Digital Transformation in Thoracic Surgery: a survey among the European Society of Thoracic Surgeons.

OBJECTIVES: Digital transformation has drastically changed the surgical sector, but few is known about its impact on thoracic surgical practice. The aim of this paper is to report the European Society of Thoracic Surgeons (ESTS) survey results, assessing the impact of and the need for Digital Transformation in Thoracic Surgery. METHODS: A 23-item survey was designed by the ESTS Digital Transformation Working Group to assess the impact of and the need for Digital Transformation in Thoracic Surgery. All ESTS members (1668) were invited to complete the survey between 13 March and 21 May 2022 anonymously. Data analysis was descriptive calculating frequencies and percentages. Group comparison was done using chi-square test. RESULTS: The response rate was 6.3%. Surgeons from 26 European countries participated of which more than 80% were based in academic hospitals. The impact of digital transformation was rated very important (43.8%) and fundamental (22.7%) in more than two-thirds of the cases, regardless of surgeons' age. None of the participants felt that digital transformation was of no importance and more than 85% had implemented digital platforms in their direct patient care. Almost 90% of the surgeons, currently not using digital platforms for training and education, would consider introducing them. About 70% were at least 'somewhat satisfied' with their current engagement in Digital Transformation in Thoracic Surgery. CONCLUSIONS: Digital transformation seems to play a major role across European Thoracic Surgery departments in direct patient care, professional networking and surgical training. However, overall satisfaction with the current status of Digital Transformation in Thoracic Surgery was rather reserved, implying the need to increase the implementation of digital solutions in the latter.

Surgical access to the mediastinum-all roads lead to Rome: a literature review.

Background and Objective: The mediastinum is a complex, heterogeneous area, which leads vertically across the thoracic cavity between the bilateral mediastinal pleurae, connecting the head and neck region with the thoracic cavity. Different classifications have been published to differentiate between the so-called mediastinal compartments while the most used classification surely is the 4-compartments Gray`s classification, dividing it into the superior, anterior, middle and posterior mediastinum. Mediastinal abnormalities include infections (mediastinitis) and solid or cystic mediastinal masses. These masses can be divided into benign and malignant lesions originating from mediastinal structures/organs or represent manifestations of metastatic disease, often metastatic non-small cell lung cancer (NSCLC). This review aims to explore the different mediastinal pathologies along with indications and surgical approaches. Methods: We performed literature research in PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases. Only papers written in English were included. Key Content and Findings: Depending on the indication for surgical intervention and the localization of the pathology, surgical approach may differ immensely. Mediastinal staging of lung cancer, primary lesions of the mediastinum, mediastinitis and traumatic mediastinal injuries display the most frequent indications for mediastinal surgery. Surgical approaches trend towards minimally invasive, video- or robotic-assisted techniques and are becoming increasingly refined to adapt to the special characteristics of the mediastinum. However, certain indications still require open access for best possible mediastinal exposure or oncological reasons. Conclusions: To guide optimal surgical approach selection to the mediastinum, the following overview will present all published surgical approaches to the mediastinum and discuss their practical relevance and indications aiming to help surgeons in the management of patients with mediastinal pathologies who should undergo surgery.

Treatment of Pulmonary Carcinoid Tumors With Bronchoscopic Cryotherapy: A 28-Year Single-center Experience.

BACKGROUND: Pulmonary carcinoids are rare tumors originating from neuroendocrine cells in the lungs. Because of their potentially infiltrative nature, surgical resection remains the treatment of choice. However, not all patients with technically resectable disease will be able to undergo surgery, primarily because of poor lung function or medical co-morbidities. Centrally located, intraluminal tumors have been reported to be amenable to bronchoscopic treatment. We specifically examined the role of cryotherapy in the treatment of bronchial carcinoid tumors. METHODS: Sixty-three patients (52.38% female) who underwent a combined total of 243 cryotherapy procedures for treatment of bronchial carcinoid between 1992 and 2020 in our institution were included in the study. Following discussion in multidisciplinary meetings, patients were considered for first-line cryotherapy when lung resection was deemed not possible or when they had rejected surgery. RESULTS: Cryotherapy resulted in complete remission in 21 (33.33%) patients with maximum tumor diameter less than 20 mm (mean: 11.08 mm, 95% confidence interval: 8.76-13.40), and allowed 22 (34.92%) patients with larger lesions (mean: 24.04 mm, 95% confidence interval: 18.78-29.30) to proceed with parenchymal sparing resections. Marked symptomatic relief (P<0.001) was reported by 58 (92.06%) patients. The median follow-up was 33 months (range: 0 to 243 mo). One (1.59%) patient was diagnosed with recurrence in a contralateral lobe 3 years after surgery and was treated with radiofrequency ablation. CONCLUSIONS: In the absence of a definitive randomized controlled trial comparing bronchoscopic treatment with surgical resection, we provide evidence on the safety and efficacy of cryotherapy and encourage wider adoption of this inexpensive and minimally invasive technique for treatment of bronchial carcinoids.

Sclerosing Pneumocytoma: A Host for a Typical Carcinoid With Pleural Metastasis-A Wolf in Sheep`s Clothing.

Sclerosing pneumocytoma (SP) is a rare primary lung tumor. Typical carcinoids (TCs) count for 2% of lung malignancies. A description of a combined neoplasm of SP with a nodal and pleural metastasized TC has, to our knowledge, never been published. A 57-year-old actively smoking woman received a diagnosis of a lesion in the left lower lobe via a screening CT scan for rheumatoid arthritis. A fluorodeoxyglucose-PET scan confirmed a 21 × 26 × 16 mm (standardized uptake maximum value, 3.0), well-circumscribed round lesion with calcification, which was thought to be most probably benign. No mediastinal lymph node enlargement or fluorodeoxyglucose uptake was detected. The results of routine laboratory tests, respiratory function tests, and physical examination were unremarkable. In diagnostic thoracoscopy pleural, diaphragmatic, and pericardial lesions were discovered and biopsied in addition to a wedge resection. After diagnosis of a pleural metastasized TC mixed with SP, radical resection and systemic lymph node dissection were performed. The patient is in remission after 36 months of follow-up.

Innate immune defense defines susceptibility of sarcoma cells to measles vaccine virus-based oncolysis.

The oncolytic potential of measles vaccine virus (MeV) has been demonstrated in several tumor entities. Here, we investigated the susceptibility of eight sarcoma cell lines to MeV-mediated oncolysis and found five to be susceptible, whereas three proved to be resistant. In the MeV-resistant cell lines, we often observed an inhibition of viral replication along with a strong upregulation of the intracellular virus-sensing molecule RIG-I and of the interferon (IFN)-stimulated gene IFIT1. Not only expression of IFIT1 but also phosphorylation of IFN-stimulated Stat1 took place rapidly and were found to be persistent over time. In contrast, susceptible cell lines showed a much weaker, delayed, or completely missing expression of IFIT1 as well as a delayed or only transient phosphorylation of Stat1, whereas exogenic stimulation with beta interferon (IFN-ß) resulted in a comparable profound activation of Stat1 and expression of IFIT1 in all cell lines. Pretreatment with IFN-ß rendered three of the susceptible cell lines more resistant to MeV-mediated oncolysis. These data suggest that differences in the innate immune defense often account for different degrees of susceptibility of sarcoma cell lines to MeV-mediated oncolysis. From a therapeutic perspective, we were able to overcome resistance to MeV by increasing the multiplicity of infection (MOI) and by addition of the prodrug 5-fluorocytosine (FC), thereby exploiting the suicide gene function of virotherapeutic vector MeV-SCD armed with the SCD fusion protein, which consists of yeast cytosine deaminase and yeast uracil phosphoribosyltransferase.

Immobilization stress responses in adult rats exposed in utero to immobilization.

The present study investigated the influence of immobilization prenatal stress on adult male rats, with the same postnatal stress, on the immune parameters and its relation with plasma corticosterone (COR) and glucose levels. To study the immunity parameters, profiles of the leucocytes, size of spleen and number of the mononuclear cells of this organ were determined. Basal levels of COR and glucose were higher in prenatally stressed animals. When the adult animals were exposed to immobilization stress, COR increased but the increase was less than that for the control group, and glucose was equal in both groups. Although postnatal acute stress decreased the number of leucocytes and lymphocytes and increased the number of neutrophils, the effect was lower in prenatally stressed animals; for that reason, the ratio neutrophil/lymphocyte increased less. The number of mononuclear cells were higher in the spleen of prenatally stressed animals. This effect was probably due to retention of blood lymphocytes in the spleen. There seemed to be an alteration in the redistribution of leucocytes, both in basal conditions and under postnatal stress. The alteration of the immunological function may be partly due to an alteration in the functionality of the hypothalamic­pituitary­adrenal axis, which was hyperactive in basal conditions but appeared to suffer habituation to the same stress.

Effects of prenatal stress on male offspring sexual maturity.

Prenatal stimulations have been shown to have long-term effects on at reproductive activity. We evaluated the influence of the prenatal stress on the hypothalamic-pituitary-gonad (HPG) axis in male offsprings from mothers with high number of offsprings per litter (HNL) and low number of offsprings per litter (LNL) after hypothesizing that the number of offsprings per litter may modify the effect of the prenatal stress on the HPG of adult offsprings. Pregnant Wistar rats were used for this study. Immobilization (IMO) stress was used, 30 min, 3 times per week, from the 5th to 21st day of pregnancy. The weight of adrenal and gonads, and the corticosterone (COR), testosterone (TES) and luteinizing hormone (LH) plasmatic levels were analyzed in the male offspring at 30, 45 and 70 days of age. The offspring males coming from LNL showed a decrease in testicle weight and TES levels, without changes in the plasmatic LH levels. However, the offspring of HNL showed a decrease of LH levels. It is possible to conclude that in LNL prenatal stress would produce alterations to gonadal level, while in HNL the effect of stress would be evident at pituitary level.

Atropine enhancement of aldosterone induced renal sodium reabsorption in dogs

El objetivo del presente trabajo fue investigar el efecto de la atropina sobre la membrana de los túbulos renales, como hemos sugerido en un trabajo previo. Se anestesiaron perros mestizos a los que se les infundió una solución de ClNa isotónica por vía endovenosa. Se cateterizaron ambos uréteres y se recogieron muestras de orina en períodos de diez minutos. Diferentes grupos de perros recibieron una dosis única de aldosterona ev (2 y 4 ug/kg de peso corporal); atropina (1 ug/kg de peso corporal); atropina previa a la dosis menor de aldosterona y solución salina en volúmenes de 1 ml. La administración de atropina previa a la dosis menor de aldosterona aumentó el efecto antinatriurético de la hormona y, además, produjo una anticipación en la aparición del efecto. Los resultados obtenidos parecen compatibles con cambios de la permeabilidad o de la capacidad de transporte de las membranas tubulares inducidos por atropina

Atropine enhancement of aldosterone induced renal sodium reabsorption in dogs

El objetivo del presente trabajo fue investigar el efecto de la atropina sobre la membrana de los túbulos renales, como hemos sugerido en un trabajo previo. Se anestesiaron perros mestizos a los que se les infundió una solución de ClNa isotónica por vía endovenosa. Se cateterizaron ambos uréteres y se recogieron muestras de orina en períodos de diez minutos. Diferentes grupos de perros recibieron una dosis única de aldosterona ev (2 y 4 ug/kg de peso corporal); atropina (1 ug/kg de peso corporal); atropina previa a la dosis menor de aldosterona y solución salina en volúmenes de 1 ml. La administración de atropina previa a la dosis menor de aldosterona aumentó el efecto antinatriurético de la hormona y, además, produjo una anticipación en la aparición del efecto. Los resultados obtenidos parecen compatibles con cambios de la permeabilidad o de la capacidad de transporte de las membranas tubulares inducidos por atropina (AU)