156 results on '"Marshall MB"'
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2. Design and implementation of a non-resonant vibration-assisted machining device to create bespoke surface textures
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Suzuki, H, primary, Marshall, MB, additional, Sims, ND, additional, and Dwyer-Joyce, RS, additional
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- 2016
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3. The influence of material properties on the wear of abradable materials
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Fois, N, primary, Watson, M, additional, and Marshall, MB, additional
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- 2016
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4. Relaxation of contact pressure and self-loosening in dynamic bolted joints
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Stephen, JT, primary, Marshall, MB, additional, and Lewis, R, additional
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- 2016
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5. Ultrasonic monitoring of insulated block joints
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Stephen, JT, Hardwick, C, Beaty, P, Lewis, R, and Marshall, MB
- Abstract
Insulated block joints are essential components used in railway tracks. They are divided into circuits and are used for train detection and signalling. However, they also represent a weak point in the track system and have a finite life. Condition monitoring of these components for planning preventative maintenance is currently labour intensive, and can be significantly expensive for the rail operator. In this study, insulated block joints were fatigued via shear load, whilst being condition monitored for degradation using a normally incident ultrasonic technique. Tests were also initially performed on lap-joints and shear specimens to further understand the response of the ultrasonic signal to failure of the adhesive layer under controlled conditions. Dynamic reflection coefficients as well as the applied load were recorded in all tests, and results were compared to failure zones on the specimens. The results showed that the ultrasonic technique was able to determine the onset of failure and de-bonding of the adhesive layer in addition to degradation and wear. The technique was also able to highlight differences in performance between two different liners, pultruded glass reinforced polyester resin and a flexible glass fibre sheet, with the latter showing improved resistance. The outcomes of this study have highlighted the viability of condition monitoring insulated block joints using an ultrasonic approach and have provided a basis for a future field trial.
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- 2019
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6. An investigation of the relationship between wear and contact force for abradable materials
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Fois, N, primary, Watson, M, additional, Stringer, J, additional, and Marshall, MB, additional
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- 2014
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7. An investigation into contact pressure distribution in bolted joints
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Stephen, JT, primary, Marshall, MB, additional, and Lewis, R, additional
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- 2014
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8. Relaxation of contact pressure and self-loosening in dynamic bolted joints
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Stephen, JT, Marshall, MB, and Lewis, R
- Abstract
Bolted joints are widely used in a variety of engineering applications where they are dynamically loaded with frequencies of vibration spread over a wide spectrum with the same general effects. When under dynamic loading, bolted joints can become loose due to a loss in clamping pressure in the joints. This vibrational loosening sometimes can cause serious problems, and in some cases can lead to fatal consequences if it remains undetected. Non-intrusive ultrasonic and image processing techniques were simultaneously used to investigate the relaxation of contact pressure and loosening of bolted joints subjected to cyclic shear loading. Three critical areas, the contact interface of the bolted component, the bolt length and the rotation of the bolt head, were monitored during loosening of the joints. The results show that loosening of bolted joints can be grouped into three stages: very rapid, rapid, and gradual loosening. The earliest stage of the loosening of bolted joints is characterised by cyclic strain ratcheting–loosening of the bolted joint during vibration without rotation of the bolt head. The higher the rate of relaxation at this early stage, the lower is the resistance of the bolted joint to vibration-induced loosening. Both the dynamic shear load and an additional constant shear load in another direction were observed to affect the rate of loosening, and at this early stage, a rise in the magnitude of the additional constant shear load increases the rate of loosening. Furthermore, the contact pressure distribution affects the rate of loosening at the bolted joint interface, as loosening increases away from area of high contact pressure.
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- 2017
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9. Design and implementation of a non-resonant vibration-assisted machining device to create bespoke surface textures
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Suzuki, H, Marshall, MB, Sims, ND, and Dwyer-Joyce, RS
- Abstract
Non-resonant vibration-assisted machining involves the superposition of controlled vibrations onto traditional machining processes such as turning or milling. In this study, a novel variant of this technique has been investigated using an off-the-shelf piezoelectric actuator to create bespoke surface textures in a conventional milling machine. The purpose of these surfaces is to provide enhanced tribological performance by reserving lubricant, trapping and discharging debris and wear particles, and delaying the collapse of the full hydrodynamic lubricant film. Surface textures consisting of a repeating radial striation pattern of sine waves were reproducibly generated on the face of the disc work piece (an aluminium alloy AlSi1MgMn and a low-alloyed steel 16MnCr5) when the frequency of the superposed vibration was in phase with the rotational speed of the work piece. The texture parameters were controllable from approximately 1 mm to 8 mm in the wavelength and from a few microns to 25 µm in the peak to peak amplitudes which would reasonably cover the range of hydrodynamic lubrication film thickness.
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- 2017
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10. The influence of material properties on the wear of abradable materials
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Fois, N, Watson, M, and Marshall, MB
- Abstract
In aero-engines it is possible for the blades of the compressor, turbine or fan to incur into their casings. At these interfaces a lining of composite abradable material is used to limit damage to components and thereby sustain the efficiency and longevity of the engine as a whole. These composite materials must have good abradability and erosion resistance. Previously, the wear mechanisms at the contact between the blade and the coating have been characterised using stroboscopic imaging and force measurement on a scaled test-rig platform. This work is focused on the characterisation of the wear mechanism for two different hardnesses of abradable lining. The established stroboscopic imaging technique and contact force measurements are combined with sectioning of the abradable material in order to analyse the material’s response during the tests. A measure of the thermal properties and the resulting temperature of the linings during the test have also been made to further understand the effect of coating hardness. The wear mechanism, material response, contact force and thermal properties of the coating have been used to characterise the different material behaviour with different hardness. At low incursion rates, with a soft coating, the blade tip becomes worn after an initial adhesive transfer from the coating. Post-test sectioning showed blade material and significant compaction present in the coating. The harder coating produced adhesion on the blade tip with solidification observed in the coating. Thermal diffusivity measurements and modelling indicated that thermally driven wear observed was as a consequence of the increased number of boundaries between the metal and hBN phases present interrupting heat flow, leading to a concentration of surface heat. At higher incursion rates, the wear mechanism is more similar between the coatings and a cutting mechanism dominates producing negligible adhesion and blade wear.
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- 2017
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11. Ultrasonic measurement of self-loosening in bolted joints
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Marshall, MB, primary, Lewis, R, additional, Howard, T, additional, and Brunskill, H, additional
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- 2011
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12. An investigation of the relationship between wear and contact force for abradable materials.
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Fois, N, Watson, M, Stringer, J, and Marshall, MB
- Abstract
Abradable linings are frequently used on the inside of aero-engine casings. During the operation of engine, the rotating blades may strike the lining of the casing. The wear mechanisms present during these incursions have been re-produced on a scaled test rig platform. Previously, characterisation of the wear has been performed using a stroboscopic imaging technique in order to identify the different wear mechanisms at the incursion conditions investigated. In the present study, a dynamometer has been included in the test arrangement allowing the measurement of the contact force. This approach has then been combined with sectioning of the abradable test samples, in order to investigate the material response to the different incursion conditions. The wear results, the cutting force and material structure post-incursion show a high degree of correlation. At low incursion rates, significant consolidation and solidification of abradable material was observed, whilst at the same time adhesive transfer to the blade was recorded along with a low tangential to normal force ratio. At high incursion rates, little solidification and consolidation was observed, together with negligible adhesion and a higher tangential force, suggesting a cutting mechanism. Transitions in material behaviour, wear mechanism, and force ratio were observed at the same incursion condition, further highlighting the link between the different experimental measurements. [ABSTRACT FROM PUBLISHER]
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- 2015
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13. Ultrasonic measurement of self-loosening in bolted joints.
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Marshall, MB, Lewis, R, Howard, T, and Brunskill, H
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VIBRATION (Mechanics) ,ENGINEERING ,BOLTED joints ,ULTRASONIC imaging ,ELECTRONIC excitation ,WASHERS (Fasteners) ,MECHANICAL engineering - Abstract
Self-loosening of bolted joints in response to vibration can lead to the catastrophic failure of a range of engineering components and structures. Many techniques employed to study this phenomenon focus on directly measuring the pre-load remaining in the bolt itself, and offer little insight into the behaviour of the clamped interface.In this study, a non-intrusive ultrasonic reflection-based technique is used to first characterize interface pressure in the joint, and then determine the rate at which relaxation occurs. A key advantage of the technique is that it does not require the modification of the contact conditions, and rather utilizes the spring-like behaviour of a rough surface interface when subject to ultrasonic excitation.A series of different bolt torques were investigated, along with the inclusion of both plain and spring washers under the bolt head. All test samples were subjected to an oscillating fixed–displacement vibration cycle. An initial rapid reduction in interface clamping pressure was observed, followed by a more steady-state period. Increasing bolt torque was seen to enhance joint integrity, whereas both the plain and spring washers showed little improvement. The spring washer was observed to extend the secondary steady-state phase of loosening, though as the majority of pre-load was removed prior to this period any change was largely unbeneficial. [ABSTRACT FROM AUTHOR]
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- 2012
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14. Suction vs water seal after pulmonary resection: a randomized prospective study.
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Marshall MB, Deeb ME, Bleier JIS, Kucharczuk JC, Friedberg JS, Kaiser LR, Shrager JB, Marshall, M Blair, Deeb, Maher E, Bleier, Joshua I S, Kucharczuk, John C, Friedberg, Joseph S, Kaiser, Larry R, and Shrager, Joseph B
- Abstract
Study Objective: To evaluate whether suction or water seal is superior in the management of chest tubes after pulmonary resection.Design: A prospective, randomized, controlled trial. After an initial, brief period of suction, patients were randomized to water seal or - 20 cm H(2)O suction.Setting: University hospital.Patients: Sixty-eight patients who underwent wedge resection, segmentectomy, or lobectomy were included in the study. Those patients who underwent reoperative surgery or lung volume reduction surgery were excluded.Results: There were 34 patients in each group. The two groups were evenly matched for age, sex, operation performed, severity of lung disease, and nutritional status. Fifteen patients in each group (44%) had an air leak at the completion of surgery. The duration of the air leak was shorter in the water seal group than in the suction group (mean +/- SEM, 1.50 +/- 0.32 days vs 3.27 +/- 0.80 days, respectively; p = 0.05). The mean times to removal of chest tubes were 3.33 +/- 0.35 days in the water seal group and 5.47 +/- 0.98 days in the suction group (p = 0.06). The length of stapled parenchyma was measured for each patient and averaged 24.9 cm for the water seal group and 18.5 cm for the suction group (p = 0.18). When corrected for the length of staple lines, the duration of air leaks and days with chest tube were dramatically lower in the water seal group (p = 0.02 and p = 0.02, respectively).Conclusion: Placing chest tubes on water seal after a brief period of suction after pulmonary resection shortens the duration of the air leak and likely decreases the time that the chest tubes remain in place. Adoption of this practice may result in lower morbidity and lower hospital costs. [ABSTRACT FROM AUTHOR]- Published
- 2002
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15. Multi-modality therapy for metastatic colorectal cancer-ready for prime time?
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Chua TC, Marshall JL, Marshall MB, and Esquivel J
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- 2010
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16. Hobbies, Distractions, Obsessions, and Addictions.
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Gulati S and Marshall MB
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- Humans, Thoracic Surgery, Substance-Related Disorders epidemiology, Obsessive Behavior psychology, Obsessive Behavior epidemiology, Surgeons psychology, Leisure Activities, Behavior, Addictive psychology, Behavior, Addictive epidemiology
- Abstract
A career in cardiothoracic surgery takes a psychological and emotional toll, which is likely increased by recent changes in our health care environment. The benefits of leisure pursuits are severalfold, one of which includes supporting physician wellness. However, we are at risk of relying on unhealthy mechanisms to provide relief. The incidence of addiction and substance abuse is high, particularly among women surgeons. There are a variety of opportunities to help ourselves and support our colleagues. We need to promote healthy activities outside of our profession for the long-term well-being of cardiothoracic surgeons and our specialty., Competing Interests: Disclosure Dr M.B. Marshall has received honoraria and grant funding from Intuitive Surgical, Inc. United States, and honoraria from Siemens Inc, Germany. The other authors report no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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17. Industry payments and implicit bias in cardiothoracic surgery: Difference in industry payments to cardiothoracic surgeons by gender.
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Gulati S, Wang S, Mazzola E, and Marshall MB
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Objective: Industry payments, as sources of revenue and prestige, may contribute to gender implicit bias. We examined industry payments to cardiothoracic surgeons to determine differences with respect to gender while accounting for practice focus and experience., Methods: Payments to cardiothoracic surgeons from 2014, 2016, 2018, 2020, and 2022 were abstracted from the Centers for Medicare and Medicaid Services Open Payment database. Data were restricted to individual payments >$1000 and the following payment criteria: consulting fees, compensation for services other than consulting, honoraria, education, compensation for serving as faculty or as a speaker for a nonaccredited and noncertified continuing education program, and grant. Physician profiles were queried for gender, practice type, and year of last fellowship completion. Descriptive statistics were reported based on these factors., Results: In 2014, 509 cardiothoracic surgeons (497 men and 12 women) received meaningful industry payments. Male surgeons received $10,471,192 (99.3%) with median payment of $6500 and mean of $21,069, whereas women received $70,310 (0.7%) with median of $3500 and mean of $5859. In 2022, 674 cardiothoracic surgeons (613 men and 61 women) received industry payments, with men receiving $10,967,855 (92.4%) with a median payment of $6611 and mean of $17,892 and women receiving $905,431 (7.6%) with a median payment of $6000 and mean of $14,843., Conclusions: Industry payments to women increased from 2014 to 2022 as the proportion of women in practice rose. Industry support of women, with increases in compensation and roles as speakers, consultants, and educators, offers a potential strategy to combat implicit bias within cardiothoracic surgery., Competing Interests: Conflict of Interest Statement Dr Marshall has received honoraria and grant funding from Intuitive Inc and honoraria from Siemens Inc. The other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling and reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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18. Supporting the Use of Institutional Data to Improve Outcomes.
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Feingold PL, Kennedy-Shaffer L, Wee JO, Jaklitsch MT, and Marshall MB
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- 2024
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19. Lung cancer outcomes in the elderly: potential disparity in screening.
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Singh A, Mazzola E, Xie Y, Marshall MB, Jaklitsch MT, and Wilder FG
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- Humans, Aged, Adolescent, Retrospective Studies, Neoplasm Staging, Early Detection of Cancer, Lung Neoplasms diagnosis, Lung Neoplasms epidemiology, Carcinoma, Non-Small-Cell Lung diagnosis, Carcinoma, Non-Small-Cell Lung epidemiology, Carcinoma, Non-Small-Cell Lung surgery
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Objectives: The aim of this study was to analyse outcomes of lung cancer in the elderly., Methods: A retrospective analysis was performed of patients in the National Cancer Database with NSCLC from 2004 to 2017 grouped into 2 categories: 70-79 years (A) and 80-90 years (B). Patients with multiple malignancies were excluded. Kaplan-Meier curves estimated the overall survival for each age group based on stage., Results: In total, 466 051 patients were included. Less-invasive techniques (imaging and cytology) diagnosed cancer as a function of age: 14.6% in A vs 21.3% in B [P < 0.001, standardized mean difference (SMD) 0.175]. Clinical stage IA was least common in B (15%) compared to 17.3% in A (P < 0.001, SMD 0.079). Approximately 83.0% in B did not receive surgery compared to 70.0% in A (P < 0.001, SMD 0.299). Of the 83.0%, 8.0% were considered poor surgical candidates because of age or comorbidities compared with 6.2% in A (P < 0.001, SMD 0.299) For 71.0% in B, surgery was not the first treatment plan compared to 62.0% in A (P < 0.001, SMD 0.299). Survival curves showed worse prognosis for each clinical and pathologic stage for B compared to A., Conclusions: Patients older than 80 years present less frequently as clinical stage IA, are less commonly offered surgical intervention and are more frequently diagnosed using less accurate measures. They also have worse outcomes for each stage compared to younger patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2024
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20. Empiric flap coverage for the pneumonectomy stump: How protective is it? A single-institution cohort study.
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Steimer D, Coughlin JM, Yates E, Xie Y, Mazzola E, Jaklitsch MT, Swanson SJ, Orgill D, and Marshall MB
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- Humans, Pneumonectomy adverse effects, Cohort Studies, Surgical Flaps adverse effects, Bronchial Fistula etiology, Bronchial Fistula prevention & control, Bronchial Fistula surgery, Pleural Diseases surgery, Lung Neoplasms surgery, Lung Neoplasms complications
- Abstract
Objective: To evaluate the impact of empiric tissue flaps on bronchopleural fistula (BPF) rates after pneumonectomy., Methods: Patients who underwent pneumonectomy between January 2001 and December 2019 were included. Primary end point was development of BPF. Secondary end points were impact of flap type on BPF rates, time to BPF development, and perioperative mortality., Results: During the study period, 383 pneumonectomies were performed; 93 were extrapleural pneumonectomy. Most pneumonectomy cases had empiric flap coverage, with greater use in right-sided operations (right: 97%, 154/159; left: 80%, 179/224, P < .001). Empiric flaps harvested included intercostal, latissimus dorsi, serratus anterior, omentum, pectoralis major, pericardial fat/thymus, pericardium, and pleura. BPF occurred in 10.4% of the entire cohort but decreased to 6.6% when extrapleural pneumonectomy cases were excluded; 90% (36/40) of BPFs occurred on the right side (P < .001). Median time to develop BPF was 63 days, and 90-day mortality was greater in patients with BPF (12.5% BPF vs 7.4% non-BPF, P < .0001). Intercostal muscle had the lowest rate of BPF (4.5%), even in right-sided operations (8.7%). In contrast, larger muscle flaps such as latissimus dorsi (21%) and serratus anterior (33%) had greater rates of BPF, but the sample size was small in these cohorts., Conclusions: Empiric bronchial stump coverage should be performed in all right pneumonectomy cases due to greater risk of BPF. In our series, intercostal muscle flaps had low BPF rates, even in right-sided operations. Coverage of the left pneumonectomy stump is unnecessary due to low incidence of BPF in these cases., (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2024
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21. Thymic en-bloc resection with veins: case demonstrations and review of the literature.
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Young JS, DeBarros M, Singh A, and Marshall MB
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Locally invasive thymic neoplasms are challenging clinical scenarios and typically require a multidisciplinary approach. The involvement of major mediastinal veins such as the superior vena cava (SVC) used to be a contraindication to surgery, but with improved surgical technique and outcomes, this paradigm has shifted. In some situations, complex resections and reconstructions may be indicated and required to improve the long-term outcome of these patients. We report two of our cases along with a current review of literature. We also describe the preoperative workup, operative techniques, postoperative management, complications, and outcomes of patients with invasive thymic neoplasms that involve the mediastinal veins. Our first case describes a patient who was diagnosed with a thymoma extending from the diaphragm to the base of the neck that was also encasing major vascular structures including the SVC and left innominate vein. Our second case describes a patient who was also diagnosed with a large anterior mediastinal mass encasing the great veins and invading the chest wall. We describe the management of these patients and then delve deeper into operative techniques including SVC resection and reconstruction. We describe the types of conduits that can be used and complications to be mindful of when clamping the great veins, such as the SVC. Improvements in conduit materials and neoadjuvant and adjuvant therapies over the years have made it more feasible for patients with invasive thymic neoplasms to undergo surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-20-69/coif). The series “Venous Surgery of the Mediastinum” was commissioned by the editorial office without any funding or sponsorship. A.S. served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare., (2024 Mediastinum. All rights reserved.)
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- 2024
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22. Association of conduit dimensions with perioperative outcomes and long-term quality of life after esophagectomy for malignancy.
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Kim S, Lee SY, Vaz N, Leo R, Barcelos RR, Mototani R, Lozano A, Sugarbaker EA, Oh SS, Jacobson F, Wee JO, Jaklitsch MT, and Marshall MB
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Objective: The impact of conduit dimensions and location of esophagogastric anastomosis on long-term quality of life after esophagectomy remains unexplored. We investigated the association of these parameters with surgical outcomes and patient-reported quality of life at least 18 months after esophagectomy., Methods: We identified all patients who underwent esophagectomy for cancer from 2018 to 2020 in our institution. We reviewed each patient's initial postoperative computed tomography scan measuring the gastric conduit's greatest width (centimeters), linear staple line length (centimeters), and relative location of esophagogastric anastomosis (vertebra). Quality of life was ascertained using patient-reported outcome measures. Perioperative complications, length of stay, and mortality were collected. Multivariate regressions were performed., Results: Our study revealed that a more proximal anastomosis was linked to an increased risk of pulmonary complications, a lower recurrence rate, and greater long-term insomnia. Increased maximum intrathoracic conduit width was significantly associated with trouble enjoying meals and reflux long term after esophagectomy. A longer conduit stapled line correlated with fewer issues related to insomnia, improved appetite, less dysphagia, and significantly enhanced "social," "role," and "physical'" aspects of the patient's long-term quality of life., Conclusions: The dimensions of the gastric conduit and the height of the anastomosis may be independently associated with outcomes and long-term quality of life after esophagectomy for cancer., Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2023 The Author(s).)
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- 2023
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23. Minimally invasive transaxillary surgery: A novel technique for the resection of axillary Castleman disease.
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Gulati S, Boyer KR, and Marshall MB
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Competing Interests: Dr Marshall has received honoraria and consultancy fees from Intuitive, Inc, and honoraria from Siemens, Inc. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
- Published
- 2023
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24. Gender trends in cardiothoracic surgery authorship.
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Bryan DS, Debarros M, Wang SX, Xie Y, Mazzola E, Bueno R, and Marshall MB
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Objective: In recent years, the historically low proportion of women cardiothoracic surgeons and trainees has been a subject of intense focus. Publications remain a key metric of academic success and career advancement. We sought to identify trends in the gender of first and last author publications in cardiothoracic surgery., Methods: We searched for publications between 2011 and 2020 in 2 US cardiothoracic surgery journals, identifying those with Medical Subject Heading publication types of clinical trials, observational studies, meta-analyses, commentary, reviews, and case reports. A commercially available, validated software (Gender-API) was used to associate gender with author names. Association of American Medical Colleges Physician Specialty Data Reports were used to identify concurrent changes in the proportion of active women in cardiothoracic surgery., Results: We identified 6934 (57.1%) pieces of commentary; 3694 (30.4%) case reports; 1030 (8.5%) reviews, systematic analyses, meta-analyses, or observational studies; and 484 (4%) clinical trials. In total, 15,189 total names were included in analysis. Over the 10-year study period, first authorship by women rose from 8.5% to 16% (0.42% per year, on average), whereas the percentage of active US women cardiothoracic physicians rose from 4.6% to 8% (0.42% per year). Last authorship was generally flat over the decade, going from 8.9% in 2011% to 7.8% in 2020 and on average, increased at just 0.06% per year (P = .79)., Conclusions: Over the past decade, authorship by women has steadily increased, more so at the first author position. Author-volunteered gender identification at the time of manuscript acceptance may be useful to more accurately follow trends in publication., (Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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25. Robotic repair of a large chronic traumatic diaphragmatic hernia.
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Gulati S, Marshall MB, and Shemmeri E
- Abstract
Competing Interests: Dr Marshall has received honoraria and grant funding from Intuitive Inc. and honoraria from Siemens Inc. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
- Published
- 2023
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26. Anastomotic Stricture After Minimally Invasive Esophagectomy.
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Feingold PL, Bryan DS, Kuckelman J, Kennedy-Shaffer L, Wang V, Deeb A, Wee J, Jaklitsch M, and Marshall MB
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- Humans, Constriction, Pathologic surgery, Esophagectomy adverse effects, Treatment Outcome, Anastomosis, Surgical adverse effects, Retrospective Studies, Minimally Invasive Surgical Procedures adverse effects, Esophageal Stenosis epidemiology, Esophageal Stenosis etiology, Esophageal Stenosis surgery, Esophageal Neoplasms complications
- Abstract
Background: Despite improved outcomes, minimally invasive esophagectomy (MIE) continues to be associated with anastomotic strictures. Most resolve after a single dilation; however, some become refractory. Little is known about strictures after MIE in North America., Methods: We performed a single-institution retrospective review of MIEs from 2015 to 2019. Primary outcomes were the proportion of patients requiring anastomotic dilation and the dilation rate per year. Univariate analyses of patients undergoing dilation by various risk factors were performed with nonparametric tests, and multivariate analyses of the dilation rate were conducted using generalized linear models., Results: Of 391 included patients, 431 dilations were performed on 135 patients (34.5%, 3.2 dilations per patient who required at least 1 per patient). One complication occurred after dilation. Comorbidities, tumor histology, and tumor stage were not significantly associated with stricture. Three-field MIE was associated with a higher percentage of patients undergoing dilation (48.9% vs 27.1%, P < .001) and a higher rate of dilations (0.944 vs 0.441 dilations per year, P = .007) than 2-field MIE, and this association remained significant after controlling for covariates. When accounting for surgeon variability, this difference was no longer significant. Among patients with 1 or more dilations, those receiving dilation within 100 days of surgery needed more subsequent dilations (2.0 vs 0.6 dilations per year, P < .001)., Conclusions: After controlling for multiple variables, a 3-field MIE approach was associated with a higher rate of repeat dilations in patients undergoing MIE. A shorter interval between esophagectomy and initial dilation is strongly associated with the need for repeated dilations., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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27. Rapid Prototyping Techniques for the Development of a Take-Home Surgical Anastomosis Simulation Model.
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Kazlovich K, Donahoe LL, Yasufuku K, Wang SX, and Marshall MB
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- Humans, Models, Anatomic, Computer Simulation, Hand, Anastomosis, Surgical education, Clinical Competence, Thoracic Surgical Procedures, Simulation Training
- Abstract
Objective: The objective of this paper is to describe the techniques and process of developing and testing a take-home surgical anastomosis simulation model., Design: Through an iterative process, a simulation model was customized and designed to target specific skill development and performance objectives that focused on anastomotic techniques in thoracic surgery and consist of 3D printed and silicone molded components. Various manufacturing techniques such as silicone dip spin coating and injection molding have been described in this paper and explored as part of the research and development process. The final prototype is a low-cost, take-home model with reusable and replaceable components., Setting: The study took place at a single-center quaternary care university-affiliated hospital., Participants: The participants included in the model testing were 10 senior thoracic surgery trainees who completed an in-person training session held during an annual hands- on thoracic surgery simulation course. Feedback was then collected in the form of an evaluation of the model from participants., Results: All 10 participants had an opportunity to test the model and complete at least 1 pulmonary artery and bronchial anastomosis. The overall experience was rated highly, with minor feedback provided regarding the set- up and fidelity of the materials used for the anastomoses. Overall, the trainees agreed that the model was suitable for teaching advanced anastomotic techniques and expressed an interest in being able to use this model to practice skill development., Conclusions: Developed simulation model can be easily reduced, with customized components that accurately simulate real-life vascular and bronchial components suitable for training of anastomoses technique amongst senior thoracic surgery trainees., (Copyright © 2023. Published by Elsevier Inc.)
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- 2023
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28. Intraperitoneal seeding of a testicular mixed germ cell tumor following spontaneous intraperitoneal mass rupture with associated anti-NMDA paraneoplastic encephalitis.
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Marshall MB, Dindinger-Hill K, Swami U, Lyden S, and Sanchez A
- Abstract
A 25-year-old male was admitted to the neurological intensive care unit for neurologic deterioration, likely caused by a paraneoplastic syndrome secondary to testicular malignancy. He experienced spontaneous rupture and hemorrhage of his testicular mass arising from an undescended testis while admitted. The tumor was excised, revealing a mixed germ cell tumor. Serum tumor markers began to rise after 4 cycles of chemotherapy. Surveillance scans 32 weeks after mass rupture revealed numerous tumor deposits throughout his peritoneum concerning for teratoma. We review a case of intraperitoneal metastasis of a testicular mixed germ cell tumor following intra-abdominal mass rupture., (© 2023 The Authors.)
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- 2023
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29. Bronchoplasty for pulmonary preservation: A novel technique.
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Marshall MB and Sugarbaker EA
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- 2023
- Full Text
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30. Gender differences in Medicare payments to cardiothoracic surgeons in 2019.
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Kim S, Kim S, Wang SX, Kanwar R, Bryan DS, Bueno R, and Marshall MB
- Subjects
- Male, Humans, Female, Aged, United States, Medicare, Sex Factors, Cross-Sectional Studies, Surgeons, Thoracic Surgery
- Abstract
Objectives: The STS Thoracic Surgery Practice and Access Task Force - 2019 Workforce Report noted gender-based differences in the income of cardiothoracic surgeons in the United States. We analysed the 2019 Medicare payment data for thoracic and cardiac surgeons to investigate the gender-based payment gap among cardiothoracic surgeons., Methods: The 2019 Medicare Physician and Other Practitioners by Provider and Services data set merged with the Doctors and Clinicians National Downloadable File was utilized to conduct a cross-sectional analysis of gender differences in Medicare payments, numbers of services, unique billing codes, years in practice, Medicare beneficiary age, regional population density (rural-urban commuting area code) and patient panel complexity (hierarchical condition category) for providers. The providers' self-reported gender (women or men) and provider type (thoracic surgery or cardiac surgery) were binarily set according to the Center for Medicare and Medicaid Services standards. Independent analyses were performed with thoracic and cardiac surgeons. We also used the 2013 and 2016 Medicare Physician and Other Practitioners by Provider and Services data sets to analyse the trends in adjusted gender-based payment differences across 2013, 2016 and 2019., Results: After controlling for the covariates, women thoracic surgeons received $25,183.50 [95% confidence interval (CI) $16,307.60, $34,059.40] less than the mean Medicare payment than men thoracic surgeons. Likewise, women cardiac surgeons received $20,960 [95% confidence interval (CI) $1,014.80, $40,902.80] less than the mean adjusted Medicare payment than their men counterparts., Conclusions: In 2019, women cardiothoracic surgeons received a significantly lower mean Medicare payment than men cardiothoracic surgeons after controlling for the number of services, unique billing codes, the complexity of the patient panel, years in practice and regional population density. The payment gap between women and men exhibited no statistically significant change over 2013, 2016 and 2019. Future studies are warranted to understand the association between gender representation and the pay gap., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2023
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31. Three-dimensional technologies in chest wall resection and reconstruction.
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Young JS, McAllister M, and Marshall MB
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- Humans, Printing, Three-Dimensional, Prostheses and Implants, Imaging, Three-Dimensional methods, Thoracic Wall diagnostic imaging, Thoracic Wall surgery, Plastic Surgery Procedures
- Abstract
Resection and reconstruction of the chest wall can pose unique challenges given its vital role in the protection of the thoracic viscera and the dynamic part it plays in respiration. A number of new three-dimensional (3D) technologies may be invaluable in tackling these challenges. Herein we review the use of 3D technologies in preoperative imaging with virtual 3D models, printing of 3D models for preoperative planning, and printing of 3D prostheses when approaching complex chest wall reconstruction., (© 2022 Wiley Periodicals LLC.)
- Published
- 2023
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32. Response.
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Shafiq M and Marshall MB
- Published
- 2023
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33. Routine Chest Roentgenogram After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection.
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Dezube AR, Deeb A, De Leon LE, Kucukak S, Marshall MB, Jaklitsch MT, and Rochefort MM
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- Humans, Pneumonectomy adverse effects, Pneumonectomy methods, Retrospective Studies, Treatment Outcome, Lung, Length of Stay, Chest Tubes, Pneumothorax diagnostic imaging, Pneumothorax etiology, Pneumothorax surgery
- Abstract
Background: Chest roentgenograms after chest tube removal are common practice in postoperative thoracic surgery patients. Whether these roentgenograms change clinical management is debatable. We investigated prevalence and management of post-pull pneumothoraces after lung resection., Methods: Patients undergoing minimally invasive wedge resections, segmentectomies, and lobectomies between March 2018 and September 2018 were retrospectively reviewed. Baseline factors, operative technique, chest tube management, and outcomes after post-pull chest roentgenograms, and factors associated with post-pull pneumothoraces were analyzed., Results: The study analyzed 200 consecutive patients comprising 117 wedge resections (59%), 24 segmentectomies (12%), and 59 lobectomies (30%). Wedge resections compared with segmentectomy or lobectomy had lower rates of chest tube use, drain duration, air leaks, and need for a clamp trial, with Blake drains most often removed last compared with segmentectomy or lobectomy (all P < .001). Post-pull pneumothoraces, which were largely small/tiny/trace (96%), occurred in 110 patients (55%). Five patients experienced symptoms, and no patients required intervention. Resection type was associated with the pneumothorax rate, need for additional imaging, and discharge timing (all P < .05). Those with pneumothoraces compared with those without differed in type of resection and chest drain, presence of air leak within 24 hours of removal, need for clamp trial, order of tube removal, and hospital length of stay (all P < .05). Multivariable regression showed only clamp trial was associated with post-pull pneumothorax development (odds ratio, 2.48; 95% CI, 1.13-5.45; P = .024)., Conclusions: Although routine use of post-pull chest roentgenograms identified a high prevalence of pneumothorax, no intervention was required. Our study demonstrates post-pull imaging may not be indicated in asymptomatic patients without prior air leak or clamp trial., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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34. Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.
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Holben DH and Marshall MB
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- Academies and Institutes, Food Insecurity, Humans, Nutritional Status, United States, Dietetics education, Nutritionists
- Abstract
It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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35. Thoracoscopic Radial Diaphragm Plication.
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Steimer D, DeBarros M, Marshall MB, and Jaklitsch M
- Subjects
- Humans, Phrenic Nerve surgery, Quality of Life, Sutures, Diaphragm innervation, Diaphragm surgery, Respiratory Paralysis etiology, Respiratory Paralysis surgery
- Abstract
In appropriately selected patients diaphragm plication improves quality of life by alleviating dyspnea and allowing patients to return to their routine activities. Many plication techniques exist, but the optimal surgical approach remains unclear. We report our experience with a minimally invasive radial diaphragm plication technique. It offers 2 distinct advantages: (1) suture placement avoids the phrenic nerve fibers, allowing for potential nerve recovery, and (2) the interrupted radial sutures improve the distribution of tension along the flaccid muscle and may achieve a more durable repair., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
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36. Commentary: Never PROMIS more than you can deliver.
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Wang SX, Kim S, and Marshall MB
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- Humans, Patient Reported Outcome Measures
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- 2022
- Full Text
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37. Bilateral Bronchoscopic Lung Volume Reduction After Surgical Fissure Completion.
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Shafiq M, Polhemus E, Perkins R, Forth V, and Marshall MB
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- Bronchoscopy methods, Humans, Lung surgery, Lung Volume Measurements methods, Treatment Outcome, Pneumonectomy methods, Pulmonary Emphysema surgery
- Abstract
Although bilateral lung volume reduction surgery has been shown to be safe and effective in carefully selected patients with upper lobe-predominant emphysema and hyperinflation, bronchoscopic lung volume reduction via placement of endobronchial valves is conventionally performed only unilaterally. Furthermore, it is not offered to patients with interlobar collateral ventilation because of the lack of clinical efficacy. We describe two novel management approaches including (1) bilateral bronchoscopic lung volume reduction, and (2) a combined thoracic surgical and interventional pulmonary procedure involving surgical fissure completion followed by endobronchial valve placement, which culminated in safe and effective lung volume reduction of both lungs along with an excellent patient outcome., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
38. Commentary: Practicing the philosophy of continuous improvement with virtual-assisted lung mapping 2.0.
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Wang SX, Kim S, and Marshall MB
- Subjects
- Humans, Philosophy, Lung diagnostic imaging, Lung surgery, Pneumonectomy
- Published
- 2022
- Full Text
- View/download PDF
39. Mandatory Nodal Evaluation During Resection of Clinical T1a Non-Small Cell Lung Cancers.
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Dezube AR, Mazzola E, Deeb A, Wiener DC, Marshall MB, Rochefort MW, and Jaklitsch MT
- Subjects
- Humans, Lymph Nodes pathology, Lymph Nodes surgery, Lymphatic Metastasis pathology, Neoplasm Staging, Retrospective Studies, Adenocarcinoma pathology, Adenocarcinoma surgery, Carcinoma, Large Cell pathology, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms pathology, Lung Neoplasms surgery
- Abstract
Background: Recommendations for intraoperative lymph node evaluation are uniform regardless of whether a primary tumor is clinical T1a or T2a according to TNM 8th edition for stage I non-small cell lung cancer (NSCLC). We quantified nodal disease risk in patients with T1a disease (≤1 cm)., Methods: The National Cancer Database was queried for clinical T1a N0 M0 primary NSCLCs ≤1 cm undergoing lobectomy with mediastinal nodal evaluation from 2004-2014. Nodal disease risk was analyzed as a function of demographics and tumor characteristics., Results: Among 2157 cases, 6.7% had occult nodal disease: 5.1% occult N1 and 1.6% N2. Adenocarcinoma (7.5%), large cell carcinoma (25%), and poor differentiation (11.8%) or undifferentiated/anaplastic (25.0%) had high rates of combined pN1 and N2 disease (P < .001). In univariable analysis, odds of pathologic N1, N2, or N1/N2 nodal disease with respect to N0 was greatest for large cell carcinoma (ref. adenocarcinoma odds ratio [OR] 4.31, 3.62, 4.12 respectively; all P < .05), and anaplastic grade (OR 10.71, 13.09, 11.55). Bronchoalveolar adenocarcinomas had the lowest odds (OR 0.41, 0.11, 0.32) and squamous cell carcinoma had lower odds for N2 (OR 0.29, all P < .05). In multivariable analysis only bronchoalveolar adenocarcinomas had lower odds of pathologic N2 and N1/N2 disease with respect to N0. Worsening grade remained significant for pathologic N1 and N1/N2 disease (both P < .05)., Conclusions: A significant rate (6.7%) of occult nodal disease is present in primary NSCLCs ≤1 cm. Risk increases with certain histology and worsening grade. We recommend mandatory systematic hilar and mediastinal nodal evaluation for T1a NSCLC tumors for accurate staging and adjuvant therapy., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2022
- Full Text
- View/download PDF
40. Bronchopleural fistula due to cavitary pneumonia after SARS-CoV-2 infection treated with open thoracostomy.
- Author
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Belyayev LA, Foroushani SM, Wiener DC, Branch-Elliman W, Marshall MB, and Khalil HA
- Abstract
Severe coronavirus disease of 2019 (COVID-19) disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes substantial parenchymal damage in some patients. There is a paucity of literature describing the surgical management COVID-19 associated bronchopleural fistula after failure of medical therapy. We present the case of a 59-year-old woman with SARS-CoV-2 pneumonia, secondary bacterial pneumonia with bronchopleural fistula and radiographic and clinical evidence of disease refractory to medical therapy. After a course of culture-driven antimicrobial therapy and failure to improve following drainage with tube thoracostomy, she was treated successfully with Clagett open thoracostomy. After resolution of the bronchopleural fistula, the thoracostomy was closed and she was discharged home. In cases of severe COVID-19 complicated by bronchopleural fistula with parenchymal destruction, a tailored approach involving surgical management when indicated can lead to acceptable outcomes without significant morbidity., (This work is written by US Government employees and is in the public domain in the US.)
- Published
- 2022
- Full Text
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41. Nonsurgical management of Fusobacterium necrophorum sternoclavicular septic arthritis: a case report.
- Author
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Kim S, Kanwar R, and Marshall MB
- Subjects
- Adult, Anti-Bacterial Agents therapeutic use, Female, Fusobacterium necrophorum, Humans, Arthritis, Infectious drug therapy, Arthritis, Infectious etiology, Sternoclavicular Joint microbiology
- Abstract
Background: To date, the gold-standard treatment for sternoclavicular septic arthritis has been surgery due to the high failure and complication rates of medical treatment. In particular, presentation of Fusobacterium sternoclavicular septic arthritis has been rarely reported and very sparsely investigated, and only one other case report of septic arthritis caused by this pathogen exists in literature., Case Presentation: We report a case of an otherwise healthy 38-year-old Caucasian woman who presented with sternoclavicular septic arthritis as a complication of Fusobacterium necrophorum mediastinitis. Our patient underwent successful management through nonstandard, conservative treatment of 7 weeks of intravenous piperacillin + tazobactam followed by 6 weeks of oral amoxicillin + clavulanic acid., Conclusion: We highlight a case of the rare presentation of Fusobacterium necrophorum sternoclavicular septic arthritis that did not require surgical intervention for successful management. Though infection of the sternoclavicular joint is unusual, it continues to be seen in thoracic surgery, and there are increasing numbers of antibiotic-resistant organisms. This case broadens insight into the clinical course and treatment of such conditions. The success of conservative management in this case aligns with the similar nonsurgical course of the one previous report of Fusobacterium sternoclavicular septic arthritis occurrence. Thus, further discussion and thought for reevaluating the current standard practice of surgery for sternoclavicular joint infection is suggested. Our case supports assessing a patient's overall health, causative organism, and extent of infection in interventional course and taking the feasibility of conservative management into more weighted consideration., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
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42. Risk factors for prolonged air leak and need for intervention following lung resection.
- Author
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Dezube AR, Dolan DP, Mazzola E, Kucukak S, De Leon LE, Bueno R, Marshall MB, Jaklitsch MT, and Rochefort MM
- Subjects
- Aged, Female, Humans, Lung surgery, Male, Retrospective Studies, Risk Factors, Pneumonectomy adverse effects, Postoperative Complications surgery, Postoperative Complications therapy
- Abstract
Objectives: Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention., Methods: Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution. Bronchoplastic reconstructions and lung-volume reduction surgeries were excluded. Incidence and risk factors for PAL and PAL requiring intervention were evaluated., Results: In total, 2384 patients were included. PAL incidence was 5.4% (129/2384); 22.5% (29/129) required intervention. PAL patients were more commonly male (56.6% vs 39.7%), older (mean age 69 vs 65 years) and underwent lobectomy or thoracotomy (all P < 0.001). Patients with PAL had longer length of stay (9 vs 3 days), more discharge needs and increased odds of complication (all P < 0.050).Twenty-nine patients required intervention (9 chest tubes; 4 percutaneous drains; 16 operations). In 50% of operative interventions, an air leak source was identified; however, the median time from intervention to resolution was 13 days. Patients requiring intervention had increased steroid use, lower diffusion capacity for carbon monoxide and twice the length of stay versus PAL patients (all P < 0.050).On univariable analysis, forced expiratory volume in 1 s (FEV1) <40%, diffusion capacity for carbon monoxide <50%, steroid use and albumin <3 had increased odds of intervention (P < 0.050)., Conclusions: Age, gender and operative technique were related to PAL development. Patients with worse forced expiratory volume in 1 s or diffusion capacity for carbon monoxide, steroid use or poor nutrition were less likely to heal on their own, indicating a population that could benefit from earlier intervention., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
- Published
- 2022
- Full Text
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43. Commentary: One Plus One Does Not Equal Two: Combined Pectus Repair With Open Cardiac Surgery.
- Author
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Feingold PL and Marshall MB
- Subjects
- Humans, Treatment Outcome, Cardiac Surgical Procedures adverse effects, Thoracic Surgery
- Published
- 2021
- Full Text
- View/download PDF
44. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.
- Author
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Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, and Swanson SJ
- Subjects
- Carcinoma, Non-Small-Cell Lung pathology, Humans, Lung Neoplasms pathology, Neoplasm Staging, Pneumonectomy, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery, Patient Selection, Risk Assessment
- Abstract
Objective: Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy., Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method., Results: The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment., Conclusions: Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life., (Copyright © 2021. Published by Elsevier Inc.)
- Published
- 2021
- Full Text
- View/download PDF
45. In situ evaluation of contact stiffness in a slip interface with different roughness conditions using ultrasound reflectometry.
- Author
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Fukagai S, Watson M, Brunskill HP, Hunter AK, Marshall MB, and Lewis R
- Abstract
Understanding the dynamic condition of the interface between a railway wheel and rail is important to reduce the risks and consider the effectiveness of countermeasures for tribological problems. Traditionally the difficulty in obtaining accurate non-destructive interfacial measurements has hindered systematic experimental investigations. Recently, an ultrasound reflectometry technique has been developed as a direct observation method of a rolling-sliding interface; however, the topography dependence under the high contact pressures in a wheel-rail contact has not been clarified. For this reason, a novel in situ measurement of the contact stiffness using ultrasound reflectometry was carried out for three different levels of roughness. A contact pressure equivalent to that in a wheel-rail interface was achieved by using a high-pressure torsion test approach. The dynamic change of contact stiffness with slip was measured using ultrasound and the influence of roughness was investigated. The measured changes were validated using a newly developed numerical simulation, and mechanisms to explain the observed behaviour were proposed in terms of fracture and plastic deformation of the asperity bonds. These findings could help in understanding the traction characteristics for different roughness conditions and also assist in understanding damage mechanisms better, such as wear and rolling contact fatigue., (© 2021 The Authors.)
- Published
- 2021
- Full Text
- View/download PDF
46. Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection.
- Author
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Rodriguez M, Dezube AR, Bravo-Iniguez CE, Fox S, De León LE, Tarascio J, Freyaldenhoven S, Mentzer SJ, Swanson SJ, Bueno R, Rochefort MM, Marshall MB, and Jaklitsch MT
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Incidence, Male, Middle Aged, Neoadjuvant Therapy, Retrospective Studies, Young Adult, Bronchi surgery, Lung Neoplasms surgery, Pneumonectomy adverse effects, Pneumonectomy methods, Postoperative Complications epidemiology, Postoperative Complications etiology
- Abstract
Background: We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications., Methods: After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15., Results: We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had non-small cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%). Incidences of pulmonary complications were higher in the neoadjuvant chemoradiation group compared with the non-neoadjuvant radiation group (15/18 patients [83%] vs 29/118 patients [25%], respectively; P < .001). Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, bronchopleural fistula, and completion pneumonectomy (2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both P < .05) CONCLUSIONS: Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased risk of pulmonary and airway complications., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
47. Commentary: TGIF? Not if You're Getting a Lobectomy.
- Author
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Ahmadi N and Marshall MB
- Published
- 2021
- Full Text
- View/download PDF
48. Commentary: A new hope: Do ADAURA trial results change the paradigm for treatment of resectable lung adenocarcinoma?
- Author
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Wang SX and Marshall MB
- Subjects
- Humans, Adenocarcinoma of Lung surgery, Lung Neoplasms surgery, Pancreatic Neoplasms
- Published
- 2021
- Full Text
- View/download PDF
49. Chemoradiation Therapy as Definitive Treatment of Esophageal Cancer.
- Author
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Wang SX and Marshall MB
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Esophageal Neoplasms mortality, Esophageal Neoplasms pathology, Humans, Survival Analysis, Treatment Outcome, Adenocarcinoma therapy, Carcinoma, Squamous Cell therapy, Chemoradiotherapy methods, Esophageal Neoplasms therapy
- Abstract
Definitive chemoradiation therapy avoids the perioperative and long-term morbidity of esophagectomy and is the standard of care for cervical esophageal cancer. There are significant differences in tumor response to chemoradiation and recurrence patterns between squamous cell cancer and adenocarcinoma of the esophagus. Multimodality therapy for esophageal cancer continues to progress, now with the widespread use of PET scanning and possible active surveillance in patients with complete clinical response to chemoradiation. As drug development and targeted therapy trials continue to expand, our understanding of tumor biology and precision medicine will continue to refine the treatment of esophageal cancer., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
50. Controlled apneic tracheostomy in patients with coronavirus disease 2019 (COVID-19).
- Author
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Weiss KD, Coppolino A 3rd, Wiener DC, McNamee C, Riviello R, Ng JM, Jaklitsch MT, Marshall MB, and Rochefort MM
- Abstract
Objective: To develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and health care personnel following implementation of this approach., Methods: An interdisciplinary Task Force was constructed to develop innovative strategies for management of a novel disease. A single-institution, prospective, nonrandomized cohort study was then conducted on patients with coronavirus disease 2019 (COVID-19) respiratory failure who underwent tracheostomy using an induced bedside apneic technique at a tertiary care academic institution between April 27, 2020, and June 30, 2020., Results: In total, 28 patients underwent tracheostomy with induced apnea. The median lowest procedural oxygen saturation was 95%. The median number of ventilated days following tracheostomy was 11. There were 3 mortalities (11%) due to sepsis and multiorgan failure; of 25 surviving patients, 100% were successfully discharged from the hospital and 76% are decannulated, with a median time of 26 days from tracheostomy to decannulation (range 12-57). There was no symptomatic disease transmission to health care personnel on the COVID-19 Tracheostomy Team., Conclusions: Patients with respiratory failure from COVID-19 disease may benefit from tracheostomy. This can be completed effectively and safely without viral transmission to health care personnel. Performing tracheostomies earlier in the course of disease may expedite patient recovery and improve intensive care unit resource use. The creation of a collaborative Task Force is an effective strategic approach for management of novel disease., (© 2020 The Authors.)
- Published
- 2021
- Full Text
- View/download PDF
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