Impact of vaccination status on clinical outcomes of hospitalized COVID-19 patients.

INTRODUCTION: It is important to identify the relationship between the COVID-19 vaccination status and the prognosis of this disease in hospitalized patients to gain a more accurate picture of their status and the effect of vaccination, as well as take necessary measures to improve their medical care. Thus, the present study was conducted to investigate the relationship between the vaccination status of hospitalized COVID-19 patients and the disease severity index in terms of clinical, imaging, and laboratory criteria. METHODS: This research is a descriptive-analytical cross-sectional study. the study population consisted of patients with a positive RT-PCR test for coronavirus, admitted to COVID-19 departments of teaching hospitals in Yazd, Iran, during two months in the sixth peak of COVID-19. The patients' data comprised demographic information (age, sex, and underlying disease), clinical information (length of hospital stay, length of ICU stay, and vaccination status), disease outcome (mortality and intubation), laboratory information (ESR, CRP, and NLR), and imaging information (lung involvement percentage), and finally, the relationship between patients' vaccination status and disease severity indices were analyzed with the chi-square test, independent t-test, and logistic regression analysis at a 95% confidence interval (CI). FINDINGS: According to research findings, the duration of hospitalization was 5.25 ± 2.34 and 6.11 ± 3.88 days in groups of patients with complete and incomplete vaccination, respectively (P = 0.003). The lengths of ICU stay were 6 ± 4.63 and 5.23 ± 3.73 days in both groups of patients admitted to the ICU (P = 0.395). Furthermore, there were significant relationships between the ICU admission rates, endotracheal intubation, mortality rate, the lung involvement score in the chest CT scan, and the NLR with the vaccination status.Multivariate regression analysis indicated that DM, IHD, NLR, CT scan score and vaccination status were related to patients' in-hospital mortality. CONCLUSION: Complete vaccination of COVID-19 led to a milder disease in terms of clinical, imaging, and laboratory criteria of patients and decreased the possibility of hospitalization in ICUs, intubation, and mortality in patients.

Primary benign intratracheal schwannoma: A case report and review of the literature.

Shwannomas are rare benign tumours especially in tracheal. A 16-year-old male presented with a chronic cough, and a thoracic CT scan revealed a pedunculated tumour measuring approximately 11 × 13 mm in size, located 22 mm away from the main carina. Tissue sample was obtained via rigid bronchoscopy and cryobiopsy, and the pathological analysis confirmed the diagnosis of a benign nerve sheath tumour consistent with schwannoma. The patient subsequently underwent resection of the tumour and tracheal anastomosis. Schwannomas are uncommon pulmonary tumours that typically occur in adults, with a higher incidence among females. The presenting symptoms vary depending on the size and location of the tumour. Treatment options include therapeutic bronchoscopy or surgical resection, with the choice of approach based on tumour characteristics (pedunculated or sessile), preoperative surgical risk, and risk of recurrence. The prognosis is generally favourable, with a low risk of recurrence and excellent outcomes.

Barriers to Safe Oxygen Therapy and the Effect of the Training on the Knowledge and Performance of ICU Nurses.

Introduction: Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients' clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses. Methods: This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants' perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two-group study with pre- and post-tests to examine the effect of training on ICU nurses' knowledge and performance in oxygen therapy. Results: The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after-1 month 24.41 vs. 20.29, 95% CI [3.144-5.098], after-3 month 22.13 vs. 20.24, 95% CI [0.729-3.053]), performance (after-1 month 21.54 vs. 18.05, 95% CI [2.898-4.073], after-3 month 19.74 vs. 18.63, 95% CI [0.400-1.824]), and total score of oxygen therapy (after-1 month 45.95 vs. 38.34, 95% CI [6.288-8.925], after-3 month 41.87 vs. 38.87, 95% CI [1.394-4.613]). Conclusion: The study's findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.

COVID-19 and spontaneous pneumothorax: a survival analysis.

INTRODUCTION: COVID-19 Patients may be at risk for involving with spontaneous pneumothorax. However, clinical data are lacking in this regard. In this study, we aimed to investigate the demographic, clinical, and radiological characteristics and survival predictors in COVID-19 patients with pneumothorax. METHODS: This is a retrospectivestudy conducted on COVID-19 patients with pneumothorax that had been hospitalized at hospital. l from December 2021 to March 2022. The chest computed tomography (CT) scan of all patients was reviewed by an experienced pulmonologist in search of pulmonary pneumothorax. Survival analysis was conducted to identify the predictors of survival in patients with COVID-19 and pneumothorax. RESULTS: A total of 67 patients with COVID-19 and pneumothorax were identified. Of these, 40.7% were located in the left lung, 40.7% were in the right lung, and 18.6% were found bilaterally. The most common symptoms in the patient with pneumothorax were dyspnea (65.7%), increased cough severity (53.7%), chest pain (25.4%), and hemoptysis (16.4%). The frequency of pulmonary left and right bullae, pleural effusion, andfungus ball were 22.4%, 22.4%, 22.4%, and 7.5%, respectively. Pneumothorax was managed with chest drain (80.6%), chest drain and surgery (6%), and conservatively (13.4%). The 50-day mortality rate was 52.2% (35 patients). The average survival time for deceased patients was 10.06 (2.17) days. CONCLUSIONS: Our results demonstrated that those with pleural effusion or pulmonary bullae have a lower survival rate. Further studies are required to investigate the incidence and causality relation between COVID-19 and pneumothorax.

Analyzing Trends in Demographic, Laboratory, Imaging, and Clinical Outcomes of ICU-Hospitalized COVID-19 Patients.

Background: COVID-19 has led to significant hospitalization and intensive care unit admission rates. The demographic parameters of COVID-19 patients, such as age, underlying illnesses, and clinical symptoms, substantially influence the incidence and mortality of these individuals. The current study examined the clinical and demographic characteristics of COVID-19 intensive care unit (ICU) patients in Yazd, Iran. Methods: The descriptive-analytical cross-sectional study was conducted on ICU patients with a positive RT-PCR test for coronavirus, admitted to the ICU in Yazd province, Iran, over 18 months. To this end, demographic, clinical, laboratory, and imaging data were collected. Moreover, patients were divided into good and worse clinical outcome groups based on their clinical outcomes. Subsequently, data analysis was performed at a 95% confidence interval (CI) using SPSS 26 software. Results: 391 patients with positive PCR were analyzed. The average age of the patients in the study was 63.59 ± 17.76, where 57.3% were male. On the high-resolution computed tomography (HRCT) scan, the mean lung involvement score was 14.03 ± 6.04, where alveolar consolidation (34%) and ground-glass opacity (25.6%) were the most prevalent type of lung involvement. The most common underlying illnesses in the study participants were hypertension (HTN) (41.4%), diabetes mellitus (DM) (39.9%), ischemic heart disease (IHD) (21%), and chronic kidney disease (CKD) (20.7%). In hospitalized patients, the rates of endotracheal intubation and mortality were 38.9% and 38.1%, respectively. Age, DM, HTN, dyslipidemia, CKD, cerebral vascular accident (CVA), cerebral hemorrhage, and cancer were reported to be significantly different between these two groups of patients, indicating an increase in the rate of intubation and mortality among these patients. Furthermore, the multivariate logistic regression analysis revealed that DM, HTN, CKD, CVA, neutrophil-to-lymphocyte ratio (NLR), the percentage of lung involvement, and initial O2 saturation significantly increase the mortality of ICU patients. Conclusion: Several features of COVID-19 patients influence the mortality in these individuals. According to the findings, early detection of this disease in people at high risk of death can prevent its progression and lower mortality rates.

The thoracoacromial artery as the lifeboat in recipient artery deficiency in complex chest wall defect reconstruction.

INTRODUCTION AND IMPORTANCE: Reconstruction of chest wall defects is a complex procedure requiring an accurate understanding of the complete anatomy of the chest wall to deal with challenging defects. This report investigates the use of the thoracoacromial artery and cephalic vein as recipient vessels in a musculocutaneous latissimus dorsi free flap to cover the large chest wall defect resulting from post-radiation necrosis for breast cancer. CASE PRESENTATION: A 25-year-old woman with established necrotic osteochondritis of the left side ribs following radiotherapy in breast cancer management was admitted for reconstructing the violated chest wall. The contralateral latissimus dorsi muscle was selected as an alternative to the previously used ipsilateral muscle. The thoracoacromial artery was the only one available as a recipient artery with a successful outcome. CLINICAL DISCUSSION: Breast cancer is the most common indication for radiotherapy. Osteoradionecrosis can present months to years after radiation with deep ulcers and major bone destruction with soft tissue necrosis. Large defect reconstruction is sometimes challenging due to lack of recipient artery and vein because of previous unsuccessful interventions. Thoracoacromial artery and its branches can be recommended as a good alternative recipient artery. CONCLUSION: The Thoracoacromial artery may aid surgeons in achieving successful anastomoses in difficult thoracic defects.

Efficacy and safety of Tocilizumab, plasmapheresis and their combination in severe COVID-19: A randomized clinical trial.

BACKGROUND: This study sought to evaluate and compare the effectiveness of plasmapheresis, Tocilizumab, and Tocilizumab with plasmapheresis treatment on the removal of inflammatory cytokines and improvement clinically of patients with severe COVID-19 in Intensive Care Units (ICU) due to the association between increased cytokine release and the severity of COVID-19. METHODS: This clinical trial study was conducted in three treatment arms in Iran. All patients received standard care and randomization into one of three treatment groups; Tocilizumab (TCZ) alone, plasmapheresis alone, or a combination of Tocilizumab and plasmapheresis. Demographics, clinical evaluation, oxygenation status, laboratory tests and imaging data were evaluated in the three groups and re-checked 48 h after the end of treatment trials. Primary outcomes were oxygenation status, the need for mechanical ventilation and the rate of death. RESULTS: Ninety-four patients were included in the trial after meeting the eligibility requirements. Twenty-eight patients received Tocilizumab alone, 33 had plasmapheresis alone, and 33 received both Tocilizumab and plasmapheresis. Baseline characteristics did not differ between three groups that included demographic, clinical and laboratory parameters. Following therapy, there was no difference between the three groups for CRP, ferritin, d-dimer, IL-6, pro-calcitonin and neutrophil to lymphocyte ratio (NLR) (P > 0.05). While a significant reduction was found in CRP levels within each group (32.04 ± 42.43 to 17.40 ± 38.11, 51.28 ± 40.96 to 26.36 ± 33.07 and 41.20 ± 34.27 to 21.56 ± 24.96 in the tocilizumab, plasmapheresis, and combined group, respectively) (p < 0.05), procalcitonin levels were elevated significantly in the Tocilizumab group (0.28 ± 0.09 to 0.37 ± 0.11) (p < 0.05). Clinically there was no difference between the three groups following treatment for O2 saturation levels with supplementary oxygen at discharge, endotracheal intubation rate, use of NIVPP, mortality, mean hospital and ICU length of stay (p > 0.05). CONCLUSION: Study results showed that the reduction of serum inflammatory markers, the rate of intubation and therapeutic complications including death were no different between the three groups; however, CRP levels were significantly reduced in all three groups, indicating that the interventions reduced inflammation likely through a reduction in the cytokine storm, though clinical outcomes were unaffected.

Subcutaneous octreotide therapy for malignant pleural effusion after pleurodesis with talc powder: a placebo-controlled, triple-blind, randomized trial.

PURPOSE: In many cases, pleurodesis is the only treatment available for the treatment of malignant pleural effusion (MPE), and in the case of excessive daily pleural effusion, its therapeutic effect may be reduced. In this study, we intended to investigate the therapeutic effects and safety of octreotide in patients with MPE undergoing pleurodesis with talc powder. METHODS: This study was a single-center, placebo-controlled, and triple-blind, randomized trial designed to investigate the therapeutic effects and safety of octreotide in patients with MPE in Tehran, Iran, from March 2020 to March 2021. Patients with MPE were randomly divided into two parallel groups, one receiving subcutaneous octreotide (3 doses of 50 µg/day) and the other receiving placebo before and after pleurodesis with talc powder. The patients were followed up with a chest X-ray 1 week, 1 month, and 3 months later. The primary outcome measures of this study were the amount of discharge from the chest tube before and after pleurodesis and the length of hospital stay. Treatment failure, relapse, pleural effusion analysis, and side effects were considered the secondary outcome measures of the study. RESULTS: A total of 46 patients (23 in the octreotide group and 23 in the placebo group) with MPE was included in this study. Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder. We showed that compared to the placebo group, patients in the octreotide group have significantly decreased production of pleural effusion both before (p = 0.009) and after (p = 0.002) pleurodesis. Octreotide treatment led to a decreased hospital stay (p = 0.004 before pleurodesis and p = 0.001 after pleurodesis) and reduced treatment failure (p = 0.022). However, octreotide did not decrease the relapse at 1-week, 1-month, and 3-month follow-ups. Moreover, octreotide did not affect pleural effusion parameters compared to placebo. Ultimately, our results also showed that treatment with octreotide was safe and did not have significant side effects. CONCLUSION: Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder without any significant side effects. Future studies with a larger sample size and longer follow-up time can confirm the results of this study and also determine the appropriate dose of octreotide for the treatment of MPE. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20210915052492N1. Registered 11 October 2021 - Retrospectively registered, https://www.irct.ir/trial/58776 .

Giant primary low-grade fibromyxoid sarcoma arising from the left pulmonary parenchyma: A case report and literature review.

BACKGROUND: Low-grade fibromyxoid sarcoma is a rare painless neoplasm that primarily grows in young adults' proximal extremities and trunks. The lungs are infrequent sites for this type of sarcoma. CASE PRESENTATION: We reported a 26-year-old female that presented with a chief complaint of chest pain from a few months ago to Kasra hospital, Tehran, Iran, in August 2021. Chest computed tomography (CT) showed a hypodense mass with a well-defined margin measuring 9.3 cm in the left upper lobe and multiple hypodense lesions with a lobulated appearance with a total diameter of 15.5 × 13.5 cm in the left lower lobe of the lung. CONCLUSION: This is the largest case of primary pulmonary low-grade fibromyxoid sarcoma (30 × 28 × 7 cm), which seemed unresectable at first evaluation. Due to the extent of the tumor, left pneumonectomy was performed, leading to attenuation of symptoms and no recurrence at a six-month follow-up.

Efficacy of video-assisted thoracoscopic surgery versus intrapleural streptokinase for treatment of parapneumonic empyema with multiloculation and septation.

Introduction: Effective treatment of parapneumonic empyema with multiloculation and septation has been a challenge for clinicians for many years. Aim: This study compared the clinical outcomes of video-assisted thoracoscopic surgery (VATS) and intrapleural streptokinase in patients with stage II empyema. Material and methods: This is a retrospective study of 46 patients with parapneumonic empyema with multiloculation and septation in the pleural cavity treated with VATS or streptokinase in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, between January 2018 and January 2021. The main outcome measures of this study were hospital stay, febrile period, days with drainage, and treatment failure. Results: A total of 46 patients were included in this study. Of these, 28 were treated with VATS deloculation, and 18 were treated with streptokinase. The average hospital stay was 2.8 ±1.7 days for the VATS group and 7.5 ±3.5 days for the streptokinase group (p < 0.001). The average days with fever were 1.9 ±0.7 days for the VATS group and 3.0 ±1.64 days for the streptokinase group (p = 0.017). The average days with drainage were 3.0 ±1.6 days for the VATS group and 7.5 ±4.4 days for the streptokinase group (p < 0.001). The success rate was 92.9% for the VATS group and 66.7% for the streptokinase group, which was significantly higher in the VATS group compared to the streptokinase group (p = 0.042). No cases of perioperative mortality occurred. The frequency of adverse events did not differ between study groups (p > 0.05). Conclusions: Our results demonstrated that treatment of empyema with VATS is superior to streptokinase therapy.

Intrathoracic gossypiboma presenting 47 years later as a purulent fistula: a case report.

BACKGROUND: Intrathoracic gossypiboma is a consequence of retained sponge/swap, gauzoma, muslinoma, textiloma, or cottonoid in the thoracic cavity during surgery. The thoracic cavity is of the rarest place for gossypiboma as these entities most occur after abdominal surgery. CASE PRESENTATION: We report a case of intrathoracic gossypiboma that was missed for an extended period of time with no symptoms and was successfully treated with surgical intervention. CONCLUSIONS: The rarity of gossypiboma necessitates a high index of suspicion for correct diagnosis. Gossypiboma is often difficult to diagnose, leading to misdiagnosis and unnecessary interventions. It is important to consider this entity as a diagnosis in any case with an unexplained or unusual presentation during the postoperative period.

Characterization of persistent materials of deposited PM2.5 in the human lung.

Clearance of deposited urban air particulates (PMs) from the lung is vital for the protection of the lung tissue. Several studies have investigated the behavior of immune cells against these particulates in vitro and in vivo. However, the fate of particulates in the lung is yet unclear. Here, we report the results of our investigations on the clearance of particulates from the lung. Twelve normal lung tissue samples were taken from nonsmoking and non-occupationally exposed patients who needed lung lobectomy or segmentectomy. The remaining particulates were isolated from the alveolar area and extracellular matrix (ECM), separately, and their chemical composition was determined using the FE-SEM EDAX and GC-MS. Moreover, urban air PM2.5 was collected in two forms dry and washed. These were characterized too. Our results showed that none of the metals in the deposited particulates structure is fully water-soluble. After contact with mucosal liquid, the alveolar particulates included Fe, Al, Si, Ti, and Ni. These elements were absent in the PMs isolated from ECM. The organics of alveolar and ECM particulates were the same and included tetra-decane, hexadecane, and octa-decane. None of the organics present in the urban air PM2.5, such as PAHs, were available in isolated particulates from the lung tissue. This study shows that the full clearance of inhaled particulates does not happen in the lung. The immune system's primary function is detoxification by removing all components identifiable by immune cells. After that, the remained PMs will be relocated and deposited into the ECM.

Cushing syndrome secondary to a mediastinal carcinoid tumor: a case report.

Neuroendocrine tumors (NET) are a rare and diverse set of malignancies that can develop anywhere within the body. ACTH-producing mediastinal NETs often originate from the thymus in the anterior mediastinum and are very rare. Primary diagnostic modalities for NETs include CT scan, MRI, scintigraphy, and Ga-DOTA PET scan. Here we report a case of a young male without any past medical history presenting with hypercortisolism secondary to a middle mediastinal typical carcinoid tumor. The patient underwent a successful resection which reduced serum ACTH levels. To the best of our knowledge, this is the first case of Cushing syndrome caused by a middle mediastinal NET.

Effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis: A randomised controlled trial.

This is a prospective randomized controlled trial to investigate the effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis. This study was a single-center randomized controlled trial performed at the general surgery ward of Taleghani hospital, in Tehran, Iran, from July 2018 to October 2018. Patients were randomly divided into two parallel groups, one receiving routine abdominal drainage and the other receiving no treatment. Postoperative pain was measured by the Universal Pain Assessment Tool (UPAT) 0, 2, 4, 6, 12, and 24 h postoperatively. A total of 60 patients (30 patients in the study and control groups) were included. GLM repeated measure analysis showed a significant time*treatment effect for routine abdominal drainage in decreasing UPAT scores from baseline to 24 h after surgery (F = 4.59, df = 3.98, P-value = 0.001). Our findings demonstrated that abdominal drainage significantly reduces postoperative pain 0, 2, 4, 6, and 12 h after surgery (P-value<0.05). We also showed that abdominal drainage increases the time to first morphine sulfate administration and decreases the total dose of morphine sulfate administration (P-value<0.001). Moreover, we demonstrated that abdominal drainage decreases the average postoperative pain (P-value<0.001) and does not lead to any considerable side effects. However, 24 h after surgery, no significant pain-relieving effect was evident for abdominal drainage. In conclusion, insertion of abdominal drainage leads to decreased postoperative pain. Future studies need to investigate the optimal time for removal of the abdominal drain. This trial was prospectively registered in the Iranian Registry of Clinical Trials with a registration ID of IRCT20130706013875N2.

Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report.

Laryngotracheal stenosis is a major side effect of intubation in patients with Coronavirus 2019 (COVID-19). However, no study has since reported tracheal stenosis in patients with COVID-19 without a history of tracheal intubation. The current study reports a 77-year-old male patient with the COVID-19 infection but without a history of tracheal intubation diagnosed with distal tracheal stenosis. Tracheal stenosis was successfully treated with rigid bronchoscopy. This study reported the first case of tracheal stenosis due to viral tracheitis associated with COVID-19 infection. However, further studies are required to investigate this speculation.

Primary thoracic gastrinoma causing Zollinger-Ellison syndrome.

Gastrinomas are located largely in the pancreaticoduodenal region. However, gastrinomas have also been found in non-pancreaticoduodenal regions. Our study is a rare report of gastrinomas within the thoracic cavity. A 53-year-old male patient presented with acute abdomen and multiple prepyloric ulcers. Serum gastrin level was significantly elevated. Computed tomography (CT) scan of the chest, abdomen, and pelvis showed a mass in the inferior section of the right hemithorax. Octreotide scan also confirmed a neuroendocrine tumor (NET)-like mass in the right para-aortic region in the right hemithorax. In thoracotomy, a hypervascular solid tumor was detected adjacent to the aorta, also receiving a branch from the aorta. We ligated the feeding artery and resected the 3-cm tumor. The post-operative serum gastrin level was 36 pg/mL, which implied that the tumor was successfully resected. The pathology assessment reported nests of monotonous low-grade neuroendocrine cells with salt and pepper nuclei with rare mitotic features, cellular uniformity, and abundant amphophilic cytoplasm, confirming the diagnosis of gastrinoma. Based on our report, we suggest that the search for gastrinomas should include not only the abdominal sites but also uncommon areas like the thoracic cavity.

Development of a new method for isolation of urban air particulates deposited in the human lung tissue.

Particulate matters (PMs) are important pollutants in urban air pollution because of their variable composition. The pulmonary clearance of PMs is critical to prevent long-term immunological responses. This study established a new method for the isolation of probably deposited urban air particulates from the human lung tissue, to investigate the features of uncleared particulates. The lung samples were acellularized with SDS solution of various concentrations ranging from 1 to 10%to lyse cells and release the PMs. In addition, the extracellular matrix (ECM) that remained was digested by proteinase K enzyme. The results of this study demonstrated that an SDS solution of 4% is the optimum concentration for the isolation of settled PMs from the lung tissue. Moreover, the used enzymatic method could separate settled PMs from the lung ECM appropriately. The results exhibited that epithelial cells form 46% of the samples' weight on average, whereas just 20% of isolated PMs were found in this part of the tissue. Both groups of separated PMs tend to agglomerate, but it is significantly higher in cellular isolated PMs. The particles separated from ECM have an agglomeration tendency, which is observable only by FE-SEM imaging. Moreover, we found a major part of urban air PMs deposited in ECM. The established method in this study can be used in future investigations to isolate other types of PMs settled in the lung, such as occupationally inhaled carbonaceous particulates.

Particulates induced lung inflammation and its consequences in the development of restrictive and obstructive lung diseases: a systematic review.

Particulate matters (PMs) are significant components of air pollution in the urban environment. PMs with aerodynamic diameter less than 2.5 µm (PM2.5) can penetrate to the alveolar area and introduce numerous compounds to the pneumocystis that can initiate inflammatory response. There are several questions about this exposure as follows: does PM2.5-induced inflammation lead to a specific disease? If yes, what is the form of the progressed disease? This systematic review was designed and conducted to respond to these questions. Four databases, including Web of Science, Scopus, PubMed, and Embase, were reviewed systematically to find the related articles. According to the included articles, the only available data on the inflammatory effects of PM2.5 comes from either in vitro or animal studies. Both types of studies have shown that the induced inflammation is type I and includes secretion of proinflammatory cytokines. The exposure duration of longer than 28 weeks was not observed in any of the reviewed studies. However, as there is not a specific antigenic component in the urban particulate matters and based on the available evidence, the antigen-presenting is not a common process in the inflammatory responses to PM2.5. Therefore, neither signaling to repair cells such as fibroblasts nor over-secretion of extracellular matrix (ECM) proteins can occur following PM2.5-induced inflammation. These pieces of evidence weaken the probability of the development of fibrotic diseases. On the other hand, permanent inflammation induces the destruction of ECM and alveolar walls by over-secretion of protease enzymes and therefore results in progressive obstructive effects.

Successful tracheal necrosis management using a pedicle pectoralis flap: A case report.

Thyroidectomy is considered an overall low-risk procedure. However, severe life-threatening complications, including tracheal necrosis may occur postoperatively. A 45-year-old male patient was referred to our clinic for papillary thyroid carcinoma surgery. The patient had mediastinitis signs and symptoms seven days after total thyroidectomy. Subsequent imaging demonstrated air leak and with mediastinitis as the primary diagnosis, and the patient underwent reoperation. During the operation, four necrotic tracheal rings were found to be the source of air leak. Due to tissue inflammation and infection, neither primary repair with tracheal resection and anastomosis, nor strap muscle plugging procedure were feasible. Therefore, a pedicle flap derived from the right pectoralis major muscle was transferred to the necrotic trachea. The patient"s clinical condition improved after the operation and subsequent bronchoscopies confirmed healing of trachea. During six-month follow-up, no complications were observed. In conclusion, the technique discussed in the current report shows promising outcomes for reconstructing large tracheal defects in inflammatory conditions where primary repair techniques are not suitable.

Tracheopleural fistula after thoracoscopic esophagectomy: novel therapeutic approach with pericardial and intercostal muscle flaps.

Tracheal rupture following thoracoscopic esophagectomy is a dangerous event requiring primary repair with flap reinforcement. If the injury is not diagnosed during the surgery, morbidity and mortality increase significantly. Meanwhile, primary repair in such cases is not feasible due to the inflammation and difficulty in approximating the defect. Here, we report a case of tracheal injury during thoracoscopic esophagectomy with primary repair failure. We successfully repaired the injury by covering the defect first by a pericardial flap, then reinforcing it with an intercostal muscle flap. To our knowledge, there are few reports of such novel surgical techniques.