survival (OS) in EGFR positive and EGFR negative groups were analyzed. Results: EGFR mutations were found in 65 surgical patients (8.9%) and did not differ from patients with advanced stages of lung adenocarcinoma (7.9%). EGFR mutations occurred more frequently in females than males, 48 out of 344 (14%) and 17 out of 388 (4.4%), respectively. Deletions within exon 19 and the L858R mutation in exon 21 constituted 49.2% and 24.6% of all mutations, respectively, while others comprised 26.2%. One case of L858R mutation coincided with T790M in exon 20 mutation. Detailed results divided by stages are presented in the Table. The occurrence of EGFR mutation had no significant influence on DFS and OS in patients after radical resection. Conclusions: The frequency of EGFR mutation in postoperative lung cancer was comparable to the occurrence in the general lung cancer population. EGFR mutation did not affect DFS and OS in patients after radical resection. [Table: see text]

A five year follow-up of 605 cases of the MCCL (metal-cancellous cementless Lübeck) total hip prosthesis

The porous surface of the MCCL prosthesis macroscopically resembles spongy bone, with a porous depth of up to 10 mm, the width of the pores measuring 1-2 mm, with reticular spaces forming an intercommunicating system. The superficial porous surface and the implant stem are combined in a single structure. The standard prosthesis is made up of four components; an acetabulum in cobalt-chrome-molybdenum alloy, an interposed layer of polyethylene, a ceramic head and a stem in cobalt-chrome-molybdenum alloy, the shape of which is anatomically matched to the proximal femur. What emerges from the present study is the possibility of using right and left stems, each available in six sizes. The ceramic head may be attached to the neck of the femoral stem, which may be long, average, or short. An "extra-long" metal head is also available.

The relation of body adiposity to the outcomes of thoracoscopic lobectomy for lung cancer - a single-center cohort study

Introduction

The outcomes of lung cancer surgery depend on the patients' nutritional status. Body fat percentage (BF%) is one of the indicators of body composition and nutritional status. Direct measurement of BF% is complicated, requires significant resources and is rarely performed. The CUN-BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) index has been shown to accurately predict BF% is several clinical settings, but its relation to the outcomes of lung surgery has not been reported so far.

Aim

To determine the relation of the BF% to the outcomes of thoracoscopic lobectomy.

Material and methods

This retrospective study included 1,183 patients who underwent thoracoscopic lobectomy for non-small cell lung cancer between June 1999, and September 2019 at one department. BF% was calculated according to the Clínica Universidad de Navarra - Body Adiposity Estimator equation. The primary endpoints were postoperative complications and long-term survival.

Results

Univariate analysis showed that higher BF% was related to lower incidence of complications (p = 0.001), including prolonged air leak (p < 0.001), atelectasis (p < 0.05), psychosis (p < 0.001), reoperations (p < 0.05), and shorter chest drainage (p = 0.001) and hospitalization duration (p < 0.001). Multivariate analysis showed that higher BF% was correlated with lower risk of complications (p = 0.005; OR = 0.964; 95% CI: 0.940 to 0.989), including prolonged air leak (p < 0.001; OR = 0.923; 95% CI: 0.886 to 0.962), and shorter duration of chest drainage (p < 0.001; B = -0.046; 95% CI: -0.069 to -0.023) and hospitalization (p < 0.001; B = -0.112; 95% CI: -0.176 to -0.048). Cox proportional hazards regression analysis showed that BF% was not related to long-term survival.

Conclusions

Body fat percentage is a valuable tool that can help predict the short-term outcomes of minimally lobectomy for lung cancer.

A Multicenter Retrospective Case-Control Study on Simple vs Extended Sleeve Lobectomies

BACKGROUND

Sleeve resection is currently the gold standard procedure for centrally located non-small cell lung cancer (NSCLC). Extended sleeve lobectomy (ESL) consists of an atypical bronchoplasty with resection of >1 lobe and carries several technical difficulties compared with simple sleeve lobectomy (SSL). Our study compared the outcomes of ESL and SSL for NSCLC.

METHODS

This multicenter, retrospective, cohort study included 1314 patients who underwent ESL (155 patients) or SSL (1159 patients) between 2000 and 2018. The primary end points were 30-day and 90-day mortality, overall survival (OS), disease-free survival (DFS), and complications.

RESULTS

No differences were found between the 2 groups in general characteristics and surgical and survival outcomes. In particular, there were no differences in early and late complication frequency, 30- and 90-day mortality, R status, recurrence, OS (54.26 ± 33.72 months vs 56.42 ± 32.85 months, P = .444), and DFS (46.05 ± 36.14 months vs 47.20 ± 35.78 months, P = .710). Mean tumor size was larger in the ESL group (4.72 ± 2.30 cm vs 3.81 ± 1.78 cm, P < .001). Stage IIIA was the most prevalent stage in ESL group (34.8%), whereas stage IIB was the most prevalent in SSL group (34.3%; P < .001). The multivariate analyses found nodal status was the only independent predictive factor for OS.

CONCLUSIONS

ESL gives comparable short- and long-term outcomes to SSL. Appropriate preoperative staging and exclusion of metastases to mediastinal lymph nodes, as well as complete (R0) resection, are essential for good long-term outcomes.

A large single-center propensity score-matched cohort study on outcomes and complications based on the number of corrective bars used in the Nuss procedure

The Nuss procedure is the most common corrective surgery for pectus excavatum. We analyzed treatment outcomes and complication rates in 1238 patients treated with the Nuss procedure from 2002 to 2021, focusing on the number of corrective bars used. Using Propensity Score Matching based on age, sex, BMI, pre-operative FEV1, and the Haller index, we created two groups: 546 patients with a single bar and 546 with two bars. Both groups achieved similar correction effects (Haller index: single bar = 2.58 vs. two bars = 2.56; p = 0.65). In the univariate analysis, in the two-bar group, the postoperative complications were observed more often (28.6% vs. 15.4%, p < 0.001), including pneumothorax (11.2% vs. 6.2%, p < 0.001), hemothorax (3.7% vs. 0.7%, p < 0.001), additional drainage (13.7% vs. 5.3%, p < 0.001), the need for thoracentesis (8.6% vs. 2.9%, p < 0.001), bar displacement (3.8% vs. 0.7%, p < 0.001), pleural effusion (10.6% vs. 3.1%, p < 0.001), and fever (6.6% vs. 3.8%, p < 0.041). In the logistic regression, two bars significantly increased the risk of postoperative complications (p = 0.019), including hematoma (p = 0.036), pleural effusion (p = 0.002), and the need for thoracentesis (p = 0.013). Using two corrective bars during the Nuss procedure is associated with a higher rate of postoperative complications but similar corrective results.