The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.

Background: Superior vena cava (SVC) replacement is infrequently performed and technically challenging in low-volume centers. Venovenous shunt (VVS) technique is used to reduce SVC pressure during SVC replacement and has not been well reported. This study aimed to add information on this subject and evaluate the surgical outcomes of patients who underwent SVC replacement combined with VVS in our center.Methods: A retrospective analysis of six patients who underwent SVC replacement combined with VVS from September 2011 to February 2017 was performed. Clinical characteristics, pathological features, operative characteristics, postoperative outcomes, and the survival of the six patients were reviewed.Results: There were four males and two females with a median age of 44 years (range, 35-69 years).There were three lung cancer patients and three thymoma patients at a stage from IIIA to IVA. Five patients underwent induction therapy. Complete resection was performed on five patients. One patient underwent internal VVS, and the other five patients underwent external VVS. Prosthesis grafts were employed in five cases and autologous pericardium in one case. Three patients underwent single-vein reconstruction, and the other three patients underwent double-vein reconstruction. The median SVC clamping time was 75 minutes.There were no postoperative deaths or major complications. All patients were alive at follow-up, and no thrombosis was found in any of the grafts.Conclusions: SVC replacement combined with VVS is technically feasible and safe. Although VVS technique is not a must, it may make SVC replacement safer in inexperienced centers. Surgery-based multidisciplinary treatment for selected patients with type T4 lung cancer and SVC involvement or thymoma and SVC involvement may achieve a favorable long-term outcome.

ObjectivePostoperative cognitive dysfunction (POCD) is common after surgery in elderly patients and is associated with high morbidity. The molecular mechanisms responsible for POCD are unknown. Minocycline, an inhibitor of microglial activation, may be useful in treating and preventing POCD. We explored whether minocycline can inhibit microglial activation and prevent POCD in aged rats as a surgery model.MethodsRats aged 18 to 20 months were randomly allocated to the following groups: naïve, abdominal surgery alone, or minocycline injection before abdominal surgery. Hippocampal cytokine mRNA levels were measured at 3 hours, 1 day, 3 days, and 7 days after surgery, and microglial activation was measured at 3 hours and 7 days after surgery. Memory was assessed using the Morris water maze test.ResultsSurgery resulted in severe cognitive impairment in aged rats and induced a significant neuroinflammatory response and microglial activation. The use of minocycline can prevent microglial activation after surgery, but delayed microglial activation may occur. The use of minocycline may further impair memory after surgery.ConclusionMinocycline can restrain microglial activation and restrict the inflammatory response in the hippocampus early after surgery, but it may induce delayed microglial activation and cannot prevent POCD in aged rats.