Background: The highly contagious COVID-19 has created unprecedented challenges in providing care to patients with resectable non-small cell lung carcinoma (NSCLC). Surgical management now needs to consider the risks of malignant disease progression by delaying surgery, and those of COVID-19 transmission to patients and operating room staff. The goal of our study was to describe our experience in providing both emergent and elective surgical procedures for patients with NSCLC during the COVID-19 pandemic in Israel, and to present our point of view regarding the safety of performing lung cancer surgery. Methods: This observational cross-sectional study included all consecutive patients with NSCLC who operated at Tel Aviv Medical Center, a large university-affiliated hospital, from February 2020 through December 2020, during the COVID-19 pandemic in Israel. The patients’ demographics, COVID-19 preoperative screening results, type and side of surgery, pathology results, morbidity and mortality rates, postoperative complications, including pulmonary complications management, and hospital stay were evaluated. Results: Included in the study were 113 patients, 68 males (60.2%) and 45 females (39.8%), with a median age of 68.2 years (range, 41–89). Of these 113 patients, 83 (73.5%) underwent video-assisted thoracic surgeries (VATS), and 30 (26.5%) underwent thoracotomies. Fifty-five patients (48.7%) were preoperatively screened for COVID-19 and received negative results. Fifty-six postoperative complications were reported in 35 patients (30.9%). A prolonged air leak was detected in 11 patients (9.7%), atrial fibrillation in 11 patients (9.7%), empyema in 5 patients (4.4%), pneumonia in 9 patients (7.9%) and lobar atelectasis in 7 patients (6.2%). Three patients (2.7%) with postoperative pulmonary complications required mechanical ventilation, and two of them (1.6%) underwent tracheostomy. Two patients (1.6%) were postoperatively diagnosed as positive for COVID-19. Conclusions: Our data demonstrate the feasibility and efficacy of implementing precautionary strategies to ensure the safety of lung cancer patients undergoing pulmonary resection during the COVID-19 pandemic. The strategy was equally effective in protecting the surgical staff and healthcare providers, and we recommend performing lung cancer surgery during the pandemic era.

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Background Giant lung bullae (GLB) are rare, and the only currently available management involves either an open surgical resection (thoracotomy) or the newer minimally invasive resection consisting of video-assisted thoracoscopic surgery (VATS). The aim of our study was to evaluate the possible influence of GLBs pulmonary attachment on patient's post-operative complications. Methods A retrospective analysis included all consecutive patients with GLBs who underwent bullae's surgical resection from 7/2007 to 12/2018. GLBs patient's individual characteristics, including demographics, comorbidities, and clinical pre-operative, surgical intra-operative and post-operative data were evaluated. Results 20 patients with GLBs, 15 males and 5 females with average age of 48.9 years (range, 22–67 years) underwent 21 surgical procedures. The GLBs were located in the right lung in 12 patients, in the left lung in seven patients, and in both lungs in one patient. Fifteen patients (75%) were symptomatic on admission and underwent urgent surgery. Five asymptomatic patients (25%) were operated on electively. Thirteen from 21 surgical procedures (61.9%) were VATS bullectomy, while the other eight were thoracotomies (38.1%). Complications included pneumonia successfully treated with intravenous antibacterial therapy in two thoracotomy patients and in one VATS patient (three patients, 14.2%) and a prolonged air leak in two thoracotomy and four VATS patients (six patients, 28.5%). Out of 21 GLBs, eight had a wide attachment with lung parenchyma (wide-based bullae's) and 13 had a short attachment (short-based bullae's). Two re-operated patients, with prolonged air leak complicated with empyema, had a wide-based GLBs. The median hospital stay was nine days. All patients completed the 24-month follow-up. Conclusions Minimally invasive video-assisted thoracoscopic surgery as an open thoracotomy surgery is a safe and effective for giant lung bullae (GLB). Patients with wide-based GLBs were more likely to develop postoperative prolonged air leak that requiring re-operation.

Purpose. Research of reinforcement methods of natural block stone and possibilities of its application as a load-bearing building structure. Methods. The study used such general logical methods as generalization, analysis and synthesis, analogy, abstraction and modelling. Results. Disadvantages of traditional technology of mining of raw materials for concrete production and the factors that increase the final cost of concrete structures are considered. Advantages and disadvantages of natural block stone in comparison with reinforced concrete building structures on the example of foundation blocks are considered. In order to reduce the cost, improve performance and give the production more flexibility, it is proposed to make such blocks of natural stone blocks with low decorative value. The analysis of known methods of reinforcement of natural stone is made, and the scheme of reinforcement of the block is developed. In order to develop effective reinforcement of such blocks, it is proposed to place the longitudinal reinforcement in the holes drilled in the block before its removal from massif, and fill them with self-expanding cement. Known methods of strengthening the inclined sections of reinforced concrete beams without transverse reinforcement are considered. To strengthen the inclined sections of the natural stone block, it is proposed to use a similar system of external reinforcement of reinforced concrete beams with carbon fiber-based tapes, which are glued with epoxy resins. Scientific novelty. For the first time in the general case, it is proposed to use natural block stone, reinforced with internal and external reinforcement, as a load-bearing structural element of the prefabricated ferro-stone foundation. Practical significance. Preliminary calculation of the minimum allowable distance from the inner wall of the holes for reinforcement rods to the outer surface of the unit without taking into account the inhomogeneities and defects that may occur in the rock, and additional loads during operation of such a unit was made. The obtained result is determined by the pressure of the cement mortar, which expands itself. If this distance is reduced, the whole wall may be destroyed. The issues that need to be solved to substantiate the proposed method of manufacturing foundation blocks, which will use all the benefits of natural stone and reduce the cost of manufacturing foundation blocks, are formulated.

Background Blood transfusion rates during surgery and hospitalization for thoracic surgery vary from 16% to 55%. The religious beliefs of Jehovah’s Witnesses (JW) permit medical and surgical procedures but exclude the use of blood and blood products. Performing major pulmonary resection without the possibility of compensating for blood loss is a daunting challenge that few surgeons are willing to meet. Methods The clinical and surgical data on two JW patients who underwent major pulmonary resections for non-small cell lung carcinoma (NSCLC) in Tel Aviv Medical Center between the years 2019 and 2020 were retrieved from the departmental databases and analyzed for the requirement and consumption of blood products. The patients were a 70-year-old female and a 49-year-old man that have underwent a completion right upper lobe lobectomy and a left lower lobe lobectomy, respectively. Results None required blood transfusions and the surgeries were successful, demonstrating that it is possible to successfully perform “bloodless” major pulmonary resection while respecting the limitations set by the patient’s religious beliefs. Conclusion This concept paves the way for the consideration of major pulmonary resection for patients who are currently denied such procedures due to religious restrictions or to their being high-risk surgical candidates, when resources are limited or lacking.