Journal of thoracic disease
-
The introduction of immune checkpoint inhibitors have greatly improved clinical outcomes in several cancer types, revolutionizing the management of a wide variety of tumors endowed with poor prognosis. Despite its success, high grade immune related adverse events were observed in patients treated with checkpoint inhibitors. ⋯ In this review we discuss possible mechanisms involved in cardiac toxicity triggered by inhibition of cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway, the most prominent checkpoint inhibitors available in the clinic. Major cardiovascular events associated with checkpoint inhibitors adds another layer of complexity in cancer therapy and urges for an interdisciplinary approach between oncologists, cardiologists, and immunologist.
-
Postsurgical pain control can have a significant impact on patient outcomes and hospital-associated costs. We sought to evaluate the effect of intercostal nerve blocks using liposomal bupivacaine on length of stay (LOS) in patients undergoing video-assisted thoracoscopic surgery (VATS). ⋯ The use of liposomal bupivacaine is associated with decreased LOS in postoperative thoracic surgery patients and earlier return to ambulation. It does not, however, decrease 24-hour postoperative pain scores or opioid usage.
-
A single long-acting bronchodilator, ultra-long acting muscarinic antagonist (ultra-LAMA) or ultra-long acting β2-agonist (ultra-LABA) is preferred for the initial treatment of patients with chronic obstructive pulmonary disease (COPD); however, there are few head-to-head comparative studies between the two. Here, a meta-analysis of randomized controlled trials was performed to compare the clinical efficacy between ultra-LABA and ultra-LAMA in patients with moderate-to-severe COPD. ⋯ This study suggests that COPD exacerbation occurred less often in patients taking an ultra-LAMA than in those taking an ultra-LABA with similar efficacy of lung function and quality of life.
-
In 2013, the Centers for Disease Control and Prevention (CDC) issued the concept of the ventilator-associated events (VAEs) as a quality indicator (QI) in the intensive care unit (ICU). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAEs in non-Western countries is scarce. The purpose of this preliminary study was to illuminate the incidence and associated mortality rate of VAEs in Japan, as a first step in the effort to determine its practicality. ⋯ The prevalence of VAEs appears low in Japanese ICUs. Nonetheless, mortality was substantially higher in patients who developed VAEs. Although some potential indices of VAEs are suggested to serve as QIs, additional studies to elaborate its practicality would further be required.