Should we remain hopeful? The key 8 weeks: spatiotemporal epidemic characteristics of COVID-19 in Sichuan Province and its comparative analysis with other provinces in China and global epidemic trends.

BACKGROUND: The COVID-19 spread worldwide quickly. Exploring the epidemiological characteristics could provide a basis for responding to imported cases abroad and to formulate prevention and control strategies in areas where COVID-19 is still spreading rapidly. METHODS: The number of confirmed cases, daily growth, incidence and length of time from the first reported case to the end of the local cases (i.e., non-overseas imported cases) were compared by spatial (geographical) and temporal classification and visualization of the development and changes of the epidemic situation by layers through maps. RESULTS: In the first wave, a total of 539 cases were reported in Sichuan, with an incidence rate of 0.6462/100,000. The closer to Hubei the population centres were, the more pronounced the epidemic was. The peak in Sichuan Province occurred in the second week. Eight weeks after the Wuhan lockdown, the health crisis had eased. The longest epidemic length at the city level in China (except Wuhan, Taiwan, and Hong Kong) was 53 days, with a median of 23 days. Spatial autocorrelation analysis of China showed positive spatial correlation (Moran's Index > 0, p < 0.05). Most countries outside China began to experience a rapid rise in infection rates 4 weeks after their first case. Some European countries experienced that rise earlier than the USA. The pandemic in Germany, Spain, Italy, and China took 28, 29, 34, and 18 days, respectively, to reach the peak of daily infections, after their daily increase of up to 20 cases. During this time, countries in the African region and Southeast Asian region were at an early stage of infections, those in the Eastern Mediterranean region and region of the Americas were in a rapid growth phase. CONCLUSIONS: After the closure of the outbreak city, appropriate isolation and control measures in the next 8 weeks were key to control the outbreak, which reduced the peak value and length of the outbreak. Some countries with improved epidemic situations need to develop a continuous "local strategy at entry checkpoints" to to fend off imported COVID-19.

Are we really doing better with Hem-o-lok in VATS?

BACKGROUND: Due to advances in clip design, new types of surgical ligation clips are available that may reduce clip failure and improve function, but in the field of minimally invasive thoracic surgery, experience of using Hem-o-lok for pulmonary artery ligation is limited. METHODS: To assess risk factors and predictors of failure of the Hem-o-lok vascular clip, using vessels harvested from a porcine model. RESULTS: The Hem-o-lok clip had the worst holding strength compared to other clips. Its hemostatic ability for pulmonary vessels was far less stable compared with renal and hepatic vessels. The Hem-o-lok clip either leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the vessel sleeve was mobilized too "clean." CONCLUSION: Our experiment proved that the use of Hem-o-lok clips in video-assisted thoracoscopic surgery (VATS) has some potential risk. We recommend that all possible care be taken when it is applied to pulmonary vessels during VATS. Leaving some tissues around vessels may increase the thickness of the vessel, which, in turn, may increase the holding strength.

Giant right atrial diverticulum in an adult.

We describe a 32-year-old man with chest pain and a giant right atrial diverticulum who underwent surgical resection. Examination of resected atrial tissue showed extreme wall thinning, central aneurysmal formation, and focal endocardial fibrosis consistent with idiopathic dilatation of the right atrium. It is unclear what the best treatment of right atrial diverticulum are, nor are the risks of thromboembolism, arrhythmia, and rupture of the diverticulum clearly defined, either for patients as a whole or for symptomatic or asymptomatic subgroups. However, to reduce the risk of sudden death we recommend surgical resection of large diverticula.

[Apico-thoracic retro-aortic anastomosis in radical operation for esophageal carcinoma].

OBJECTIVE: To evaluate the result of surgical treatment of the middle and upper-middle esophageal carcinoma with a new operation, performing the anastomosis posterior to the aortic arch at the apex of the thoracic cavity. METHODS: From April 1996 to May. 2000, 179 patients with esophageal carcinoma were treated. Sixty-eight of these patients (49 in the middle and 19 in the upper-middle segment) were treated by esophogogastrostomy at the top of the chest, posterior to the aortic arch. There were squamous cell carcinoma 50, adenocarcinoma 16, undifferentiated carcinoma 2, including 8 double-primaries. The lesions were stage I 9 and stage II-III 59. RESULTS: All patients have been alive after follow-up of 2 months to 3 years. Without any positive margins, anastomotic leak or perioperative death, this new method has merits: 1. Length of esophagus resected was maximal through one single incision. It would be especially useful for some of the upper-middle lesions. 2. This new method requires a shorter transposed stomach than that required by the combined triple cervico-thoraco-abdominal approach. 3. As the site of thoracic stomach was on the bed of esophagus, there was less chance of post-operative embarrassment in respiration due to the dilatation of the transpositioned stomach and pylorostenosis, etc. 4. There would be less chance of reflux esophagitis because of the "blocking" by the aortic arch, thereby, the patients life is improved. CONCLUSION: This radical operation for esophageal carcinoma with anastomosis at top of the thoracic cavity posterior to the aortic arch, being a newly designed surgical method, is especially useful for carcinoma in the middle and upper-middle esophageal segment.