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Objective To investigate the effect of intravenous lidocaine on postoperative atrial fibrillation, IL-6 and IL-10 levels in patients undergoing cardiac surgery. Methods Sixty patients scheduled for cardiac surgery requiring cardiopulmonary bypass, were randomly divided into two groups based on computer-generated randomized assignments： lidocaine group （Group L, n = 30） and control group （Group C, n = 30）. Patients in Group L received three-phase intravenous lidocaine infusion regimen as follows： upon induction of general anesthesia, a bolus of intravenous lidocaine 1.5 mg/kg was given over a minimum of 5 min; subsequently, lidocaine 2.3 mg/（kg·h） was infused for the first 3 h; lidocaine was then reduced to 0.8 mg/（kg·h） and discontinued 24 h postoperatively. Patients in Group C received intravenous saline infusion. The bolus amounts and infusion rates were identical to those in Group L. Blood samples were collected before, at the end of surgery and 24 h after surgery for measurement of IL-6 and IL-10 levels. The episode of new onset of atrial fibrillation and the development of cardiovascular events after surgery were recorded. Results Compared with preoperative levels, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly higher （all P < 0.01）. Compared with Group C, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly lower in Group L （P < 0.05 or P < 0.01）. In Group C, postoperative extubation time was （15.9±3.6） h, significantly longer than （12.2±4.7） h in Group L （P < 0.01）. Compared with Group C, the incidence of postoperative atrial fibrillation tended to decline in Group L（10% vs. 24%, P > 0.05）. Conclusions Perioperative intravenous infusion of lidocaine could decrease postoperative serum IL-6 and IL-10 levels, shorten tracheal extubation time and lower the risk of postoperative atrial fibrillation.

Mechanical ventilation is an important life-saving therapy for general anesthesia and critically ill patients, but ventilation itself may be accompanied with lung injury. Ventilator-induced lung injury (VILI) exacerbates pre-existing lung disease, leading to poor clinical outcomes. Especially for patients undergoing cardiothoracic surgery and receiving one-lung ventilation (OLV), optimizing the parameters of OLV is closely related to their prognosis. It is not clear what is the best strategy to minimize VILI through adjusting ventilation parameters, including tidal volume, positive end expiratory pressure and driving pressure, etc. Different parameters, in combination, are responsible for VILI. Protective ventilation strategies, aiming to reduce postoperative pulmonary complications, have been discussed in many clinical studies and different opinions have been raised. This review addresses the pathogenesis of VILI and focus on the OLV management and better protective OLV strategies during thoracic surgery. [ABSTRACT FROM AUTHOR]

Objective: The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. Methods: The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant–Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t‐tests was used for follow‐up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant–Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. Results: There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant–Murley shoulder function score at the last follow‐up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). Conclusion: A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture. [ABSTRACT FROM AUTHOR]

Delayed extubation was commonly associated with increased adverse outcomes. This study aimed to explore the incidence and predictors and to construct a nomogram for delayed extubation after thoracoscopic lung cancer surgery. We reviewed medical records of 8716 consecutive patients undergoing this surgical treatment from January 2016 to December 2017. Using potential predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal validation. For external validation, we additionally pooled 3676 consecutive patients who underwent this procedure between January 2018 and June 2018. Extubation performed outside the operating room was defined as delayed extubation. The rate of delayed extubation was 1.60%. Multivariate analysis identified age, BMI, FEV1/FVC, lymph nodes calcification, thoracic paravertebral blockade (TPVB) usage, intraoperative transfusion, operative time and operation later than 6 p.m. as independent predictors for delayed extubation. Using these eight candidates to develop a nomogram, with a concordance statistic (C-statistic) value of 0.798 and good calibration. After internal validation, similarly good calibration and discrimination (C-statistic, 0.789; 95%CI, 0.748 to 0.830) were observed. The decision curve analysis (DCA) indicated the positive net benefit with the threshold risk range of 0 to 30%. Goodness-of-fit test and discrimination in the external validation were 0.113 and 0.785, respectively. The proposed nomogram can reliably identify patients at high risk for the decision to delayed extubation after thoracoscopic lung cancer surgery. Optimizing four modifiable factors including BMI, FEV1/FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation. This study identified eight independent predictors for delayed extubation, among which lymph node calcification and anaesthesia type were not commonly reported. Using these eight candidates to develop a nomogram, we could reliably identify high-risk patients for the decision to delayed extubation. Optimizing four modifiable factors, including BMI, FEV1/FVC, TPVB usage, and operation later than 6 p.m. may reduce the risk of delayed extubation. [ABSTRACT FROM AUTHOR]

Despite the significant improvement in the survival rate of cancer patients, the total cure of bone cancer is still a knotty clinical challenge. Traditional surgical resectionof bone tumors is less than satisfactory, which inevitably results in bone defects and the inevitable residual tumor cells. For the purpose of realizing minimal invasiveness and local curative effects, photothermal therapy (PTT) under the irradiation of near-infrared light has made extensive progress in ablating tumors, and various photothermal therapeutic agents (PTAs) for the treatment of bone tumors have thus been reported in the past few years, has and have tended to focus on osteogenic bio-scaffolds modified with PTAs in order to break through the limitation that PTT lacks, osteogenic capacity. These so-called bifunctional scaffolds simultaneously ablate bone tumors and generate new tissues at the bone defects. This review summarizes the recent application progress of various bifunctional scaffolds and puts forward some practical constraints and future perspectives on bifunctional scaffolds for tumor therapy and bone regeneration: two hawks with one arrow. [ABSTRACT FROM AUTHOR]

Simple Summary: Operative duration is considered an important predictor of poor prognosis in several surgical specialties; however, for patients receiving thoracoscopic lung cancer surgery, whether this association remains, and what the trigger point of operative duration contributing to a dramatic increase in adverse perioperative outcomes (APOs) and a significant decrease in early discharge is, is unknown. This retrospective cohort study included 12,392 patients who underwent this surgical treatment and explored the continuous relationship of operative duration with risk of the six most common APOs and early discharge using restricted cubic spline (RCS). The results showed that the risk of APOs exponentially increases as the operative duration exceeds 90 min, accompanied by a significant decrease in the likelihood of early discharge, indicating that shortening the operative duration to less than 90 min may be an important adjustable factor to greatly reduce APOs and accelerate early discharge. Background: For thoracoscopic lung cancer surgery, the continuous relationship and the trigger point of operative duration with a risk of adverse perioperative outcomes (APOs) and early discharge remain unknown. Methods: This study enrolled 12,392 patients who underwent this surgical treatment. Five groups were stratified by operative duration: <60 min, 60–120 min, 120–180 min, 180–240 min, and ≥240 min. APOs included intraoperative hypoxemia, delayed extubation, postoperative pulmonary complications (PPCs), prolonged air leakage (PAL), postoperative atrial fibrillation (POAF), and transfusion. A restricted cubic spline (RCS) plot was used to characterize the continuous relationship of operative duration with the risk of APOs and early discharge. Results: The risks of the aforementioned APOs increased with each additional hour after the first hour. A J-shaped association with APOs was observed, with a higher risk in those with prolonged operative duration compared with those with shorter values. However, the probability of early discharge decreased from 0.465 to 0.350, 0.217, and 0.227 for each additional hour of operative duration compared with counterparts (<60 min), showing an inverse J-shaped association. The 90 min procedure appears to be a tipping point for a sharp increase in APOs and a significant reduction in early discharge. Conclusions: Our findings have important and meaningful implications for risk predictions and clinical interventions, and early rehabilitation, for APOs. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer-induced bone pain commonly occurs in patients with bone tumors or bone metastases, and in recent years, central nervous system hyperalgesia has received increasing attention. In the present study, we confirmed STING pathways may activate M1 microglia in the mPFC after cancer-induced bone pain. C-176 treatment to inhibit STING can effectively relieve cancer-induced bone pain and pain-related anxiety. In addition, in vivo or in vitro, we both found that C-176 can significantly promote the polarization of M2 microglia and inhibit M1 microglia, which provides a new direction in the treatment of cancer-induced bone pain. The medial prefrontal cortex (mPFC) is the main cortical area for processing both sensory and affective aspects of pain. Recently, mPFC was reported to participate in cancer-induced bone pain (CIBP) via the mechanism of central inflammation. STING is a key component of neuroinflammation in the central neuron system by activating downstream TBK1 and NF-κB signaling pathways. We aimed to investigate whether STING regulated neuroinflammation in the mPFC in rat models of CIBP. It is worth noting that we found a significant upregulation of STING in the mPFC after CIBP, accompanied by activation of TBK1 and NF-κB signaling pathways. In addition, pain and anxiety-like behaviors were alleviated by intraperitoneal injection of the STING inhibitor C-176. Furthermore, in microglia GMI-R1 cells, C-176 reversed LPS-induced M1 polarization. Collectively, this evidence indicated that STING may contribute to cancer-induced bone pain by activating TBK1 and NF-κB, and by promoting M1 polarization of microglia in the mPFC. [ABSTRACT FROM AUTHOR]

Background: The association between elevated body mass index (BMI) and perioperative and oncological outcomes among elderly patients undergoing minimally invasive McKeown esophagectomy (MIE) remains unclear. Methods: We performed a single‐center retrospective analysis of 526 consecutive patients aged 65 years or older who underwent MIE for esophageal squamous cell carcinoma (SCC) between January 2016 and December 2019. Two groups were stratified by BMI: normal (18.5 ≤ BMI < 24 kg/m2) and elevated groups (BMI ≥ 24 kg/m2). A 1:1 propensity score matching (PSM) analysis was used to compare perioperative and oncological outcomes between the two groups. Results: A total of 480 elderly patients were eventually enrolled, with a mean age of 70.2 years (range: 65–87), and 185 patients were eligible for elevated BMI, with a mean BMI of 26.3 ± 1.9 kg/m2. Compared with the normal BMI group, the elevated BMI group had prolonged operation time (261.7 ± 57.2 vs. 278.9 ± 62.7 mins, p = 0.002) and increased incidence of intraoperative hypoxemia (12.2% vs. 21.6%, p = 0.006). The differences in intraoperative estimated blood loss, transfusion, new‐onset arrhythmia, and conversion rates and postoperative outcomes regarding pulmonary and surgical complications, intensive care unit and 30‐day readmissions, the length of hospital stay, and oncological outcomes regarding R0 dissection, and the number of dissected lymph nodes between two groups were comparable. After a 1:1 PSM analysis, there was no significant difference in both perioperative and oncological outcomes between two groups. Conclusions: Among elderly patients undergoing MIE for esophageal SCC, there was insufficient evidence to demonstrate that elevated BMI could increase perioperative and oncological adverse outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between obesity status and perioperative outcomes in elderly patients undergoing thoracoscopic anatomic lung cancer surgery. Methods: From January 2016 to December 2018, we performed a monocentric retrospective cohort study among 4164 consecutive patients aged 65 years or older who underwent thoracoscopic anatomic lung cancer surgery at Shanghai Chest Hospital. Two groups were stratified by body mass index (BMI): nonobese (BMI<28kg/m2) and obese status (BMI≥28kg/m2). Using a 1:1 propensity score matching (PSM) analysis to compare perioperative outcomes between two groups. Results: 4035 older patients were eventually enrolled, with a mean age of 69.8 years (range: 65-87), and 305 patients were eligible for obese status, with a mean BMI of 29.8 ± 1.7kg/m2. Compared with nonobese patients, obese patients were more likely to have higher rates of intraoperative hypoxemia (1.2% vs 3.9%, P=0.001) and new-onset arrhythmia (2.3% vs 4.3%, P=0.034). The difference in intraoperative transfusion and conversion rates and postoperative outcomes regarding pulmonary complications, new-onset arrhythmia, transfusion, length of hospital stay, 30-day readmission and hospitalization costs between two groups were not significant (P>0.05). After a 1:1 PSM analysis, the difference in both intraoperative and postoperative complications among two groups were not significant (P>0.05). In subgroup analysis, patients with BMI≥30kg/m2 had a similar incidence of perioperative complications compared to patients with BMI between 28 and 30 kg/m2 (P>0.05). Conclusions: Our research data support evidence for "obesity paradox" and also contribute the growing body of evidence that obesity in older patients should not exclude candidates for thoracoscopic anatomic lung cancer surgery. [ABSTRACT FROM AUTHOR]

Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery is a major concern and can be associated with increased adverse outcomes. Therefore, this study was conducted to identify any possible clinical risk factors and related outcomes. This monocentric retrospective study was conducted between January 2016 and December 2018 and included 20,565 consecutive patients who were undergoing thoracoscopic lung operations. Planned thoracotomy, complete pneumonectomies, angioplastic or bronchoplastic or chest wall resections, bilateral lung resections, or cases with missing data were excluded. Univariate and multivariate analyses were performed to identify risk factors for conversion to thoracotomy. A 1:1 propensity score matching analysis was conducted to verify postoperative outcomes. The overall incidence of conversion to thoracotomy was 1.0% (205 of 20,565). The most common cause of conversion was vascular injury, found in 60 patients (29.3%). Multivariable logistic regression analysis identified age older than 60 years, male sex, preoperative chemotherapy, lesion diameter of 1.4 cm or larger, clinical nodal involvement, lymph node calcification, pleural adhesions, type of resection, location of resection, ipsilateral reoperation, and lower surgical experience as independent risk factors of conversion. Among patients who underwent conversion to thoracotomy and who had any complications, the percentages of pulmonary complications, chest tube duration, intensive care unit stay, and hospital length of stay were higher. Within the conversion groups, emergency (37 of 205; 18%) and nonemergency (168 of 205; 82%) conversion groups were similar for overall postoperative complications. The study identified 11 potential risk factors of conversion to thoracotomy, which was associated with increased postoperative complications. The findings may be important for operative planning, preoperative patient counseling and risk adjustment, and eventually reducing conversion rates and related outcomes. [ABSTRACT FROM AUTHOR]