RESUMO
OBJECTIVE: The study objective was to evaluate the experience of previous American Association for Thoracic Surgery Summer Intern Scholarship recipients. METHODS: A database of recipients of the American Association for Thoracic Surgery Summer Intern Scholarship in Cardiothoracic Surgery provided by the American Association for Thoracic Surgery was analyzed. A questionnaire was sent via email to recipients with 10 questions within the survey to assess the types of exposure during the internship, the impact of the internship on career choices, the current career setting, and any additional thoughts regarding the internship. RESULTS: Between 2007 and 2017, there were 356 awardees of the American Association for Thoracic Surgery Summer Intern Scholarship. These awardees were from 41 different medical schools and went to 39 different sponsoring institutions. Ultimately, 55 (15.5%) medical students chose a career in cardiothoracic surgery, with 153 (43.0%) awardees deciding to pursue a surgical subspecialty. Of those who received our survey, 75 awardees responded (29.2%). A majority of the American Association for Thoracic Surgery Summer Interns were exposed to the sponsoring surgeon (98.7%, n = 74) and operating room (88.0%, n = 66) on at least a weekly basis during the 8-week internship. All of the respondents participated in basic science or clinical research at their sponsoring institution. Some 92.0% (n = 69) of the awardees highly recommended this scholarship to medical students interested in cardiothoracic surgery. CONCLUSIONS: The awardees of the American Association for Thoracic Surgery Summer Intern Scholarship come from a variety of medical schools and visited a diverse group of sponsoring institutions. The 8-week program provides valuable early exposure for medical students to cardiothoracic surgeons, the operating room, and research opportunities. This experience was highly recommended by prior recipients to medical students interested in cardiothoracic surgery.
Assuntos
Escolha da Profissão , Bolsas de Estudo/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Cirurgia Torácica/educação , Adolescente , Adulto , Feminino , Humanos , Masculino , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: We hypothesize that segmentectomy is associated with similar recurrence-free and overall survival when compared with lobectomy in the setting of patients with clinical T1cN0M0 non-small cell lung cancer (NSCLC; >2-3 cm), as defined by the American Joint Committee on Cancer 8th edition staging system. METHODS: We performed a single-institution retrospective study identifying patients undergoing segmentectomy (90) versus lobectomy (279) for T1c NSCLC from January 1, 2003, to December 31, 2016. Univariate, multivariable, and propensity score-weighted analyses were performed to analyze the following endpoints: freedom from recurrence, overall survival, and time to recurrence. RESULTS: Patients undergoing segmentectomy were older than patients undergoing lobectomy (71.5 vs 68.8, respectively, P = .02). There were no differences in incidence of major complications (12.4% vs 11.7%, P = .85), hospital length of stay (6.2 vs 7 days, P = .19), and mortality at 30 (1.1% vs 1.7%, P = 1) and 90 days (2.2% vs 2.3%, P = 1). In addition, there were no statistical differences in locoregional (12.2% vs 8.6%, P = .408), distant (11.1% vs 13.9%, P = .716), or overall recurrence (23.3% vs 22.5%, P = 1), as well as 5-year freedom from recurrence (68.6% vs 75.8%, P = .5) or 5-year survival (57.8% vs 61.0%, P = .9). Propensity score-matched analysis found no differences in overall survival (hazard ratio [HR], 1.034; P = .764), recurrence-free survival (HR, 1.168; P = .1391), or time to recurrence (HR, 1.053; P = .7462). CONCLUSIONS: In the setting of clinical T1cN0M0 NSCLC, anatomic segmentectomy was not associated with significant differences in recurrence-free or overall survival at 5 years. Further prospective randomized trials are needed to corroborate the expansion of the role of anatomic segmentectomy to all American Joint Committee on Cancer 8th Edition Stage 1A NSCLC.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonectomia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study is to examine the effects of the coronavirus disease 2019 (COVID-19) pandemic on adult lung transplants and report practice changes in the United States. METHODS: A retrospective analysis of a public dataset from the United Network for Organ Sharing was performed regarding adult lung transplantation (January 19, 2020-June 30, 2020). Data were stratified into 3 periods: pre-COVID-19 (January 19, 2020-March 14, 2020), first COVID-19 era (March 15, 2020-May 8, 2020), and second COVID-19 era (May 9, 2020-June 30, 2020). Weekly changes in waitlist inactivations (COVID-19 precautions or not), waitlist additions, transplant volume, and donor recovery were examined across eras and changes across era were correlated. RESULTS: During the first COVID-19 era, 301 patients were added to the waitlist, representing a 40% decrease when compared to the prior 8-week period. This was followed by a significant increase in listing during the second COVID-19 era (t = 2.16, P = 0.032). Waitlist inactivations decreased in the second COVID-19 era from the first COVID-19 era (t = 3.60, P < 0.001). There was no difference in waitlist inactivations between the pre-COVID era and the second COVID-19 era (P = 0.10). Weekly volume was not associated with trends in COVID-19 cases across any era, but was negatively associated with waitlist inactivations due to COVID-19 precautions entering the first COVID-19 era (r = -0.73, P = 0.04) and second COVID-19 era (r = -0.89, P = 0.003). CONCLUSIONS: Due to the COVID-19 pandemic, the United States experienced a decrease in lung transplant volume. While overall volume has returned to normal, additional studies are needed to identify areas of improvement to better prepare for future pandemics.
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COVID-19/epidemiologia , Transplante de Pulmão/tendências , SARS-CoV-2 , Estudos Transversais , Humanos , Transplante de Pulmão/estatística & dados numéricos , Estudos Retrospectivos , Doadores de Tecidos , Estados Unidos/epidemiologia , Listas de EsperaRESUMO
OBJECTIVE: Ascending thoracic aortic aneurysm (ATAA) in patients with bicuspid aortic valve (BAV) commonly dilate asymmetrically compared with patients with tricuspid aortic valve (TAV). This discrepancy in aneurysm geometry led us to hypothesize that microarchitectural differences underlie the observed asymmetric dilatation pattern. The purpose of this study was to characterize the microarchitectural distinctions of the extracellular matrix of the 2 phenotypes with a focus on the proportion of radially oriented elastin and collagen fibers in different circumferential aortic regions. METHODS: Aortic tissue rings were obtained just distal to the sinotubular junction from patients with BAV or TAV undergoing elective aneurysm repair. They were sectioned into three circumferentially based regions according to adjacent aortic sinus segment (left coronary sinus [L], right coronary sinus [R], or noncoronary sinus [N]). Multiphoton microscopy was used to quantify and characterize the number of radially oriented elastin and collagen fibers. RESULTS: There were fewer radially oriented fibers in medial region N and medial-intimal region R of BAV-ATAAs when compared with TAV-ATAAs (medial region N, amplitude of angular undulation of elastin = 10.67° ± 1.35° vs 15.58° ± 1.91°; P = .041; medial-intimal region R, amplitude of angular undulation of elastin = 9.83° ± 0.83° vs 14.72° ± 1.64°; P = .015). Conversely, fibers became more radially oriented in the medial-intimal region L of BAV-ATAA when compared with TAV-ATAA (amplitude of angular undulation of collagen = 18.67° ± 0.95° vs 14.56° ± 1.37°; P = .041). CONCLUSIONS: The differential pattern of fiber orientation noted between L and N-R regions help explain the unique pattern of greater curvature dilatation of BAV-ATAA. The distinctions noted in matrix microarchitecture may form the basis of differing aneurysm geometries and aortic wall integrities in ATAAs arising in these different valve morphologies.
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Aorta Torácica/patologia , Aneurisma da Aorta Torácica/etiologia , Valva Aórtica/anormalidades , Matriz Extracelular/ultraestrutura , Doenças das Valvas Cardíacas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Doença da Válvula Aórtica Bicúspide , Elasticidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
STUDY DESIGN: Reliability analysis based on expert panel case series review and grading per the Enneking and Weinstein-Boriani-Biagini classification systems. OBJECTIVE: To assess the reliability of the Enneking and Weinstein-Boriani-Biagini classification systems. SUMMARY OF BACKGROUND DATA: The Enneking and Weinstein-Boriani-Biagini (WBB) classifications were developed to stage and facilitate treatment planning in patients with primary spine tumors. To date, their interobserver and intraobserver reliability has not been assessed-a fundamental step in facilitating broader clinical and research use. METHODS: Clinical information, imaging studies, and biopsy results were compiled from 15 selected patients with primary spinal tumors. Eighteen spine surgeons independently estimated and scored the cases for Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, with a second assessment performed after random resorting of cases. Interobserver and intraobserver reliability of each category were assessed by percent agreement or proportional overlap. The Fleiss, Cohen, and Mezzich kappa statistics (kappa) were then applied, determined by the type of variable analyzed. RESULTS: The kappa statistics for interobserver reliability were 0.82, 0.22, 0.00, 0.57, 0.47, 0.31, 0.58, and 0.54 for the fields of Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, respectively. The kappa statistics for intraobserver reliability were 0.97, 0.53, 0.47, 0.82, 0.67, 0.63, 0.79, and 0.79 for the same respective fields. According to Landis and Koch, the ranges of kappa values of 0.00 to 0.20, 0.21 to 0.40, 0.41 to 0.60, 0.61 to 0.80, and >0.80 imply slight, fair, moderate, substantial, and near-perfect agreement, respectively. CONCLUSION: Results indicate moderate interobserver reliability and substantial and near-perfect intraobserver reliability for both the Enneking and WBB classification in terms of staging and guidance for treatment, despite a less than moderate interobserver reliability in interpreting the Enneking local tumor extension and WBB sector. Before incorporating the classifications in the clinical practice and research studies, further work is required to investigate the validity of the classifications.
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Estadiamento de Neoplasias/métodos , Neoplasias da Coluna Vertebral/patologia , Biópsia , Brasil , Canadá , Feminino , Humanos , Itália , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Variações Dependentes do Observador , Seleção de Pacientes , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Neoplasias da Coluna Vertebral/classificação , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Estados UnidosRESUMO
We compared 53 patients with Dengue shock syndrome (DSS) who received preventive transfusions with 53 who did not. Significant differences in the development of pulmonary edema and length of hospitalization (P<.05) and none in hemorrhage (P=.136) were observed. Preventive transfusions did not produce sustained improvements in the coagulation status in DSS.
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Transfusão de Sangue/métodos , Necessidades e Demandas de Serviços de Saúde , Dengue Grave/prevenção & controle , Transtornos da Coagulação Sanguínea/complicações , Criança , Feminino , Humanos , Masculino , Avaliação das Necessidades , Dengue Grave/complicações , Trombocitopenia/complicaçõesRESUMO
The purpose of this study was to identify the early indicators of hemorrhage in severe dengue infections in 114 patients; 24 patients had severe hemorrhage and 92 had no hemorrhage. The platelet counts were not predictive of bleeding. The duration of shock (OR, 2.11; 95% CI, 1.13 to 3.92; P =.019) and low-normal hematocrit at the time of shock (OR, 0.72; 95% CI, 0.55 to 0.95; P =.020) were risk factors of severe hemorrhage.