ObjectiveTo compare the effects of flow-controlled ventilation (FCV) and conventional pressure-controlled ventilation (PCV) on postoperative pulmonary complications (PPCs) within 7 days after elective thoracic surgery. Methods Patients scheduled for elective thoracic surgery at Langzhong People's Hospital between August 2024 and June 2025 were enrolled and randomly assigned in a 1:1 ratio to either the FCV group or PCV group. The primary outcome was the incidence of PPCs within 7 days postoperatively. Secondary outcomes included systemic inflammatory factor levels at 24 hours postoperatively, numerical rating scale (NRS) pain scores at 3 days postoperatively, post-anesthesia care unit (PACU) stay duration, and length of postoperative hospitalization. Mechanical power (MP), oxygenation index, partial pressure of arterial carbon dioxide (PaCO2), peak pressure (Ppeak), positive end-expiratory pressure (PEEP), tidal volume (VT), respiratory rate (RR), and minute ventilation (MV) were compared between groups at 30 and 60 minutes after one-lung ventilation (OLV). Differences in MP between patients with and without PPCs were analyzed, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of MP for PPCs using area under the curve (AUC). Results A total of 60 patients were included: 30 in the FCV group [17 males, 13 females, mean age (57.4±10.0) years] and 30 in the PCV group [18 males, 12 females; mean age (58.7±11.2) years]. The FCV group demonstrated a significantly lower incidence of PPCs compared to the PCV group (16.7% vs. 40.0%, P=0.045) and reduced systemic pro-inflammatory factor levels at 24 hours postoperatively. No statistically significant difference was observed in NRS pain scores between groups at 3 days postoperatively. Additionally, the FCV group showed shorter PACU stay duration [(51.8±11.5) min vs. (66.2±24.5) min, P=0.008] and reduced postoperative hospitalization time [(7.8±1.2) d vs. (8.9±2.5) d, P=0.034]. At both 30 and 60 minutes after OLV initiation, the FCV group exhibited lower MP, MV, and RR values alongside higher oxygenation indices and VT compared to the PCV group, while PaCO2 and PEEP showed no significant differences. Although Ppeak did not differ significantly between groups at 30 minutes after OLV, it was lower in the PCV group at 60 minutes. Patients who developed PPCs consistently demonstrated higher MP values than those without PPCs at both time points. ROC curve analysis revealed excellent predictive performance of MP for PPCs occurrence within 7 days postoperatively (30-minute OLV: AUC=0.97, P<0.001; 60-minute OLV: AUC=0.93, P<0.001). Conclusion Compared with PCV, implementing FCV during OLV significantly reduces PPCs incidence. This protective effect may be attributed to reduced MP, improved oxygenation, enhanced ventilatory efficiency, and attenuated inflammatory responses. As a lung-protective ventilatory strategy, FCV effectively promotes postoperative recovery in patients undergoing elective thoracic surgery with American Society of Anesthesiologists physical status classification Ⅰ-Ⅲ.
ObjectiveTo evaluate the clinical efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy (MTLE), and to compare its outcomes with anterior temporal lobectomy (ATL). MethodsA retrospective cohort of 120 MTLE patients treated at Beijing Tiantan Hospital between August 2022 and August 2024 was analyzed, including 31 patients who underwent MRgLITT and 89 patients who underwent ATL. All patients received comprehensive presurgical evaluations, and stereoelectroencephalography (SEEG) was performed in selected cases. Clinical outcomes at 1 year were compared between the two groups, including seizure control (Engel classification, seizure reduction rate), cognitive and memory changes, quality of life, and postoperative complications. ResultsBaseline characteristics were comparable between groups. At 1-year follow-up, Engel class I outcomes were achieved in 71.0% of patients in the MRgLITT group and 67.4% in the ATL group. Seizure reduction rates were (89.6 ± 26.2)% for MRgLITT and (87.0 ± 28.7)% for ATL, with no significant difference (P=0.92). Postoperative changes in memory, cognition, and quality of life were not significantly different between groups (all P>0.05). The incidence of complications was low and similar between MRgLITT and ATL, including hemorrhage (3.2% vs. 2.2%), infection (16.1% vs. 19.1%), and neurological deficits (3.2% vs. 2.2%). ConclusionMRgLITT provides seizure control and safety outcomes comparable to ATL when applied to carefully selected MTLE patients, with the added advantages of minimal invasiveness and faster recovery. For patients with well-localized epileptogenic foci and hippocampal sclerosis, MRgLITT represents an important alternative to open resection.
ObjectiveTo analyze the effect of magnetic resonance-guided laser interstitial thermal therapy (Magnetic resonance-guided laser interstitial thermal therapy , MRgLITT) for drug resistant epilepsy (DRE). MethodsThe present study analyzed the clinical information of DRE patients treated by MRgLITT in Beijing Tiantan Hospital from August 2020 to February 2021, including the type of disease, postoperative complications, and prognosis (Engel classification) in the one year after surgery. ResultsA total of 55 patients were enrolled. There were 27 males and 28 females, with an average of (21.7±14.1) years, all of whom successfully completed the operation and were followed up for the 1 year after surgery. The diagnosis included intracranial tumors, hypothalamic hamartoma (HH), focal cortical dysplasia (FCD), cavernous malformations (CM), mesial temporal lobe epilepsy (mTLE), and idiopathic generalized epilepsy (underwent corpus callosotomy). The patients with seizure freedom accounted for 59.6% (31/52), and the average remission rate of palliative surgery was 68.6%. The short-term postoperative complications included bleeding in neurological deficit in 6 cases (10.9%), 4 cases (7.3%), and noninfectious fever in 2 cases (3.6%). No serious, long-term complications occurred. The average postoperative hospital stay was (4.7±1.6) days. ConclusionsMRgLITT is gradually mature and has a wide range of indications. This technology provides a safe and effective therapy for DRE patients.
