Search

In Western countries, breast cancer tends to occur in older postmenopausal women. However, in Asian countries, the proportion of younger premenopausal breast cancer patients is increasing. Increasing evidence suggests that the gut microbiota plays a critical role in breast cancer. However, studies on the gut microbiota in the context of breast cancer have mainly focused on postmenopausal breast cancer. Little is known about the gut microbiota in the context of premenopausal breast cancer. This study aimed to comprehensively explore the gut microbial profiles, diagnostic value, and functional pathways in premenopausal breast cancer patients. Here, we analyzed 267 breast cancer patients with different menopausal statuses and age-matched female controls. The α-diversity was significantly reduced in premenopausal breast cancer patients, and the β-diversity differed significantly between breast cancer patients and controls. By performing multiple analyses and classification, 14 microbial markers were identified in the different menopausal statuses of breast cancer. Bacteroides fragilis was specifically found in young women of premenopausal statuses and Klebsiella pneumoniae in older women of postmenopausal statuses. In addition, menopausal-specific microbial markers could exhibit excellent discriminatory ability in distinguishing breast cancer patients from controls. Finally, the functional pathways differed between breast cancer patients and controls. Our findings provide the first evidence that the gut microbiota in premenopausal breast cancer patients differs from that in postmenopausal breast cancer patients and shed light on menopausal-specific microbial markers for diagnosis and investigation, ultimately providing a noninvasive approach for breast cancer detection and a novel strategy for preventing premenopausal breast cancer., Breast cancer: gut microbes before and after menopause Women developing breast cancer before the menopause have less diverse gut microbe populations than their healthy peers, and significantly different gut microbial profiles than postmenopausal breast cancer patients. There is increasing evidence of a link between gut microbes and breast cancer, but most studies have focused on women after the menopause. The incidence of breast cancer in premenopausal women is increasing, especially in Asia. Researchers in Taiwan led by Chih-Po Chiang at Kaohsiung Medical University Hospital compared gut microbial populations in 267 breast cancer patients at different menopausal stages to matched controls. The results suggest that gut microbe profiling might offer a novel and noninvasive method for diagnosing and monitoring breast cancer. It may also lead to new strategies for prevention and treatment, as evidence emerges of a link between gut microbes and cancer.

Background In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25–28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia. Methods One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. The patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgeries (40 patients), and those without contralateral blebs only receiving unilateral surgeries (60 patients). Perioperative details and outcomes were retrospectively analyzed. Results Significant differences in contralateral recurrence rate were found among the three groups (0%, 30%, and 1%, respectively; P P = 0.034). Moreover, patients who had contralateral blebs and only received unilateral surgery were at greater risk of overall recurrence (HR 6.06, 95% CI 1.77–20.75, P = 0.004). Kaplan–Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups (P P = 0.0002). Conclusions Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomies in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.

Pulmonary carcinosarcoma is a rare lung tumor accounting for, Isodose distribution of the patient receiving total dose of 60 Gy of SBRT in three dimensions of computed tomography.

Background Persistent tracheocutaneous fistula (TCF) is a complication of prolonged use of tracheostomy tube. Although many procedures exist to correct this issue, there is no consensus regarding its optimal management. We constructed a decision algorithm to determine appropriate surgical strategies for TCF repair. Methods Retrospectively reviewing our hospital's records, we found fourteen consecutive patients who had received surgical repair of tracheocutaneous fistula (primary closure or advanced local flap) between February 2013 and December 2018 and collected data relevant to their cases. Results We identified 11 male and 3 female patients. Duration of tracheostomy dependence was 8.1±4.7 months, and timespan from decannulation to surgical closure 7.4±6.5 months. Seven patients received primary closures, six received hinged turnover flaps, and one received random and perforator flap reconstruction. There was no perioperative mortality or morbidity except for one patient requiring a repeat tracheostomy 11 months after TCF repair due to pneumonia and subsequent respiratory failure. We used our findings and those reported in the literature to construct a modified risk factor scoring system based on patient's physical status, major comorbidities, perifistular soft tissue condition, and nutritional status and an algorithm for managing TCF based on the patients' fistula size and modified risk factor scores. Conclusions In conclusion, we were able to review our cases and those of other studies to create a risk scoring system and a decision algorithm that we believe will help optimize patient-directed surgical management of TCF repair.

This report describes the case of a 17‐year‐old man who developed mediastinal growing teratoma syndrome following two cycles of chemotherapy, after an initial diagnosis of primary mediastinal nonseminomatous germ cell tumor. The large, rapidly‐growing mediastinal tumor was completely resected in conjunction with right pneumonectomy, using simultaneous clamshell thoracotomy and median sternotomy. The salvage surgery with perioperative management involved in mediastinal growing teratoma syndrome is presented here. Key points Significant findings of the study The diagnosis and surgical management are challenging for patients with mediastinal growing teratoma syndrome. Nevertheless, with proper operative planning, favorable outcomes can be attained with complete resection despite the characteristic rapid growth and massive size of these neoplasms. What this study adds In spite of postoperative sternal dehiscence, we believe that a simultaneous clamshell thoracotomy with median sternotomy approach remains a viable option for an extremely large mediastinal growing teratoma, when tumor size prevents safe resection using other approaches due to limited visualization.

NPWT fulfill graft taking in complex breast wounds., NPWT fulfill graft taking in complex breast wounds

Background: There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual's subjective experience and therefore difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Methods: Data from 26 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to April 2020. All patients received same length subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180.Results: Bilateral uniportal VATS was performed in 11 patients and unilateral multiportal VATS in 15 patients. In the unilateral VATS group, there were no significant differences in pain reported for subxiphoid and intercostal incisions. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher mean pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively) but lower pain scores on POD-90 (p = 0.03). Conclusions: In the bilateral VATS group, higher late (3 and 6 months) postoperative pain was associated with intercostal incisions as have been reported by previous studies. Interestingly, subxiphoid incisions were found to have higher early (Day 1, 2, and Discharge) postoperative pain than intercostal incisions. More research is needed to better understand the cause of pain in a surgical area previously not thought to be prone to pain.

Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype and exhibits an overall poor outcome. Due to the lack of targeted therapy, conventional systemic chemotherapy has been the main strategy for the treatment of TNBC. Further evidence has shown that combining radiation with chemotherapy is also a suitable treatment based on DNA repair deficiencies in patients with TNBC. However, the preferred treatment for metastatic TNBC remains unclear. Therefore, identification of biomarkers is an unmet need in personalized therapy for TNBC. RNF8 (ring finger protein 8) is a ubiquitin ligase implicated in TNBC metastasis, however, its role in TNBC pathogenesis is unclear. The purpose of the present study was to investigate the roles of the RNF8–CDH1(Cadherin 1) axis in node-positive TNBC patients. We found that the RNF8high/CDH1low index was significantly higher in patients with TNBC than in patients without TNBC. Furthermore, patients with an RNF8high/CDH1low index displayed poorer outcomes than those with an RNF8low-medium/CDH1medium-high index. Notably, as compared to patients with an RNF8low-medium/CDH1medium-high index, those with an RNF8high/CDH1low index had a poorer survival rate with chemotherapy treatment alone. The combination of radiation and chemotherapy resulted in a better survival rate than chemotherapy alone in patients with an RNF8high/CDH1low index. Taken together, the RNF8high/CDH1low index not only functions as a prognostic and therapeutic marker but may also act as a target in the development of anti-cancer agents for patients with TNBC.

This report describes the surgical management of a male patient with early-stage lung cancer who underwent thoracoscopic completion right lower lobectomy after previously undergoing sublobar resection for multifocal ground glass nodules of the lung. Perioperative considerations associated with the management of dense pulmonary hilar adhesions and the techniques used are discussed.

The purpose of this study is to investigate the outcomes of an alternative method for large defects reconstruction after mastectomy by applying negative pressure wound therapy onto the grafts.

Trauma is the leading cause of death among those under the age of 45 in Taiwan (1). According to the literature, thoracic injuries account for approximately 25% of trauma-related deaths, with an estimated one-third of these mortalities being immediate because of injury severity (2).

Spontaneous pneumomediastinum (SPM) is an uncommon condition that predominantly affects young males. Due to its rarity, the optimal management still remains uncertain without consensus.

In this era of minimally invasive thoracic surgeries and the prosperous development of uniportal video-assisted thoracoscopic surgery (VATS), postoperative chest tube placement is still mandatory in most thoracic surgeries despite some inspiring reports of tubeless VATS that have been performed (1-3). We read with great interest the article by Yokoyama et al. (4), who described their novel experience of chest tube wound closure using a two-layer method with triclosan-coated sutures. By the same logic,we described before.