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Background The purpose of the study was to quantify the association between body weight and health by estimating the expected lifetime with and without diabetes (diabetes-free life expectancy) at age 30 and 65. In addition, the diabetes-free life expectancy was stratified by educational level. Methods Life tables by sex, level of education and obese/not obese were constructed using nationwide register data and self-reported data on body weight and height and diabetes from the Danish National Health Survey in 2021. Diabetes-free life expectancies were estimated by Sullivan's method. Results The difference in life expectancy between not obese 30-year-old men with a long and a short education was 5.7 years. For not obese women, the difference was 4.1 years. For obese men and women, the difference in life expectancy at age 30 was 7.0 and 5.2 years. Women could expect more years without and fewer years with diabetes than men regardless of body weight and educational level. Diabetes-free life expectancy differed by 6.9 years between not obese 30-year-old men with a short and a long education and by 7.7 years for obese men with a short and a long education. For women, the differences were 5.9 and 6.6 years. Conclusion The results demonstrate an association of obesity and educational level with life expectancy and diabetes-free life expectancy. There is a need for preventive efforts to reduce educational inequality in life expectancy and diabetes-free life expectancy. Structural intervention will particularly benefit overweight people with short education. [ABSTRACT FROM AUTHOR]

Introduction There is a substantial risk of developing stenosis and dysfunction in the arteriovenous fistula (AVF) in patients on hemodialysis (HD). Far infrared radiation (FIR) is a non-invasive local intervention with a potentially beneficial effect on AVF patency. The underlying mechanism is not clear. It was hypothesized that a single FIR treatment reduces factors of inflammation and promotes endothelial vasodilators in the AVF. Methods Forty HD patients with an AVF were included in an open-label intervention study. Patients were randomized to receive either FIR (FIR group) or no FIR (control group). Blood samples were drawn directly from the AVF and from a peripheral vein in the non-AVF arm before (T0) and 40 min after (T40) treatment during a HD session. The changes [median (interquartile range)] in circulating factors of inflammation, endothelial function and vasoreactivity during FIR were measured. Results In the AVF a single FIR treatment during dialysis resulted in a significantly diminished decrease in soluble vascular cell adhesion molecule, sVCAM [−31.6 (−54.3; 22.1) vs −89.9 (−121.6; −29.3), P  = .005] and soluble intercellular adhesion molecule, sICAM [−24.2 (−43.5; 25.3) vs −49 (−79.9; −11.6), P  = .02] compared with the control group. Other factors, such as interleukins, nitrite, nitrate and tumor necrosis factor 1, also declined during dialysis, but with no significant differences related to FIR in either the AVF or the non-AVF arm. Conclusion A single FIR treatment attenuated the decrease in sVCAM and sICAM in the AVF compared with a control group during HD. Findings do not support the hypothesis of a vaso-protective effect of FIR. The long-term effects of FIR on the AVF are unknown. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Aim The aim of this study is to develop a reliable composite score based on simulator metrics to assess competency in virtual reality video-assisted thoracoscopic surgery lobectomy and explore the benefits of combining it with expert rater assessments. METHODS Standardized objective assessments (time, bleeding, economy of movement) and subjective expert rater assessments from 2 previous studies were combined. A linear mixed model including experience level, lobe and the number of previous simulated procedures was applied for the repeated measurements. Reliability for each of the 4 assessments was calculated using Cronbach's alpha. The Nelder–Mead numerical optimization algorithm was used for optimal weighting of scores. A pass–fail standard for the composite score was determined using the contrasting groups' method. RESULTS In total, 123 virtual reality video-assisted thoracoscopic surgery lobectomies were included. Across the 4 different assessments, there were significant effects (P  < 0.01) of experience, lobe, and simulator experience, but not for simulator attempts on bleeding (P  = 0.98). The left upper lobe was significantly more difficult compared to other lobes (P = 0.02). A maximum reliability of 0.92 could be achieved by combining the standardized simulator metrics with standardized expert rater scores. The pass/fail level for the composite score when including 1 expert rater was 0.33. CONCLUSIONS Combining simulator metrics with 1 or 2 raters increases reliability and can serve as a more objective method for assessing surgical trainees. The composite score may be used to implement a standardized and feasible simulation-based mastery training program in video-assisted thoracoscopic surgery lobectomy. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The use of sealants is one of the methods available to reduce the occurrence of intraoperative air leaks. The objective of this modified Delphi survey among ESTS members is to understand the attitudes of clinicians to the optimal use of sealants in air leak management. METHODS To understand the attitudes of a wider sample of clinicians, a questionnaire was developed highlighting key issues through 37 statements. Respondents were invited to score their level of agreement with each. A modified Delphi methodology was used to review responses with a threshold of agreement for consensus of 75%. RESULTS A total of 258 responses were received (response rate 17%). Respondents agreed that prolonged air leaks are a common complication in thoracic surgery presenting a burden to the patient and increasing the costs of care. There is clear support for the use of sealants to reduce costs and improve the efficiency of healthcare provision and duration of chest tube use in selected high-risk patients with intraoperative air leak at the end of the lung surgery. Respondents also agreed that, due to often complex nature of thoracic surgery, sealants should be developed specifically for this application. CONCLUSION There is a clear role for sealants in the management of air leaks and certain surgical procedures demand their use (i.e. lung volume reduction surgery, decortication). This opinion-based consensus review helps to raise the debate about the burden of air leaks in thoracic surgery in order that this issue is recognized in practice and informs the optimal use of sealants in lung surgery. [ABSTRACT FROM AUTHOR]

Background Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father's manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption. Methods We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010–14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated ('upward levelling scenario'), using Population Attributable Fractions. Results Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father's manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small. Conclusions Disadvantages in material circumstances (low income), circumstances during childhood (father's manual occupation) and high body-weight contribute to inequalities in years with disability. [ABSTRACT FROM AUTHOR]

Background In 2013, Denmark implemented a reform that tightened the criteria for disability pension, expanded a subsidized job scheme ('flexi-job') and introduced a new vocational rehabilitation scheme. The overall aim of the reform was to keep more persons attached to the labour market. This study investigates the impact of the reform among persons with chronic disease and whether this impact differed across groups defined by labour market affiliation and chronic disease type. Methods The study was conducted as a register-based, nationwide cohort study. The study population included 480 809 persons between 40 and 64 years of age, who suffered from at least one of six chronic diseases. Hazard ratios (HR) and 95% confidence intervals (CI) of being awarded disability pension or flexi-job in the 5 years after vs. the 5 years prior to the reform were estimated. Results Overall, the probability of being awarded disability pension was halved after the reform (HR = 0.49, CI: 0.47–0.50). The impact was largest for persons receiving sickness absence benefits (HR = 0.31, CI: 0.24–0.39) and for persons with functional disorders (HR = 0.38, CI: 0.32–0.44). Also, the impact was larger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being awarded a flexi-job was decreased by one-fourth (HR = 0.76, CI: 0.74–0.79) with the largest impact for high-skilled persons working in non-manual jobs. Conclusion Access to disability pension and flexi-job decreased after the reform. This impact varied according to labour market affiliation and chronic disease type. [ABSTRACT FROM AUTHOR]

Aims The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes. Methods and results We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76–0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71–0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63–0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0–19.5). Conclusion The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]

View large Download slide View large Download slide OBJECTIVES The optimal level of suction on digital chest drainage devices after lobectomy using video-assisted thoracoscopic surgery (VATS) is unknown and varies between thoracic centres. In this randomized controlled trial, we assessed the potential benefits of low suction of –2 cmH2O compared to –10 cmH2O, using a digital drainage device. METHODS Two hundred and twenty-eight patients were randomized into 2 groups after VATS lobectomy for suspected or confirmed lung cancer. Primary outcome was time to chest drain removal. Drain data were obtained from the digital drainage devices, and patient data were obtained from medical records during admission, with a follow-up until postoperative day 30. RESULTS For the –2 cmH2O and –10 cmH2O groups, median (interquartile range) drainage duration was 27.4 h (23.3–71.2) and 47.5 h (24.5–117.8) (P  = 0.047), and the incidence of prolonged air leak >5 days was 14.4% and 24.3% (P  = 0.089), respectively. Median total fluid production was 566 h (329–1155) ml and 795 h (454–1605) ml (P  = 0.007). Median time to consistent air leak cessation (<20 ml/min) was 5.2 h (0.3–34.2) and 23.7 h (0.8–90.8) (P  < 0.001). There were no differences in the proportion or the size of the pneumothorax or subcutaneous emphysema after drain removal, and no differences were observed in postoperative morbidity. Median length of in-hospital stay was 2.0 days (2.0–5.8) and 3.0 days (2.0–9.0) (P  = 0.18). CONCLUSIONS A low suction level significantly shortened drainage duration, time to air leak cessation and total fluid production, without increasing morbidity. Clinical trial registration number NCT02911259. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to estimate life expectancy and the average lifetime with and without chronic disease among male never smokers, ex-smokers and smokers living in the West Bank of the occupied Palestinian territory. Methods: The study used a life table for the West Bank male population and Danish relative risk estimates for death for smokers and ex-smokers vs. never smokers and utilized data from the Palestinian Family Survey 2010. Expected lifetime with and without chronic disease was estimated and the contributions from the mortality and the morbidity effect to smoking related difference in average lifetime with and without chronic disease were assessed by decomposition. Results: In the West bank 40% of the male population are smokers. Life expectancy of 15-year-old Palestinian men who would never start smoking was 59.5 years, 41.1 of which were expected to be without chronic disease. Ex-smokers could expect 57.9 years of remaining lifetime, 37.7 years of which without disease. For lifelong heavy smokers (> 20 cigarettes per day), the expected lifetime was reduced to 52.6 years, of which 38.5 years were without chronic disease. Of the total loss of 6.9 years of life expectancy among heavy smokers, the mortality effect accounted for 2.5 years without and 4.4 years with disease, whereas the morbidity effect was negligible. Conclusions: The high prevalence of smoking causes a considerable loss of life years and lifetime without chronic disease. We recommend the Palestinian health authorities to enforce the antismoking law. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The optimal postoperative analgesic strategy after video-assisted thoracoscopic surgery lobectomy remains undetermined. We hypothesized that high-dose preoperative methylprednisolone (MP) would improve analgesia compared to placebo. METHODS: A total of 120 adult patients were randomized equally to 125 mg MP or placebo before the start of their elective video-assisted thoracoscopic surgery lobectomy. Group allocation was blinded to patients, investigators and caregivers, and all patients received standardized multimodal, opioid-sparing analgesia. Our primary outcome was area under the curve on a numeric rating scale from 0 to 10, for pain scores on the day of surgery and on postoperative days 1 and 2. Clinical follow-up was 2–3 weeks, and telephone follow-up was 12 weeks after surgery. RESULTS: Ninety-six patients were included in the primary analysis. Methylprednisolone significantly decreased median pain scores on the day of surgery: at rest (numeric rating scale 1.6 vs 2.0, P = 0.019) and after mobilization to a sitting position (numeric rating scale 1.7 vs 2.5, P = 0.004) but not during arm abduction and coughing (P = 0.052 and P = 0.083, respectively). Nausea and fatigue were reduced on the day of surgery (P = 0.04 and 0.03), whereas no outcome was improved on postoperative Days 1 and 2. Methylprednisolone did not increase the risk of complications but increased blood glucose levels on the day of surgery (P < 0.0001). CONCLUSIONS: High-dose preoperative MP significantly reduced pain at rest and after mobilization to a sitting position on the day of surgery, without later analgesic effects. Nausea and fatigue were improved without side effects, except transient higher postoperative blood glucose levels. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Lung cancer is the most common cause of cancer-related deaths worldwide. Survival is highly dependent on surgery. Videoassisted thoracoscopic surgery (VATS) is increasingly chosen over open thoracotomy (OT) because of the possible benefits of the minimally invasive approach. Consequently, our aim was to compare the 30-day morbidity and mortality for lung cancer patients operated by VATS lobectomy or lobectomy by OT. METHOD: Data were obtained from prospective national and regional databases, including patients who underwent lobectomy for lung cancer in the eastern part of Denmark from 1 January 2005 to 31 December 2011. All patients operated before 2009 were re-staged according to the latest International Association for the Study of Lung Cancer lung cancer classification. Patient characteristics, comorbidities, pathology and operative data were assessed using an independent samples t-test, Pearson's ?2, Fisher's exact test and Mann-Whitney test. Morbidity was assessed using multinomial logistic regression adjusted for gender, age, cancer stage, forced expiratory volume in 1 s (FEV1), year of surgery and Charlson comorbidity score. RESULTS: In total, 1379 patients underwent lobectomy, 785 patients via VATS and 594 patients via thoracotomy. The two groups were similar in gender and FEV1. The patients operated by VATS were older (P < 0.001), and had a lower Charlson comorbidity score (P = 0.034), higher frequency of adenocarcinomas (P < 0.001) and lower cancer stage (P < 0.001). Among the VATS patients, 285 (36.3%) and among the thoracotomy patients, 288 (48.5%) had minor complications (P < 0.001); and 157 (20.0%) VATS patients and 212 (35.7%) thoracotomy patients had major complications (P < 0.001). The 30-day mortality rate was 1% in the VATS group and 1.5% in the thoracotomy group (P = 0.47). Multinomial logistic regression analysis showed that the prevalence of both minor [odds ratio (OR) = 1.51; 95% confidence interval (Cl) = 1.18-1.96] and major complications (OR = 1.91, 95% Cl = 1.44-2.53) was significantly higher for patients who underwent lobectomy via thoracotomy compared with VATS. CONCLUSION: Patients undergoing lobectomy via VATS were less likely to have at least one minor complication within the first 30 postoperative days and less likely to have at least one major complication, compared with patients operated by thoracotomy. These findings remained after adjusting for gender, age, FEV1, cancer stage, year of surgery and Charlson comorbidity score. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Video-assisted thoracoscopic anatomical resections are increasingly used in Europe to manage primary lung cancer. The purpose of this study was to compare the outcome following thoracoscopic versus open lobectomy in case-matched groups of patients from the European Society of Thoracic Surgeon (ESTS) database. METHODS: All patients having lobectomy as the primary procedure via thoracoscopy [video-assisted thoracoscopic surgery (VATS)-L)] or thoracotomy (TH-L) were identified in the ESTS database ( January 2007 to December 2013). A propensity score was constructed using several patients’ baseline characteristics. The matching using the propensity score was responsible for the minimization of selection bias. A propensity score-matched analysis was performed to compare the incidence of postoperative major complications (according to the ESTS database definitions) and mortality at hospital discharge between the matched groups. After exclusions, 28 771 patients were identified: 26 050 having thoracotomy and 2721 having thoracoscopy. Propensity score yielded two well-matched groups of 2721 patients. Numeric variables were compared by Student’s t-tests and categorical variables were compared by McNemar’s tests. RESULTS: Compared with TH-L, VATS-L was associated with a lower incidence of total complications [n = 792 (29.1%) vs 863 (31.7%), P = 0.0357], major cardiopulmonary complications [n = 316 (15.9%) vs 435 (19.6%), P = 0.0094], atelectasis requiring bronchoscopy [n = 65 (2.4%) vs 150 (5.5%), P < 0.0001], initial ventilation >48 h [n = 18 (0.7%) vs 38 (1.4%), P = 0.0075] and wound infection [n = 6 (0.2%) vs 17 (0.6%), P = 0.0218]. There was no difference in the incidence of postoperative atrial fibrillation between the two groups (P = 0.14). Postoperative hospital stay was 2 days shorter in the VATS-L patients (mean: 7.8 vs 9.8 days; P = 0.0003). In terms of outcome at hospital discharge, there were 27 deaths in the VATS-L group (1%) versus 50 in the TH-L group (1.9%, P = 0.0201). CONCLUSIONS: Data from the ESTS database confirmed that lobectomy performed through VATS is associated with a lower incidence of complications compared with thoracotomy. [ABSTRACT FROM AUTHOR]

Background. If blood pressure (BP) falls during haemodialysis (HD) [intradialytic hypotension (IDH)] a common clinical practice is to reduce the extracorporeal blood flow rate (EBFR). Consequently the efficacy of the HD (Kt/V) is reduced. However, only very limited knowledge on the effect of reducing EBFR on BP exists and data are conflicting. The aimof this study was to evaluate the effect and the potential mechanism(s) involved by investigating the impact of changes in EBFR on BP, pulse rate (PR) and cardiac output (CO) in HD patients with arteriovenous-fistulas (AV-fistulas). Methods. We performed a randomized, crossover trial in 22 haemodynamically stable HD patients with AV-fistula. After a conventional HD session each patient was examined during EBFR of 200, 300 and 400 mL/min in random order. After 15 min when steady state was achieved CO, BP and PR were measured at each EFBR, respectively. Results. Mean (SD) agewas 71 (11) years. Systolic BPwas significantly higher at an EBFR of 200 mL/min as compared with 300 mL/min [133 (23) versus 128 (24) mmHg; P < 0.05], but not as compared with 400 mL/min [133 (23) versus 130 (19) mmHg; P = 0.20].At EBFRof 200, 300 and 400 mL/min diastolic BP, mean arterial pressure, PR and CO remained unchanged. Conclusion. Our study does not show any consistent trend in BP changes by a reduction in EBFR. Reduction in EBFR if BP falls during IDH is thus not supported. However, none of the patients experienced IDH. Further studies are required to evaluate the impact of changes in EBFR on BP during IDH. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections. METHODS: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS. Conversions to thoracotomy, vascular injuries and major intraoperative complications were studied in relation to surgeons' experience. Major complications included immediate life-threatening complications (i.e. blood loss of more than 2 l), injury to proximal airway or other organs or those leading to unplanned additional anatomical resections. All cases were discussed by a panel and recommendations were drafted. RESULTS: A total of 3076 patients were registered. Most resections (90%, n = 2763) were performed for bronchial carcinoma. There were 3 intraoperative deaths, including 1 after conversion for technical reasons. In-hospitalmortality was 1.4% (n = 43). Conversion to open thoracotomy was observed in 5.5% (n = 170), of whom 21.8% (n = 37) were for oncological reasons, 29.4% (n = 50) for technical reasons and 48.8% (n = 83) for complications. Vascular injuries were reported in 2.9% (n = 88) patients and led to conversion in 2.2% (n = 70). In 1.5% (n = 46), major intraoperative complications were identified. These consisted of erroneous transection of bronchovascular structures (n = 9); injuries to gastrointestinal organs (n = 5) or proximal airway (n = 6); complications requiring additional unplanned major surgery (n = 9) or immediate life-threatening complications (n = 17). Twenty-three percent of the in-hospital mortalities (n = 10/43) were related to major intraoperative complications. Eight pneumonectomies (five intraoperative and three postoperative at 0.3%) were a consequence of a major complication. Surgeon's experience was related to non-oncological conversions, but not to vascular injuries or major complications in a multivariable logistic regression analysis. CONCLUSION: Major intraoperative complications during VATS anatomical lung resections are infrequent, seem not to be related to surgical experience but have an important impact on patient outcome. Constant awareness and a structured plan of action are of paramount importance to prevent them. [ABSTRACT FROM AUTHOR]

Background: Smoking reduces life years in good health but it is unclear how education modifies the impact of smoking. We hypothesize that the vulnerability of the effect of smoking on health expectancy decreases with educational level in both genders and examine the contributions of mortality and health effects. Methods: Life tables by educational level and smoking category were constructed from registers and survey data. For each educational level, difference in expected lifetime in self-rated good and poor health between 30-year-old never smokers and smokers were estimated and decomposed into contributions from mortality and health status. Results: Difference in expected lifetime in good health between never smokers and smokers decreased with educational level for women but increased for men. Thus, the differences between never smokers and heavy smokers among 30-year-old women with a low, medium and high educational level were 12.9, 8.9 and 4.1 years, respectively. In contrast, the differences between male never smokers and heavy smokers with a low, medium and high educational level were 10.3, 11.4 and 14.3 years, respectively. Regardless of educational level, the mortality effect increased by exposure to smoking but the effect of health status increased by educational level for men and decreased for women. Conclusion: The social differential vulnerability to the effect of smoking differed between genders. Thus, whereas smoking had a substantial effect on health among women with a low educational level the pattern for men was opposite because the health gain for never smokers was greatest for men with a high education. [ABSTRACT FROM AUTHOR]

Aim The MITOCARE study evaluated the efficacy and safety of TRO40303 for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). Methods Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303 (n = 83) or placebo (n = 80) via i.v. bolus injection prior to balloon inflation during primary percutaneous coronary intervention in a double-blind manner. The primary endpoint was infarct size expressed as area under the curve (AUC) for creatine kinase (CK) and for troponin I (TnI) over 3 days. Secondary endpoints included measures of infarct size using cardiac magnetic resonance (CMR) and safety outcomes. Results The median pain-to-balloon time was 180 min for both groups, and the median (mean) door-to-balloon time was 60 (38) min for all sites. Infarct size, as measured by CK and TnI AUCs at 3 days, was not significantly different between treatment groups. There were no significant differences in the CMR-assessed myocardial salvage index (1-infarct size/myocardium at risk) (mean 52 vs. 58% with placebo, P = 0.1000), mean CMR-assessed infarct size (21.9 g vs. 20.0 g, or 17 vs. 15% of LV-mass) or left ventricular ejection fraction (LVEF) (46 vs. 48%), or in the mean 30-day echocardiographic LVEF (51.5 vs. 52.2%) between TRO40303 and placebo. A greater number of adjudicated safety events occurred in the TRO40303 group for unexplained reasons. Conclusion This study in STEMI patients treated with contemporary mechanical revascularization principles did not show any effect of TRO40303 in limiting reperfusion injury of the ischaemic myocardium. [ABSTRACT FROM PUBLISHER]

Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncological lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy; however, there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques with regard to effect on acute postoperative pain following VATS, with emphasis on VATS lobectomy. The systematic review of PubMed, The Cochrane Library and Embase databases yielded 1542 unique abstracts; 17 articles were included for qualitative assessment, of which three were studies on VATS lobectomy. The analgesic techniques included TEA, multilevel and single PVB, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. Overall, the studies were heterogeneous with small numbers of participants. In comparative studies, TEA and especially PVB showed some effect on pain scores, but were often compared with an inferior analgesic treatment. Other techniques showed no unequivocal results. No clear gold standard for regional analgesia for VATS could be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented. [ABSTRACT FROM AUTHOR]

OBJECTIVE To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe. METHODS A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists. RESULTS Criteria regarding definition and scope of GTS, structure and qualification of GTS unit, training and education and recommendations for subjects of particular interest (lung transplant, oesophageal surgery, minimally invasive thoracic surgery, quality surveillance) were developed. CONCLUSIONS This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programmes. [ABSTRACT FROM AUTHOR]

OBJECTIVE Video-assisted thoracoscopic surgery (VATS) lobectomy has been gradually accepted as an alternative surgical approach to open thoracotomy for selected patients with non-small-cell lung cancer (NSCLC) over the past 20 years. The aim of this project was to standardize the perioperative management of VATS lobectomy patients through expert consensus and to provide insightful guidance to clinical practice. METHODS A panel of 55 experts on VATS lobectomy was identified by the Scientific Secretariat and the International Scientific Committee of the ‘20th Anniversary of VATS Lobectomy Conference—The Consensus Meeting’. The Delphi methodology consisting of two rounds of voting was implemented to facilitate the development of consensus. Results from the second-round voting formed the basis of the current Consensus Statement. Consensus was defined a priori as more than 50% agreement among the panel of experts. Clinical practice was deemed ‘recommended’ if 50–74% of the experts reached agreement and ‘highly recommended’ if 75% or more of the experts reached agreement. RESULTS Fifty VATS lobectomy experts (91%) from 16 countries completed both rounds of standardized questionnaires. No statistically significant differences in the responses between the two rounds of questioning were identified. Consensus was reached on 21 controversial points, outlining the current accepted definition of VATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSION The present Consensus Statement represents a collective agreement among 50 international experts to establish a standardized practice of VATS lobectomy for the thoracic surgical community after 20 years of clinical experience. [ABSTRACT FROM AUTHOR]

OBJECTIVES In fast-track pulmonary resections, we removed chest tubes after video-assisted thoracic surgery (VATS) lobectomy with serous fluid production up to 500 ml/day. Subsequently, we evaluated the frequency of recurrent pleural effusions requiring reintervention. METHODS Data from 622 consecutive patients undergoing VATS lobectomy from January 2009 to December 2011 were registered prospectively in an institutional database. Data included age, gender, lobe(s) resected, bleeding and duration of surgery. Follow-up was 30 days from discharge. All complications requiring pleurocentesis or reinsertion of a chest tube, and all readmissions were registered. Twenty-three patients were excluded due to missing data, in-hospital mortality and loss to follow-up, leaving 599 for final analysis. Our primary outcome was the number of patients requiring reintervention due to recurrent pleural effusion. Secondary outcomes included time of chest tube removal and time to discharge. The incidence of recurrent pleural effusions requiring reintervention was compared between three groups according to the postoperative day (POD) of chest tube removal (Day 0–1, 2–3 and ≥4, respectively) using Fisher's exact test. RESULTS Pleural effusion after chest tube removal required reintervention in 17 patients (2.8%). Of these, 7 needed readmission. Median time from surgery to chest tube removal was 2 days, and median time from surgery to discharge was 4 days. No statistically significant association was found between the incidence of reinterventions due to recurrent pleural effusion and the POD of chest tube removal (P = 0.50). The median time from chest tube removal to discharge was 1 day in all groups. Of the patients who needed reintervention, none had complications regarding this, except one who developed pneumothorax after pleurocentesis. CONCLUSIONS Our findings suggest that chest tube removal after VATS lobectomy is safe despite volumes of serous fluid production up to 500 ml/day. The proportion of patients who developed pleural effusion necessitating reintervention was low (2.8%), and a complication of the reintervention was seen in only 1 patient. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon. Methods: Data were obtained from a prospectively registered surgical database consisting of 262 consecutively intended VATS lobectomies. A single consultant performed 212 intended VATS lobectomies. His first 50 intended VATS lobectomies were excluded, as they were considered to be his learning curve, leaving 162 intended VATS lobectomies, of which 12 were converted to open lobectomy, performed from January 2005 to April 2008. Fifty intended VATS lobectomies were performed by a consultant in a training programme for VATS lobectomies, of which three were converted to open lobectomy from April 2007 to April 2008. The training consultant was experienced in open thoracic surgery and had performed more than 200 minor VATS procedures prior to the training programme. The surgical data and outcome between the 47 VATS lobectomies were compared with the 150 VATS lobectomies performed by the experienced consultant using statistical analysis. Results: There were significantly better results for the training consultant regarding prolonged air leak, chest tube duration and length of stay, which probably reflects the careful selection of the patients favouring the training consultant. The operation time was significant longer for the consultant in training (p <0.0001). Conclusions: With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p <0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy. [Copyright &y& Elsevier]

Background: policy makers face increasing demands for care of the aged and therefore need more information about the health status of very old people. The purpose of this study was to quantify the average lifetime according to health status among the oldest olds in Denmark. Methods: the 2,258 participants (63% of all survivors) in the 1905 Danish cohort survey were interviewed in 1998 and re-assessed in 2000, 2003 and 2005, Lifetime according to self-rated health status, physical independence and being cognitively intact was estimated. Physical independence was defined as the ability to get up from a chair or bed, walk around the house and go to the toilet, and being cognitively intact was defined as having a Mini-Mental State Examination score >22. Results: the average lifetime between ages 92 and 100 was 2.7 years for men and 3.3 years for women, of which almost half was in self-rated good health. The lifetime in physical independence was 2.0 years for men and 2.4 years for women, and both men and women spent an average of 1.1 years in a state of physical independence without cognitive impairment. Conclusion: even at ages 92-93, a substantial proportion of the remaining lifetime is spent in reasonably good health. [ABSTRACT FROM AUTHOR]

Background: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. Methods: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. Results: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. Conclusion: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. [ABSTRACT FROM AUTHOR]

Some methods for the evaluation of parameter constancy in cointegrated vector autoregressive (VAR) models are discussed. Two different ways of re-estimating the VARmodel are proposed; one in which all parameters are estimated recursively based upon the likelihood function for the first observations, and another in which the cointegrating relations are estimated recursively from a likelihood function, where the short-run parameters have been concentrated out. We suggest graphical procedures based on recursively estimated eigenvalues to evaluate the constancy of the long-run parameters in the model. Specifically, we look at the time paths of the eigenvalues using a new result on the asymptotic distribution of the estimated eigenvalues. Furthermore, we show that the fluctuation test by Ploberger et al. (1989) and the Lagrange multiplier (LM) type test for constancy of parameters by Nyblom (1989) can be applied to test the constancy of the long-run parameters in the cointegrated VAR-model. All results are illustrated using a model for the term structure of interest rates on US Treasury securities. [ABSTRACT FROM AUTHOR]

Hansen H L (Institute of Maritime Medicine, South Jutland University Centre, Esbjerg, Denmark), Pedersen G. Influence of occupational accidents and deaths related to lifestyle on mortality among merchant seafarers. International Journal of Epidemiology 1996; 25: 1237–1243.Objectives The aim of the present historical cohort study was to enhance the understanding of the unusual mortality pattern seen among seafarers. The main object was to describe the mortality pattern of Danish seafarers in recent years with special reference to the influence of accidents in the maritime workplace and ashore and the influence of diseases related to lifestyle. Subjects A cohort of 24 132 male seafarers of all job categories employed on a Danish merchant ship between 1986 and 1993, was followed up. Mortality among those who left the occupation before the end of the follow-up period was analysed separately. Results The standardized mortality ratio was 1.43 (95% Cl: 1.33–1.54) from all causes and 3.05 (95% Cl : 2.62–3.52) from accidents. An excess mortality from natural causes was attributable mostly to an excess among deck and engine room crew and was mainly caused by diseases related to lifestyle. While active as seafarers, the SMR for accidents was 2.62 (95% Cl: 2.12–3.20), accidents at the workplace explaining almost half the deaths. Among those who left shipping, the risk of fatal accidents increased. All categories of seafarers continued to have a high risk of fatal accidents into older age. Conclusion Merchant seafarers were shown to have a higher mortality than the general population. Despite a very high risk of fatal accidents in the workplace, these accidents could only explain a proportion of the observed excess mortality. Accidents ashore and diseases related to lifestyle factors such as drinking and smoking made a major contribution to the obeserved excess mortality. The results indicate that people in occupations with a high risk of fatal accidents at the workplace also seem to have a high risk of accidents away from the workplace after leaving the occupation. The high risk lifestyle seems to be linked to lifestyle in general and hence the related diseases and high risk of death. [ABSTRACT FROM PUBLISHER]

An introduction to articles in this issue is presented including traditional treatment algorithms in thoracic surgery, Double lumen intubation and video-assisted thoracoscopic surgery.

Haemodialysis (HD) treatment for end-stage renal disease bears a poor prognosis. We present a case of a patient who, apart from two transplant periods lasting 8 months in all, was treated with conventional in-centre HD three times a week and who survived for 41 years. Patients should be aware that there is no theoretical upper limit for patient survival on HD. [ABSTRACT FROM PUBLISHER]

Background: The purpose of the study was to determine trends in social inequality in mortality and life expectancy in Denmark. Methods: The study was based on register data on educational level and mortality during the period 1981-2005 and comprised all deaths among Danes aged 30-60. Sex- and age-specific death rates for each of three levels of education were calculated and age-standardized to allow comparisons over time and between groups. As data obtained since 1996 included ages up to 74, partial life expectancy (i.e. expected lifetime of 30-year-olds before the age of 75) was calculated for the period 1996-2005. Results: Between 1981 and 2005, the difference in death rates between people aged 30-60 with low and high educational level increased by two-thirds for men and was doubled for women. During the period 1996-2005, the gap in partial life expectancy from age 30 to 75 between people with low and high educational level increased by 0.3 years. Conclusion: During the past 25 years, the social gap in mortality has widened in Denmark. In particular, women with a low educational level have been left behind. [ABSTRACT FROM AUTHOR]

The present paper re-examines the effectiveness of foreign aid theoretically and empirically. Using a standard OLG model we show that aid inflows will in general affect long-run productivity. The size and direction of the impact may depend on policies, ‘deep’ structural characteristics and the size of the inflow. The empirical analysis investigates these possibilities. Overall we find that aid has been effective in spurring growth, but the magnitude of the effect depends on climate-related circumstances. Finally, we argue that the Collier-Dollar allocation rule should be seriously reconsidered by donor agencies if aid effectiveness is related to climate. [ABSTRACT FROM AUTHOR]

OBJECTIVES No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area. METHODS Prospective observational cohort. Forty-eight consecutive patients received a standardized regimen consisting of paracetamol, non-steroidal anti-inflammatory drug and gabapentin. Further, surgeons performed a single-shot paravertebral block (PVB) at five levels (15 ml of 0.5% bupivacaine) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h−1. Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. RESULTS Forty-eight patients, mean age 64 years (CI: 61–68), were included. The mean time for the PVB and ICC placement was 5 min (CI: 4.7–5.9). The mean pain score at rest using a numerical rating scale (NRS, 0–10) was <3 for 1–16 h and decreased from 4.7 to 1.7 (NRS day 1–4, getting out of bed). The ICC was removed with the drain in 48/73/92% on day 1/2/3 after surgery. The median day of discharge was 3 (interquartile range 2–4) with >85% of patients reporting satisfactory or very satisfactory pain treatment all days. CONCLUSIONS Acute pain after VATS lobectomy may be adequately controlled using a multimodal non-opioid regime including PVB and an ICC. The low pain scores and reduced time used inserting the ICC may present an alternative to continuous epidural analgesia or conventional PVB. [ABSTRACT FROM AUTHOR]