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1.
BMC Oral Health ; 22(1): 591, 2022 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-36494645

RESUMO

BACKGROUND: The diagnosis of dental implants and the periapical tissues using periapical radiographs is crucial. Recently, artificial intelligence has shown a rapid advancement in the field of radiographic imaging. PURPOSE: This study attempted to detect dental implants and peri-implant tissues by using a deep learning method known as object detection on the implant image of periapical radiographs. METHODS: After implant treatment, the periapical images were collected and data were processed by labeling the dental implant and peri-implant tissue together in the images. Next, 300 images of the periapical radiographs were split into 80:20 ratio (i.e. 80% of the data were used for training the model while 20% were used for testing the model). These were evaluated using an object detection model known as Faster R-CNN, which simultaneously performs classification and localization. This model was evaluated on the classification performance using metrics, including precision, recall, and F1 score. Additionally, in order to assess the localization performance, an evaluation through intersection over union (IoU) was utilized, and, Average Precision (AP) was used to assess both the classification and localization performance. RESULTS: Considering the classification performance, precision = 0.977, recall = 0.992, and F1 score = 0.984 were derived. The indicator of localization was derived as mean IoU = 0.907. On the other hand, considering the indicators of both classification and localization performance, AP showed an object detection level of AP@0.5 = 0.996 and AP@0.75 = 0.967. CONCLUSION: Thus, the implementation of Faster R-CNN model for object detection on 300 periapical radiographic images including dental implants, resulted in high-quality object detection for dental implants and peri-implant tissues.


Assuntos
Implantes Dentários , Humanos , Inteligência Artificial , Radiografia , Tecido Periapical , Aprendizado de Máquina
2.
Microsc Microanal ; 27(2): 237-249, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33541465

RESUMO

Two advanced, automated crystal orientation mapping techniques suited for nanocrystalline materials­precession electron diffraction (PED) in transmission electron microscopy (TEM) and on-axis transmission Kikuchi diffraction (TKD) in scanning electron microscopy (SEM)­are evaluated by comparing the orientation maps obtained from the identical location on a 30 nm-thick nanocrystalline tungsten (W) thin film. A side-by-side comparison of the orientation maps directly showed that the large-scale orientation features are almost identical. However, there are differences in the fine details, which arise from the fundamentally different nature of the spot pattern and Kikuchi line pattern in terms of the excitation volume and the angular resolution. While TEM-PED is more reliable to characterize grains oriented along low-index zone axes, the high angular resolution of SEM-TKD allows the detection of small misorientation between grains and thus yields better quantification and statistical analysis of grain orientation. Given that both TEM-PED and SEM-TKD orientation mapping techniques are complementary tools for nanocrystalline materials, one can be favorably selected depending on the requirements of the analysis, as they have competitive performance in terms of angular resolution and texture quantification.

3.
Pediatr Cardiol ; 35(6): 914-21, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24509564

RESUMO

Bronchoscopy-guided aortopexy is a surgical management option for patients with central airway obstruction after congenital heart surgery. This study aimed to evaluate the usefulness of bronchoscopy-guided aortopexy based on midterm follow-up evaluation with computed tomography (CT) and clinical outcome. From January 2004 to August 2011, bronchoscopy-guided aortopexy was performed for 16 patients (median age 0.5 years, M:F = 10:6) who had central airway obstruction caused by extrinsic compression (13 in the left main bronchus, 2 in the trachea, 1 in the diffuse trachea and bronchus) after congenital heart surgery. The surgical site for aortopexy was determined by the anatomic relationship between the aorta and the compressed bronchus according to preoperative CT and intraoperative bronchoscopy. The median follow-up period was 2.3 years. The ratios of the diameter and area of stenosis at the narrowed point were estimated using pre- and postoperative CT. Almost all the patients (15/16) showed relief of their preoperative symptoms. The median extubation time was 18 h. The stenosis diameter and area ratios significantly improved, as shown by with the immediate postoperative CT (7.7-48.5%, p = 0.003; 54.8-80.5%, p = 0.006). Airway stenosis of more than 75% (p = 0.013), immediate diameter ratio improvement of <50% (p = 0.015), preoperative severe respiratory insufficiency (p = 0.038), and male sex (p = 0.024) were associated with recurrent minor respiratory susceptibility. Bronchoscopy-guided aortopexy is a safe and reliable surgical management choice for central airway obstruction after congenital heart surgery. Furthermore, airway improvement after aortopexy was maintained during the midterm follow-up evaluation, according to CT measurements.


Assuntos
Obstrução das Vias Respiratórias , Aorta Torácica , Broncoscopia/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Obstrução das Vias Respiratórias/cirurgia , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Brônquios/lesões , Brônquios/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Cuidados Intraoperatórios/métodos , Masculino , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reprodutibilidade dos Testes , República da Coreia , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
J Chest Surg ; 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38584376

RESUMO

Background: Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods. Methods: This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups. Results: Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29-5.28; p=0.02). Conclusion: Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

5.
Artigo em Inglês | MEDLINE | ID: mdl-38879118

RESUMO

OBJECTIVE: This retrospective study analyzed the outcomes of mitral valve surgery in atrial functional mitral regurgitation (AFMR) compared with those in degenerative mitral regurgitation (DMR). METHODS: Patients with AFMR or DMR who underwent mitral valve repair/replacement at two institutions (January 2012-December 2022) were included. We excluded patients <18 years of age, undergoing concomitant cardiac surgery except for the maze procedure or tricuspid annuloplasty. We used propensity score analysis to adjust for baseline differences. RESULTS: 642 patients were enrolled. After propensity score analysis, 164 patients were classified into the DMR and 82 patients into the AFMR. All matched patients in both groups had atrial fibrillation. In DMR and AFMR, the 5-year freedom from readmission for heart failure and cardiac death was 96.3% vs. 88.6% (p = 0.045) and 100% vs. 90.0% (p = 0.002), respectively. The recurrence ratio of significant MR after mitral valve repair was not significantly different between the two groups (Log-rank = 0.699), and the 5-year freedom from MR recurrence (≥moderate) was 89.8% and 93.0%, respectively. After the maze procedure, significantly more patients in the AFMR were in junctional rhythm than in the DMR (49.1% vs. 3.3%) (p < 0.001), needing significantly more permanent pacemaker insertion during the follow-up period (11.4% vs. 1.5%, after 5 years) (Log-rank = 0.041). CONCLUSIONS: AFMR showed acceptable outcomes of mitral valve surgery, and mitral valve repair is a good treatment option. However, significantly more patients were in junctional rhythm after the maze procedure, needing more permanent pacemaker insertion.

7.
Pediatr Cardiol ; 34(6): 1366-73, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23397336

RESUMO

Although significant atrioventricular valve regurgitation (AVVR) is well known for its association with increased morbidity and mortality in patients with single-ventricle physiology, there is a lack of consensus in management of AVVR. The purpose of this study was to analyze the clinical outcomes in patients receiving AVV repair or replacement. From 2001 to 2010, a total of 33 patients (25 male and 8 female) with more than moderate-degree AVVR among 160 patients who underwent staged single-ventricle palliation were included. The median follow-up duration was 6.0 years (range 0.1-14.1). Valve repair (n = 27) or valve replacement (n = 6) was performed at the initial surgery. There were six late mortalities (18.18 %): five in the repair group and one in the replacement group and seven morbidities. Among patients with valve repair, 11 were required to undergo redo-valve operations (valve repair n = 6, valve replacement n = 5) due to deteriorated valve function. Initial shunt procedure (p = 0.04) and arrhythmia (p = 0.01) were risk factors for survival. Freedom from reoperation in the valve replacement group was higher than that in the valve repair group (67.0 ± 9.7 and 44.6 ± 11.2 % at 5 and 6 years, respectively, p = 0.03). Need for early repair (p = 0.02), presence of mitral- or tricuspid-dominant AVV (p = 0.005), and male sex (p = 0.04) were risk factors for valve durability. Early valve regurgitation affects valve durability. Thus, successful repair in the early stage may improve later outcomes. Therefore, aggressive valve surgery was required and AVV replacement might be one of the options for selected patients.


Assuntos
Cardiopatias Congênitas/complicações , Próteses Valvulares Cardíacas , Ventrículos do Coração/anormalidades , Insuficiência da Valva Mitral/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/mortalidade , Humanos , Lactente , Masculino , Insuficiência da Valva Mitral/mortalidade , Prognóstico , Desenho de Prótese , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
8.
Korean Circ J ; 53(8): 566-577, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37525493

RESUMO

BACKGROUND AND OBJECTIVES: The left atrial appendage (LAA) can contribute significantly to LA mechanical contraction. Nevertheless, the preventive effect of LAA occlusion during the maze procedure against cerebral infarction remains controversial. In this study, we compared the surgical, cardiac hemodynamic, and neurologic outcomes between LAA preservation and occlusion performed during the maze procedure. METHODS: Between January 2015 and August 2021, 252 patients underwent the maze procedure using cryoablation at our medical center. After excluding patients according to our exclusion criteria (i.e., mechanical prosthesis implantation, preexisting LAA thrombus), LAA was preserved in 113 patients (non-occlusion group) and occluded in 75 patients (occlusion group). Outcomes were compared using propensity score matching (PSM). RESULTS: PSM did not reveal significant intergroup differences in baseline characteristics between the non-occlusion (n=53) and occlusion (n=53) groups. During a median follow-up of 44 months, 2 patients in the non-occlusion group (3.8%) experienced ischemic strokes. There was no significant difference in the rate of freedom from stroke (p=0.19) and major adverse cardiac events (p=0.43) between the 2 groups. Through echocardiography at 1-year follow-up, a statistically significant difference in LA mechanical contraction was observed between the non-occlusion group and occlusion group (24 of 33 [72.7%] vs. 18 of 37 [48.6%], respectively; p=0.04). CONCLUSIONS: In this study, preservation of the LAA during the maze procedure resulted in better LA function than LAA occlusion, with similar rates of stroke.

9.
J Yeungnam Med Sci ; 40(Suppl): S23-S28, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37376736

RESUMO

BACKGROUND: Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG. METHODS: We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II). RESULTS: The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990). CONCLUSION: The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.

10.
ACS Nano ; 17(12): 11279-11289, 2023 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-37125893

RESUMO

Transition-metal dichalcogenides possess high carrier mobility and can be scaled to sub-nanometer dimensions, making them viable alternative to Si electronics. WSe2 is capable of hole and electron carrier transport, making it a key component in CMOS logic circuits. However, since the p-type electrical performance of the WSe2-field effect transistor (FET) is still limited, various approaches are being investigated to circumvent this issue. Here, we formed a heterostructural multilayer WSe2 channel and solution-processed aluminum-doped zinc oxide (AZO) for compositional modification of WSe2 to obtain a device with excellent electrical properties. Supplying oxygen anions from AZO to the WSe2 channel eliminated subgap states through Se-deficiency healing, resulting in improved transport capacity. Se vacancies are known to cause mobility degradation due to scattering, which is mitigated through ionic compensation. Consequently, the hole mobility can reach high values, with a maximum of approximately 100 cm2/V s. Further, the transport behavior of the oxygen-doped WSe2-FET is systematically analyzed using density functional theory simulations and photoexcited charge collection spectroscopy measurements.

11.
J Chest Surg ; 56(5): 322-327, 2023 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-37574879

RESUMO

Background: Superior vena cava (SVC) stenosis during follow-up is a major concern after heart transplantation, and many technical modifications have been introduced. We analyzed the surgical results of the SVC intima layer-only suture technique in heart transplantation. Methods: We performed SVC anastomosis with sutures placed only in the intima during heart transplantation. We measured the area of the SVC at 3 different points (above the anastomosis, at the anastomosis, and below the anastomosis) in an axial view by freely drawing regions of interest, and then evaluated the degree of stenosis. Patients who underwent cardiac computed tomography (CT) at 2 years postoperatively between June 2017 and May 2020 were included in this study. Results: We performed heart transplantation in 41 patients. Among them, 24 patients (16 males and 8 females) underwent follow-up cardiac CT at 2 years postoperatively. The mean age at operation was 49.4±4.9 years. The diagnoses at time of operation were dilated cardiomyopathy (n=12), ischemic heart disease (n=8), valvular heart disease (n=2), hypertrophic cardiomyopathy (n=1), and congenital heart disease (n=1). No cases of postoperative bleeding requiring intervention occurred. The mean CT follow-up duration was 1.9±0.7 years. At follow-up, the mean areas at the 3 key points were 2.7±0.8 cm2, 2.7±0.8 cm2, and 2.7±1.0 cm2 (p=0.996). There were no SVC stenosis-related symptoms during follow-up. Conclusion: The suture technique using only the SVC intimal layer is a safe and effective method for use in heart transplantation.

12.
J Thorac Dis ; 15(8): 4357-4366, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37691665

RESUMO

Background: There is not sufficient evidence of the superiority of hybrid procedures over total arch replacement (TAR) for the aortic arch aneurysm of an elderly patients. This retrospective study aimed to compare total arch replacement and hybrid procedures for treatment of aortic arch aneurysms in patients aged ≥75. Methods: This study was a multicenter retrospective investigation of peri-operative outcomes of patients undergoing aortic arch aneurysm repair using either TAR or hybrid procedures between January 2012 and May 2021. Risk factors for mortality were evaluated using multivariate analyses. Results: This study included 90 patients, of which 28 underwent hybrid procedures (hybrid group: frozen elephant trunk =9, zone 0 =6, zone 1 =1, zone 2 =12), and 62 underwent TAR (TAR group), and the mean duration of follow-up was 27.0±28.8 months. In patient characteristics, the incidence of chronic obstructive lung disease and chronic kidney disease in the TAR group was significantly higher than in the hybrid group, and other operative risk factors were not significantly different in both groups. No significant differences in the incidence of post-operative complications and mortality on hospitalization. Survival rates of both groups were not significantly different (P=0.31). However, re-intervention rates after aortic arch aneurysm repair were significantly higher in the hybrid group compared to the TAR group (freedom from re-intervention rates at 1, 3, 5 years: 100%, 93%, 93% in the TAR group, and 90%, 80%, 80% in the hybrid group, P=0.04). Conclusions: There was no definitive evidence of the superiority of hybrid procedures over TAR, although the risk of re-intervention was higher in the former group. The surgical strategy for aortic arch aneurysms should be selected based on the patient's demographic and anatomical characteristics.

13.
Adv Sci (Weinh) ; 10(2): e2204248, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36394076

RESUMO

Engineering active sites of metal nanoparticle-based heterogeneous catalysts is one of the most prerequisite approaches for the efficient production of chemicals, but the limited active sites and undesired oxidation on the metal nanoparticles still remain as key challenges. Here, it is reported that the negatively charged surface of copper nanoparticles on the 2D [Ca2 N]+ ∙e- electride provides the unrestricted active sites for catalytic selective sulfenylation of indoles and azaindoles with diaryl disulfides. Substantial electron transfer from the electride support to copper nanoparticles via electronic metal-support interactions results in the accumulation of excess electrons at the surface of copper nanoparticles. Moreover, the surface-accumulated excess electrons prohibit the oxidation of copper nanoparticle, thereby maintaining the metallic surface in a negatively charged state and activating both (aza)indoles and disulfides under mild conditions in the absence of any further additives. This study defines the role of excess electrons on the nanoparticle-based heterogeneous catalyst that can be rationalized in versatile systems.

14.
J Cardiothorac Surg ; 17(1): 237, 2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123587

RESUMO

BACKGROUND: Total anomalous pulmonary venous return (TAPVR) is rare congenital heart disease. Most TAPVRs require surgical corrections in the neonatal period and survival to adulthood without surgical correction is extremely rare. Most untreated patients with large atrial septal defects and no pulmonary venous obstruction have pulmonary vascular damage from pulmonary over circulation. CASE PRESENTATION: 44-year-old TAPVR patient admitted to our medical center. A snowman-shaped heart, including cardiomegaly and an increase in pulmonary blood flow, was seen in the chest X-ray. A large-sized (around 3 cm) atrial septal defect with dilated right atrium, right ventricle, and pulmonary artery was detected on echocardiography. Heart computed tomography was performed for further evaluation, and supra-cardiac type TAPVR without any obstructive lesion was identified. CONCLUSIONS: TAPVR in an adult patient is extremely rare, and this patient was treated successfully with surgical correction and is doing well. A sinus rhythm and mild mitral valve regurgitation have remained during 2.5 years of outpatient follow-up.


Assuntos
Comunicação Interatrial , Veias Pulmonares , Síndrome de Cimitarra , Adulto , Coração , Comunicação Interatrial/cirurgia , Humanos , Circulação Pulmonar , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Síndrome de Cimitarra/diagnóstico por imagem , Síndrome de Cimitarra/cirurgia
15.
Adv Sci (Weinh) ; 9(26): e2201756, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35869036

RESUMO

Metal nanoparticles (MeNPs) have been used in various industrial applications, owing to their unique physical and chemical properties different from the bulk counterparts. However, the natural oxidation of MeNPs is an imminent hindrance to their widespread applications despite much research efforts to prevent it. Here, a rational approach for non-oxidized bare MeNPs in air, which requires no additional surface passivation treatment is reported. The direct synthetic route uses the [Gd2 C]2+  · 2e- electride as an exceptional electron-donating agent to reduce diverse metal precursors in alcoholic solvents. All synthesized bare Cu, Ag, and Sn nanoparticles are ultra-stable in ambient air, exhibiting no trace of metal oxides even on their outermost atomic layer. This unique resistance to oxidation is ascribed to the accumulation of excess electrons on the surface of bare MeNPs, which originates from the spontaneous transfer of anionic electrons from the electride during the nanoparticle growth process. This approach provides not only a revolutionary scheme to obtain MeNPs with non-passivated and non-oxidized surfaces, but also fundamental knowledge about metal oxidation.

16.
Nat Nanotechnol ; 17(3): 285-291, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35145286

RESUMO

Copper (Cu) nanoparticles (NPs) have received extensive interest owing to their advantageous properties compared with their bulk counterparts. Although the natural oxidation of Cu NPs can be alleviated by passivating the surfaces with additional moieties, obtaining non-oxidized bare Cu NPs in air remains challenging. Here we report that bare Cu NPs with surface excess electrons retain their non-oxidized state over several months in ambient air. Cu NPs grown on an electride support with excellent electron transfer ability are encapsulated by the surface-accumulated excess electrons, exhibiting an ultralow work function of ~3.2 eV. Atomic-scale structural and chemical analyses confirm the absence of Cu oxide moiety at the outermost surface of air-exposed bare Cu NPs. Theoretical energetics clarify that the surface-accumulated excess electrons suppress the oxygen adsorption and consequently prohibit the infiltration of oxygen into the Cu lattice, provoking the endothermic reaction for oxidation process. Our results will further stimulate the practical use of metal NPs in versatile applications.

17.
Science ; 376(6594): 731-738, 2022 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-35549417

RESUMO

Continuous advancement in nonvolatile and morphotropic beyond-Moore electronic devices requires integration of ferroelectric and semiconductor materials. The emergence of hafnium oxide (HfO2)-based ferroelectrics that are compatible with atomic-layer deposition has opened interesting and promising avenues of research. However, the origins of ferroelectricity and pathways to controlling it in HfO2 are still mysterious. We demonstrate that local helium (He) implantation can activate ferroelectricity in these materials. The possible competing mechanisms, including He ion-induced molar volume changes, vacancy redistribution, vacancy generation, and activation of vacancy mobility, are analyzed. These findings both reveal the origins of ferroelectricity in this system and open pathways for nanoengineered binary ferroelectrics.

18.
J Clin Med ; 11(17)2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36079032

RESUMO

Metabolic abnormalities, such as preexisting diabetes or hyperglycemia or hypoglycemia during hospitalization aggravated the severity of COVID-19. We evaluated whether diabetes history, hyperglycemia before and during extracorporeal membrane oxygenation (ECMO) support, and hypoglycemia were risk factors for mortality in patients with COVID-19. This study included data on 195 patients with COVID-19, who were aged ≥19 years and were treated with ECMO. The proportion of patients with diabetes history among nonsurvivors was higher than that among survivors. Univariate Cox regression analysis showed that in-hospital mortality after ECMO support was associated with diabetes history, renal replacement therapy (RRT), and body mass index (BMI) < 18.5 kg/m2. Glucose at admission >200 mg/dL and glucose levels before ventilator >200 mg/dL were not associated with in-hospital mortality. However, glucose levels before ECMO >200 mg/dL and minimal glucose levels during hospitalization <70 mg/dL were associated with in-hospital mortality. Multivariable Cox regression analysis showed that glucose >200 mg/dL before ECMO and minimal glucose <70 mg/dL during hospitalization remained risk factors for in-hospital mortality after adjustment for age, BMI, and RRT. In conclusion, glucose >200 mg/dL before ECMO and minimal glucose level <70 mg/dL during hospitalization were risk factors for in-hospital mortality among COVID-19 patients who underwent ECMO.

19.
J Chest Surg ; 54(1): 45-52, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33203805

RESUMO

BACKGROUND: Atrial septal defect (ASD) is the most common congenital heart disease. However, the details of cardiac chamber remodeling after surgery are not well known, although this is an important issue that should be analyzed to understand long-term outcomes. METHODS: Between November 2017 and January 2019, cardiac magnetic resonance imaging was performed preoperatively, at a 1-month postoperative follow-up, and at a 1-year postoperative follow-up. Cardiac chamber volume, valve regurgitation volume, and ejection fraction were measured as functions of time. RESULTS: Thirteen patients (10 men and 3 women) were included. The median age at surgery was 51.4 years. The preoperative median ratio of flow in the pulmonary and systemic circulation was 2.3. The preoperative mean right ventricular (RV) end-diastolic volume index (EDVi) and RV end-systolic volume index (ESVi) had significantly decreased at the 1-month postoperative follow-up (p<0.001, p=0.001, respectively). The decrease in the RVEDVi (p=0.085) and RVESVi (p=0.023) continued until the postoperative 1-year follow- up, although the rate of decrease was slower. Tricuspid valve regurgitation had also decreased at the 1-month postoperative follow-up (p=0.022), and continued to decrease at a reduced rate (p=0.129). Although the RVEDVi and RVESVi improved after ASD closure, the RV volume parameters were still larger than the left ventricular (LV) volume parameters at the 1-year follow-up (RVEDVi vs. LVEDVi: p=0.016; RVESVi vs. LVESVi: p=0.001). CONCLUSION: Cardiac remodeling after ASD closure is common and mainly occurs in the early postoperative period. However, complete normalization does not occur.

20.
J Chest Surg ; 54(5): 393-395, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-33293483

RESUMO

The anomalous connection of umbilical vessels to the heart is rare and has not yet been reported in the international scientific literature. Herein, we report the case of a newborn who was diagnosed with an anomalous connection of the umbilical vessels to the left ventricle. These anomalous vessels were functionally open for 2 weeks, and cellulitis was present in the area of the blood vessels connected to the skin. We performed division of these abnormal vessels and removal of the skin lesion.

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