Pectus excavatum is the most common congenital malformation of the anterior chest wall. The diagnosis is usually made during puberty, when both the progression of the deformation and the first clinical symptoms (chest pain, dyspnea on exertion, arrhythmias) occur, as well as a lack of acceptance of the patient’s physical appearance. Surgical treatment using the minimally invasive Nuss method is the treatment of choice [ 1 x 1 Nuss, D., Kelly, R.E. Jr., Croitoru, D.P., and Katz, M.E. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998; 33: 545–552 Abstract | Full Text PDF | PubMed | Scopus (772) | Google Scholar See all References ] [1] . However, there is a paucity of reports regarding the correlation between the age of the patient and early- and long-term results of the repair. In the literature, the optimal age for operation is generally between 12 and 16 years of age [ 2 x 2 Fonkalsrud, E.W. Current management of pectus excavatum. World J Surg. 2003; 27: 502–508 Crossref | PubMed | Scopus (126) | Google Scholar See all References , 3 x 3 Kelly, R.E., Goretsky, M.J., Obermeyer, R. et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010; 252: 1072–1081 Crossref | PubMed | Scopus (169) | Google Scholar See all References , 4 x 4 Frantz, F.W. Indications and guidelines for pectus excavatum repair. Curr Opin Pediatr. 2011; 23: 486–491 Crossref | PubMed | Scopus (18) | Google Scholar See all References ]. However, other authors usually perform the corrective procedure earlier, even before the 10 years of age [ 5 x 5 Shu, Q., Shi, Z., Xu, W.Z. et al. Experience in minimally invasive Nuss operation for 406 children with pectus excavatum. World J Pediatr. 2011; 7: 257–261 Crossref | PubMed | Scopus (13) | Google Scholar See all References , 6 x 6 Park, H.J., Sung, S.W., Park, J.K., Kim, J.J., Jeon, H.W., and Wang, Y.P. How early can we repair pectus excavatum: the earlier the better?. Eur J Cardiothorac Surg. 2012; 42: 667–672 Crossref | PubMed | Scopus (37) | Google Scholar See all References , 7 x 7 Ohno, K., Morotomi, Y., Ueda, M. et al. Comparison of the Nuss procedure for pectus excavatum by age and uncommon complications. Osaka City Med J. 2003; 49: 71–76 PubMed | Google Scholar See all References , 8 x 8 Kim, D.H., Hwang, J.J., Lee, M.K., Lee, D.Y., and Paik, H.C. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg. 2005; 80: 1073–1077 Abstract | Full Text | Full Text PDF | PubMed | Scopus (96) | Google Scholar See all References , 9 x 9 Mao, Y.Z., Tang, S.T., Wang, Y., Tong, Q.S., and Ruan, Q.L. Nuss operation for pectus excavatum: a single-institution experience. World J Pediatr. 2009; 5: 292–295 Crossref | PubMed | Scopus (10) | Google Scholar See all References ]. There are many reports of satisfactory results from the treatment in adult patients, but the correction effect is frequently associated with higher morbidity [ 10 x 10 Pilegaard, H.K. Extending the use of Nuss procedure in patients older than 30 years. Eur J Cardiothorac Surg. 2011; 40: 334–337 PubMed | Google Scholar See all References , 11 x 11 Aronson, D.C., Bosgraaf, R.P., van der Horst, C., and Ekkelkamp, S. Nuss procedure: pediatric surgical solution for adults with pectus excavatum. World J Surg. 2007; 31: 26–29 Crossref | PubMed | Scopus (39) | Google Scholar See all References , 12 x 12 Coln, D., Gunning, T., Ramsay, M., Swygert, T., and Vera, R. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg. 2002; 26: 1217–1221 Crossref | PubMed | Scopus (78) | Google Scholar See all References ]. The divergence of opinion among surgeons performing the Nuss procedure makes it somewhat difficult to create standardized age criteria for treatment yielding the best possible results.

Genome-wide association studies have identified loci at 15q25 (IREB2) and 4q22 (FAM13A), associated with lung cancer (LC) and chronic obstructive pulmonary disease (COPD). The aim of our research was to determine the association of IREB2 and FAM13A SNPs with LC and severe/very severe COPD patients. We examined IREB2 variants (rs2568494, rs2656069, rs10851906, rs13180) and FAM13A (rs1903003, rs7671167, rs2869967) among 1.141 participants (468 LC, 149 COPD, 524 smoking controls). The frequency of the minor IREB2 rs2568494 AA genotype, was higher in LC vs controls (P = 0.0081, OR = 1.682). The FAM13A rs2869967 was associated with COPD (minor CC genotype: P = 0.0007, OR = 2.414). The rs1903003, rs7671167 FAM13A variants confer a protective effect on COPD (both P < 0.002, OR < 0.405). Haplotype-based tests identified an association of the IREB2 AAAT haplotype with LC (P = 0.0021, OR = 1.513) and FAM13A TTC with COPD (P = 0.0013, OR = 1.822). Cumulative genetic risk score analyses (CGRS), derived by adding risk alleles, revealed that the risk for COPD increased with the growing number of the FAM13A risk alleles. OR (95% CI) for carriers of ≥5 risk alleles reached 2.998 (1.8 to 4.97) compared to the controls. This study confirms that the IREB2 variants contribute to an increased risk of LC, whereas FAM13A predisposes to increased susceptibility to COPD.

The pedicled intercostal muscle flap (IMF) is a high quality vascularized tissue commonly used to buttress the bronchial stump after pneumonectomy or bronchial anastomosis after sleeve lobectomy in order to prevent bronchopleural fistula formation. The evaluation of the viability of the muscle flap is difficult. The aim of this study was the assessment of the application of indicyanine green fluorescence for the evaluation of IMF perfusion. The study included 27 patients (10 males and 17 females), mean age 62.6 years (47–77 years). Indocyanine green fluorescence (ICG) was used for objective assessment of the IMF quality by a near-infrared camera system (Photodynamic Eye^®, Hamamatsu Photonics, Japan). The following factors that may have an impact on the quality of the IMF were assessed: age, gender, body mass index, comorbidities, IMF length and thickness and timing of the harvesting during the procedure. The following surgical pulmonary resections with IMF harvesting were performed: 12 pneumonectomies, 2 sleeve lobectomies and 13 lobectomies. Intercostal muscle flap (IMF) was harvested before rib spreader insertion in 23 patients (85%) and at the end of the surgery in 4 patients (15%). The mean length and thickness of the harvested intercostal muscle were 19.9 ± 2.9 cm (range 13–24 cm) and 2.4 cm ± 0.7 cm (range 1.0–3.5 cm), respectively. Indocyanine green angiography showed ischaemia in the distal part of the muscle in all cases, despite the lack of obvious macroscopic signs. Median length of the ischaemic part was 4 cm (range 0.5–20 cm). The IMF length and thickness had a significant impact on the length of the ischaemic segment. In 24 patients, the ischaemic part of the muscle flap was severed. In 3 patients with the longest ischaemic segment (11, 13 and 20 cm), an alternative tissue was used to cover the bronchial stump. No major complications occurred. Our preliminary results confirmed the simplicity and high efficacy of ICG in the assessment of intercostal muscle blood perfusion. ICG was superior to macroscopic evaluation and influenced surgical proceeding.

Several genome-wide association studies (GWASs), have identified that FAM13A and IREB2 loci are associated with lung cancer, but the mechanisms by which these genes contribute to lung diseases susceptibility, especially in hypoxia context, are unknown. Hypoxia has been identified as a major negative factor for tumor progression in clinical observation. It has been suggested, that lower oxygen tension, may modulate the IREB2 and FAM13A activity. However, the role of these genes in hypoxia response has not been explained. To precise the role of these genes in hypoxia response, we analyzed the FAM13A and IREB2 expression, in lung cancer cells in vitro and lung cancer tissue fragments cultured ex vivo.

INTRODUCTION: Radical surgical treatment is the preferred action for patients with early-stage non-small cell lung cancer (NSCLC). Qualification for surgical treatment should consider a risk associated with the effect of comorbidities on the general condition of the patient. The aim of this article was an attempt to identify the risk factors for postoperative complications in patients treated for NSCLC, with a special focus on the coexisting diseases. METHODS: A total of 400 patients with NSCLC were included in this retrospective study. The incidence of postoperative complications (including major complications according to the European Society of Thoracic Surgeons [ESTS]) was analyzed. Factors associated with high risk of postoperative complications were identified. RESULTS: Postoperative complications occurred in 151 patients (39% operated patients), including severe complications according to ESTS in 75 patients (19%). From univariate analysis, risk factors for postoperative complications were arrhythmias, pneumonectomy, and open thoracotomy. According to ESTS, for major complications, the risk factors included age ≥65 years, the presence of comorbidities, hypertension, and arrhythmias. From multivariate analysis, the risk of complications was higher in patients undergoing pneumonectomy and with cardiac arrhythmias, whereas the risk of serious complications according to ESTS was found in people ≥65 years of age and suffering from comorbidities. CONCLUSIONS: The risk of postoperative complications is affected by both surgical factors and the general health of the patient. Elderly patients with chronic disease history, hypertension, and arrhythmias have an increased risk of postoperative complications. Knowledge of these factors will identify a group of patients requiring internal consultation and optimization of preoperative treatment and postoperative follow-up.