COVID-19 versus Other Disease Etiologies as the Cause of ARDS in Patients Necessitating Venovenous Extracorporeal Membrane Oxygenation-A Comparison of Patients' Data during the Three Years of the COVID-19 Pandemic.

Considering the characteristics of coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS), we compared the clinical course and outcomes of patients with ARDS who received venovenous extracorporeal membrane oxygenation (VV ECMO) based on the etiology of ARDS. This retrospective single-center study included adult patients with severe ARDS necessitating VV ECMO during the COVID-19 pandemic. Among 45 patients who received VV ECMO, 21 presented with COVID-19. COVID-19 patients exhibited lower sequential organ failure assessment scores (9 [8-12.75] versus 8 [4-11.5], p = 0.033) but longer duration of VV ECMO support (10.5 days [3.25-29.25] versus 28 days [10.5-70.5] p = 0.018), which was accompanied by an weaning off rate from VV ECMO in 12/24 (50%) versus 12/21 (57.1%) and 28-day mortality in 9/24 [37.5%] versus 2/21 [9.5%] in non-COVID-19 and COVID-19 patients (p = 0.767, p = 0.040), respectively. Finally, in the adjusted Cox regression model for hospital mortality, the hazard ratio of COVID-19 was not significant (hazard ratio 0.350, 95% confidence interval 0.110-1.115, p = 0.076). Although the VV ECMO period was longer, COVID-19 did not significantly impact ECMO weaning off and mortality rates. Nonetheless, judicious patient selections based on risk factors should be followed.

Intrinsically stretchable three primary light-emitting films enabled by elastomer blend for polymer light-emitting diodes.

Intrinsically stretchable light-emitting materials are crucial for skin-like wearable displays; however, their color range has been limited to green-like yellow lights owing to the restricted stretchable light-emitting materials (super yellow series materials). To develop skin-like full-color displays, three intrinsically stretchable primary light-emitting materials [red, green, and blue (RGB)] are essential. In this study, we report three highly stretchable primary light-emitting films made from a polymer blend of conventional RGB light-emitting polymers and a nonpolar elastomer. The blend films consist of multidimensional nanodomains of light-emitting polymers that are interconnected in an elastomer matrix for efficient light-emitting under strain. The RGB blend films exhibited over 1000 cd/m2 luminance with low turn-on voltage (<5 Von) and the selectively stretched blend films on rigid substrate maintained stable light-emitting performance up to 100% strain even after 1000 multiple stretching cycles.

Endovascular repair of growing chronic type B aortic dissection with a vascular plug.

We report the successful endovascular repair of a growing chronic type B aortic dissection using an Amplatzer Vascular Plug II. A 44-year-old man, with previous medical history of aortic surgery and stenting complained of vague back pain. An approximately 5-mm entry remained in the stented segment of the aorta on computed tomography (CT). Endovascular closure of the entry with a Vascular Plug was uneventful. A 3-month follow-up CT showed no leak, complete false lumen thrombosis in the thoracic segment, shrinkage of the false lumen, and a reduced diameter of thoracic aorta.

Thoracomyoplasty for Chronic Empyema and Osteoradionecrosis of the Chest Wall

Herein, we report a case in which thoracomyoplasty was performed to manage chronic postlobectomy empyema (PLE). A 54-year-old male patient with a surgical history of right upper lobectomy and thymectomy 35 years previously who had undergone adjuvant radiotherapy presented with purulent discharge on the anterior chest wall. The patient was diagnosed with chronic PLE with ascending infection and concurrent osteonecrosis of the parasternum. Proper drainage was performed for local infection control and the dead spaces were successfully closed with muscle flaps. There have been no complications to date.

Improving the performance of quantum-dot light-emitting diodes via an organic-inorganic hybrid hole injection layer.

Poly(3,4-ethylenedioxythiophene):poly(styrene-sulfonate) (PEDOT:PSS) is a commonly used material for the hole injection layer (HIL) in quantum-dot light-emitting diodes (QLEDs). In this work, we improved the performance of the QLED by using an organic-inorganic hybrid HIL. The hybrid HIL was prepared by mixing PEDOT:PSS with vanadium oxide (V2O5), which is a transition-metal oxide (TMO). The hole injection properties of PEDOT:PSS were improved according to the amount of V2O5 mixed into the PEDOT:PSS. The maximum luminance and current efficiency were 36 198 cd m-2 and 13.9 cd A-1, respectively, when the ratio of PEDOT:PSS and V2O5 was 10 : 1. Moreover, the operating lifetime exceeded 300 h, which is 10 times longer than the lifetime of the device with only PEDOT:PSS HIL. The improvement was analyzed using ultraviolet and X-ray photoelectron spectroscopy. We found that the density of state (DOS) of PEDOT:PSS near the Fermi energy level was increased by mixing V2O5. Therefore, the increase of DOS improved the hole injection and the performance of QLEDs. The result shows that the hybrid HIL can improve the performance and the stability of QLEDs.

Dual-functional quantum-dots light emitting diodes based on solution processable vanadium oxide hole injection layer.

Dual-functional quantum-dots light emitting diodes (QLEDs) have been fabricated using solution processable vanadium oxide (V2O5) hole injection layer to control the carrier transport behavior. The device shows selectable functionalities of photo-detecting and light-emitting behaviors according to the different operating voltage conditions. The device emitted a bright green light at the wavelength of 536 nm, and with the maximum luminance of 31,668 cd/m2 in a forward bias of 8.6 V. Meanwhile, the device could operate as a photodetector in a reverse bias condition. The device was perfectly turned off in a reverse bias, while an increase of photocurrent was observed during the illumination of 520 nm wavelength light on the device. The interfacial electronic structure of the device prepared with different concentration V2O5 solution was measured in detail using x-ray and ultraviolet photoelectron spectroscopy. Both the highest occupied molecular orbital and the gap state levels were moved closer to the Fermi level, according to increase the concentration of V2O5 solution. The change of gap state position enables to fabricate a dual-functional QLEDs. Therefore, the device could operate both as a photodetector and as a light-emitting diode with different applied bias. The result suggests that QLEDs can be used as a photosensor and as a light-emitting diode for the future display industry.

Aortic Valve-Sparing Surgical Treatment of Supravalvar Aortic Stenosis in a 65-Year-Old Adult.

Supravalvar aortic stenosis (SVAS) is a rare congenital cardiac disease that usually co-occurs with Williams syndrome. In the adult population, a few SVAS cases have been reported in patients affected by homozygous familial hypercholesterolemia. However, because of the rarity of this disease entity, there is no standard surgical treatment for SVAS. Here, we present a case of successful surgical treatment using an autologous excised aortic patch in a 65-year-old patient with SVAS.

Left Hemitruncus Treated Along with Ventricular Septal Defect in a Neonate.

Hemitruncus arteriosus is a rare cardiovascular malformation in which one of the pulmonary arteries anomalously originates from the aorta. Left hemitruncus arteriosus, defined as the origination of the left pulmonary artery from the aorta, is less common than right hemitruncus arteriosus. In this study, we report the case of a neonate diagnosed with left hemitruncus arteriosus, ventricular septal defect, and atrial septal defect who underwent successful surgical treatment.

A case of pulmonary lymphomatoid granulomatosis successfully treated by combination chemotherapy with rituximab.

Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive lymphoproliferative disease characterized by Epstein-Barr virus-positive B cells admixed with reactive T cells. LYG most commonly affects the lung but can also involve other extrapulmonary sites. Pulmonary LYG usually presents as multiple pulmonary nodules with rapid progression and excavation. It can mimic various infectious diseases, vasculitis or metastatic malignancy and is difficult to be diagnosed clinically. Standard treatment for LYG has not yet been established. Despite combination chemotherapy, the overall prognosis is poor. Recently, anti-CD20 monoclonal antibody, rituximab, has been used to treat LYG. We report the case of a 70-year-old male patient with pulmonary LYG, who showed rapid remission of the disease after combination chemotherapy with rituximab.

Aortic Reconstruction Using a Main Pulmonary Artery Flap in an Isolated Aortopulmonary Window.

Aortopulmonary window (APW) is a rare cardiac anomaly that was reported to occur in only 43 cases over 33 years at a large-volume cardiac center. It can present as an isolated anomaly or in combination with another cardiac anomaly. The surgical technique for APW has evolved from simple ligation to separation of the 2 great arteries. However, because of the rarity of APW, there is no standard surgical treatment for this disease entity. Herein, we present successful aortic reconstruction using a main pulmonary artery flap after separation of the 2 great arteries in a neonate with isolated APW.

How small is enough for the left heart decompression cannula during extracorporeal membrane oxygenation?

BACKGROUND: Left ventricular (LV) distension is a recognizable problem accompanied by subsequent complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression has been established, and no minimal flow requirement has been designated. Thus, we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression during VA-ECMO in adult patients. METHODS: Left heart decompression was performed when severe pulmonary edema was detected on chest radiography or when no generation of pulse pressure followed severe LV dysfunction in patients receiving VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath into the left atrium via the femoral vein. The sheath was connected to the venous catheter used for ECMO. The catheter was maintained during VA-ECMO. RESULTS: The left heart decompression procedure was performed in seven of 35 patients who received VA-ECMO between February 2017 and June 2018. Three patients had acute myocardial infarction; three, fulminant myocarditis; and one, dilated cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an increase in pulse pressure of >20 mm Hg within 24 hours from the left heart decompression procedure. All seven patients were successfully weaned from VA-ECMO. No complications related to the left heart decompression procedure occurred. CONCLUSIONS: An 8-Fr sheath may be a possible option for left heart decompression in adult patients with LV distension under VA-ECMO who are expecting recovery of LV function.

Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period.

BACKGROUND: Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. METHODS: Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 µg/kg for 10 min and then maintained in dosages of 0.3-1 µg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. RESULTS: The times for anesthesia, operation and emergence were significantly shorter in SA than GA. Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. CONCLUSIONS: Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.

Successful extracorporeal life support in cardiac arrest with recurrent ventricular fibrillation unresponsive to standard cardiopulmonary resuscitation.

Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We present a case of a male, 37-year-old out-of-hospital cardiac arrest patient who received prolonged CPR followed by ECPR. Despite advanced cardiac life support, he did not regain a sustained spontaneous circulation and had recurrent ventricular fibrillation (VF) during the prolonged CPR. VF was unresponsive to CPR, defibrillation, adrenaline (epinephrine), and antiarrhythmics. The CPR time before ECPR was approximately 2h. During extracorporeal life support, the VF did not recur and percutaneous coronary angioplasty was achieved. Ultimately, the patient was discharged without neurological complications. Although cardiac arrest occurred out-of-hospital and CPR was performed for a long time, a patient might be a candidate for ECPR if perfusing rhythms are restored transiently but not successfully maintained due to recurrent VF. ECPR may be used for VF unresponsive to standard CPR techniques.

Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes.

Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes.

Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome.

BACKGROUND: First rib resection is a surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, extrathoracic approaches have used a posterior, supraclavicular, or transaxillary incision to remove the first rib. In this report, we demonstrate video-assisted thoracoscopic surgery for intrathoracic first rib resection (VATS-IFRR). METHODS: Between 2009 and 2014, eight patients underwent VATS-IFRR for TOS. Surgery was performed through two 5-mm ports and one 10-mm port. Endoscopic graspers, a hook-type electrocautery probe, a long peapod intervertebral disc rongeur, and Kerrison punches were used. The types of disease, operative times, chest tube indwelling days, lengths of hospital stay after operation, perioperative complications, postoperative pain scale ratings, and postoperative symptom recurrence rates at provocation tests were reviewed. The surgical outcomes were compared to published outcomes of extrathoracic approaches and other VATS approaches. RESULTS: The eight patients (3 right ribs, 5 left ribs) exhibited neurogenic (1 patient), combined type (2 patients), arterial (4 patients), and venous type (1 patient) TOS. The mean operative time was 190 (range 155-310) minutes. No mortalities or major complications occurred. The mean chest tube indwelling duration was 6 (range 3-10) days, and the mean postoperative hospital stay was 9 (range 4-21) days. The mean immediate postoperative pain numeric rating scale (NRS) score was 2.7/10 (range 2-4). No recurrence was observed during follow-up (median 25.5 months, range 10-64 months) in any patient. CONCLUSIONS: VATS-IFRR was safe and had several advantages. Thus, VATS-IFRR is a minimally invasive surgical option suitable for treating selective cases of TOS.

Ventricular assist device implantation using a right thoracotomy.

Most patients needing implantation of a ventricular assist device (VAD) require repeated sternotomy; some after cardiac surgery, and others later for heart transplantation. The purpose of this study was to establish the right thoracotomy technique as an alternative for VAD implantation to reduce repeated sternotomy-related morbidity and mortality. We performed a right thoracotomy in animals, preclinical cadaver fitting tests, and a clinical case. A total of 20 various animals underwent right thoracotomy for implantation of bi-VAD (BVAD, n = 17) and left VAD (LVAD, n = 3). The right chest cavity was entered through the fourth intercostal space with partial resection of the fifth rib. There was no procedure-related morbidity or mortality, except for one calf with right anterior leg paralysis. Preclinical fitting tests were performed on 7 human cadavers to observe the anatomical feasibility of BVAD cannulation from the right side of the heart. In humans, the ascending aorta, interatrial groove, right atrium, and main pulmonary artery were identified as optimal cannula insertion sites for BVAD implantation. A patient with cardiogenic shock underwent a right thoracotomy for implantation of an external LVAD. Cardiac function recovered after 3 weeks, and the device was successfully explanted through a repeat right thoracotomy. In conclusion, a right thoracotomy can be an alternative method to the standard median sternotomy for patients who need repeated sternotomy because of previous cardiac surgery, transplantation at a later date, or those with mediastinal infections.

Deep-seated intramuscular lipoma penetrates the intercostal muscle.

Deep-seated intramuscular lipomas are rare, and most exhibit an infiltrating behavior. This study reports serial radiographs of a lipoma in chest wall muscles which penetrated the intercostal muscle for a 6-year period. Although this lipoma did not involve the parietal pleura, it compressed lung. To the authors' knowledge, the present study is the first report to show the growth of a deep-seated chest wall lipoma into the thoracic cavity through serial radiographs. We consider the surgical treatment is needed before deep-seated intramuscular chest wall lipoma compress intrathoracic structures.

A simple technique for the thoracoscopic plication of the diaphragm.

We describe a simple technique for video-assisted thoracoscopic plication in patients with diaphragmatic eventration. During the plication, which is performed with a continuous running suture, a surgical assistant maintains the continuous suture traction using a homemade hook through the port. The technique can be performed easily, without any kind of thoracotomy.

Acute descending aortic dissection associated with coarctation in adult.

A 44-year-old man with congenital aortic coarctation experienced acute dissection that crossed the coarctation and extended to both iliac arteries. The primary entry of the dissection was proximal to the coarctation segment, just below the origin of the left subclavian artery. Surgical procedures involved resection of the diseased segment including the coarctation, and graft interposition.