Veno-Arterial-Venous Extracorporeal Membrane Oxygenation in a Critically Ill Patient with Coronavirus Disease 2019.

Patients with cardiopulmonary failure may not be fully supported with typical configurations of extracorporeal membrane oxygenation (ECMO), either veno-arterial (VA) or veno-venous (VV). Veno-arterial-venous (VAV)-ECMO is a technique used to support the cardiopulmonary systems during periods of inadequate gas exchange and perfusion. In the severe case of coronavirus disease 2019 (COVID-19), which simultaneously affects the heart and lung, VAV-ECMO may improve a patient's recovery potential. We report the case of a 72-year-old woman with acute respiratory distress syndrome and circulatory failure following COVID-19, who was treated with VAV-ECMO.

Prognostic impact of CD8 and programmed death-ligand 1 expression in patients with resectable non-small cell lung cancer.

BACKGROUND: The prognostic impact of the expression of CD8 and programmed death-ligand 1 (PD-L1) has not been established in patients with resectable non-small cell lung cancer (NSCLC). METHODS: Surgical tissue specimens were obtained from 136 patients with NSCLC who underwent surgical resection. The expression levels of CD8 and PD-L1 were assessed using tissue microarrays and immunohistochemistry. RESULTS: The CD8-positive group showed significant increases in overall survival (OS) (median, not reached [NR] vs. 28.452 months) and relapse-free survival (RFS) (median, NR vs. 14.916 months) compared with the CD8-negative group. In contrast to CD8, the PD-L1-negative group demonstrated significant increases in OS (median, NR vs. 29.405 months) and RFS (median, 63.573 vs. 17.577 months) compared with the PD-L1-positive group. Two prognostic groups were stratified according to CD8/PD-L1 expression: group 1 (CD8-positive/PD-L1-negative) vs. group 2 (CD8/PD-L1: positive/positive, negative/negative, negative/positive). Group 1 had better OS (median, NR vs. 29.405 months) and RFS (median, NR vs. 17.577 months) than group 2. Multivariate analysis indicated that group 1 constituted an independent favourable prognostic factor for OS (hazard ratio [HR], 0.329, p = 0.001) and RFS (HR, 0.293; p < 0.001). CONCLUSIONS: Positive CD8 and negative PD-L1 expression together may be favourable prognostic markers in resectable NSCLC.

Functionalized Magnetic PLGA Nanospheres for Targeting and Bioimaging of Breast Cancer.

Superparamagnetic iron oxide nanoparticles (SPIONs) are actively used as highly sensitive imaging probes to provide contrast in MRI. In this study, we propose the use of SPIONs encapsulated with antibody-conjugated poly(lactic-co-glycolic acid) (PLGA) as a potent theragnostic agent. The SPIONs were synthesized by a chemical co-precipitation method of ferric and ferrous ions, and subsequently encapsulated with PLGA by using an emulsification-diffusion method. Herceptin was chemically conjugated to the SPION-encapsulating PLGA nanoparticles to target the human epidermal growth factor receptor 2 (Her2/neu) overexpressing breast cancers. FACS and MR molecular imaging revealed that the Her2/neu overexpressing cell line showed a stronger contrast enhancement than the Her2/neu non-expressing cell lines, and the signal intensity of in vivo MR imaging decreased as the concentration of Herceptin increased. This strategy of encapsulating SPIONs with PLGA will be highly useful in functionalizing magnetic nanoparticles and improving the diagnostic and therapeutic efficacy of a wide array of cancer treatments.

Reversible Chromatic Response of Polydiacetylene Derivative Vesicles in D2O Solvent.

The thermal chromatic sensitivity of polydiacetylenes (PDAs) with 10,12-pentacosadiynoic acid (PCDA) derivatives, which have a hydroxyl group (HEEPCDA) and an amine group (APPCDA), were investigated using D2O and H2O as solvents. The vesicle solution with polymerized HEEPCDA exhibited a reversible chromatic response during the heating and cooling cycle in D2O, but not in H2O. On the other hand, the vesicle solution with the polymerized APPCDA exhibited a reversible chromatic response in H2O during the heating and cooling cycle, but the color of the solution did not change much in D2O. The critical vesicle concentration of HEEPCDA was lower in D2O than in H2O, and the chromatic sensitivity of the polymerized vesicles to temperature was slower in D2O than in H2O. We think that it is due to D2O being a more highly structured solvent than H2O with the hydrogen bonding in D2O stronger than that in H2O.

Chromatic response of polydiacetylene vesicle induced by the permeation of methotrexate.

The noble vesicular system of polydiacetylene showed a red shift using two types of detecting systems. One of the systems involves the absorption of target materials from the outer side of the vesicle, and the other system involves the permeation through the vesicular layers from within the vesicle. The chromatic mixed vesicles of N-(2-aminoethyl)pentacosa-10,12-diynamide (AEPCDA) and dimethyldioctadecylammonium chloride (DODAC) were fabricated by sonication, followed by polymerization by UV irradiation. The stability of monomeric vesicles was observed to increase with the polymerization of the vesicles. Methotrexate was used as a target material. The polymerized mixed vesicles having a blue color were exposed to a concentration gradient of methotrexate, and a red shift was observed indicating the adsorption of methotrexate on the polydiacetylene bilayer. In order to check the chromatic change by the permeation of methotrexate, we separated the vesicle portion, which contained methotrexate inside the vesicle, and checked chromatic change during the permeation of methotrexate through the vesicle. The red shift apparently indicates the disturbance in the bilayer induced by the permeation of methotrexate. The maximum contrast of color appeared at the equal molar ratio of AEPCDA and DODAC, indicating that the formation of flexible and deformable vesicular layers is important for red shift. Therefore, it is hypothesized that the system can be applicable for the chromatic detection of the permeation of methotrexate through the polydiacetylene layer.

A facile patterning of silver nanowires using a magnetic printing method.

Patterning of metal nanowires (NWs) is vital for the fabrication of NW-based, high-performance devices such as sensors, transparent conducting electrodes, and optoelectronics. However, the majority of existing patterning methods require complex and expensive technologies. For this reason, we report for the first time a facile and quick patterning method of silver (Ag) NWs using a magnetic printing method. We successfully demonstrated a patterned AgNW grid structure ona flexible substrate as transparent electrodes. The flexible AgNW grid electrode exhibited optical and electrical properties comparable to those of commercial transparent conducting electrodes.We believe our work will be broadly applicable to other NW-based devices such as sensors,energy storage devices, meta devices, nanoscale electronics, and optoelectronics.

Controlled self-assembly for high-resolution magnetic printing.

A controlled magnetic field creates patterns of superparamagnetic nanoparticles with a minimum line width of 10 µm on a flexible substrate. This magnetic printing method is also successfully used to print conductive patterns consisting of copper or carbon nanomaterials.

Persistent Pneumonic Consolidations due to Secondary Organizing Pneumonia in a Patient Recovering from COVID-19 Pneumonia: A Case Report and Literature Review.

In patients recovering from coronavirus disease 2019 (COVID-19) pneumonia, respiratory symptoms and radiographic pneumonic infiltrate occasionally persist for many weeks even after viral clearance; thereby, making it difficult to decide on an appropriate treatment. Here, we describe a 46-year-old woman with COVID-19 pneumonia who had persistent radiographic pneumonic infiltration and respiratory symptoms for almost 4 weeks after illness onset, despite viral clearance, and was subsequently diagnosed with secondary organizing pneumonia (SOP) using video-assisted thoracoscopic (VATS) wedge lung biopsy. Intravenous methylprednisolone was administered at an initial dose of 50 mg/day (1 mg/kg) for 7 days and was tapered to a dose of prednisolone 30 mg/day following improvement in the patient's respiratory symptoms and chest radiographic findings. The patient was discharged from the hospital 14 days after the initiation of corticosteroid treatment. The dose of prednisolone was tapered monthly to 20, 15, 10, and 5 mg/day, respectively, at the outpatient clinic for a total duration of 6 months; nearly resolved pneumonic infiltrations were observed in a follow-up computed tomography scan approximately 2 months after she was admitted. To the best of our knowledge, this is the first case report of a COVID-19 associated SOP that was pathologically confirmed through VATS wedge lung biopsy in Korea. SOP should be considered in the differential diagnosis of patients with COVID-19 pneumonia with persistent respiratory symptoms and radiographic pneumonic infiltrations during the recovery phase to avoid the redundant use of antimicrobial or antiviral agents. Furthermore, histological confirmation is essential for the definitive diagnosis of SOP to avoid unnecessarily prolonged corticosteroid treatment.

Video-Assisted Thoracic Surgery Core Needle Biopsy for Pulmonary Nodules in Patients with Impaired Lung Function: Is It Feasible and Safe?

Background: The number of patients with incidentally identified pulmonary nodules is increasing. This study attempted to confirm the usefulness and safety of video-assisted thoracic surgery (VATS) core needle biopsy of pulmonary nodules. Methods: Data from 18 patients diagnosed with pulmonary nodules who underwent VATS core need biopsy were retrospectively reviewed. Results: Of the 18 patients, 15 had malignancies (primary lung cancer, n=14; metastatic lung cancer, n=1), and 3 had benign nodules. Mortality and pleural metastasis did not occur during the follow-up period. Conclusion: In patients with solitary pulmonary nodules that require tissue confirmation, computed tomography-guided percutaneous cutting needle biopsy or diagnostic pulmonary resection sometimes may not be feasible choices due to the location of the solitary pulmonary nodule or the patient's impaired pulmonary function, VATS core needle biopsy may be performed in these patients as an alternative method.

Cardiac Calcified Amorphous Tumor in the Left Atrium: A Case Report.

A cardiac calcified amorphous tumor (CAT) is a rare non-neoplastic mass of the heart with histological characteristics comprising calcification and amorphous fibrous material. Little is known regarding the incidence, symptoms, and therapeutic strategies for CAT. Echocardiography and computed tomography were performed on a 48-year-old man who had a cardiac mass that was accidentally discovered on admission to a local hospital for a fracture related to a trauma that occurred 1 month prior. After surgery, a histological examination resulted in the diagnosis of a cardiac CAT. The patient was discharged without postoperative complications on the 12th day after surgery.

In situ catalytic activity of CuO nanosheets synthesized from a surfactant-lamellar template.

CuO nanosheets approximately 0.8 nm thick were synthesized under ambient conditions within a few hours using a surfactant lamellar mesophase as a soft template. In aqueous media, metal ions and anionic surfactants form a lamellar mesophase. In the lamellar layers, metal ions can crystallize without structural collapse. Highly ordered CuO nanosheet/surfactant lamellar layers formed in an aqueous solution can be easily delaminated by washing with water. The use of the delaminated CuO nanosheet catalyst instead of traditional metallic catalysts resulted in a reduction reaction of 4-nitrophenol with NaBH4 that obeyed zero-order kinetics. This indicates in situ conversion of CuO to Cu in the reaction solution. Cu in situ reduced by BH4- acted as a catalyst relaying electrons for the reduction of 4-NP. The catalytic reaction was investigated by UV-vis spectroscopy, and the reduction and crystalline structures of the nanosheets were analyzed by UV-vis spectroscopy and X-ray diffraction. These results indicate CuO nanosheets to be an attractive alternative to metal catalysts in reactions involving hydrogen.

Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study.

BACKGROUND: Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients. METHODS: For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management. RESULTS: The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential. CONCLUSIONS: The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study. TRIAL REGISTRATION: Not applicable.

HER2/neu antibody conjugated poly(amino acid)-coated iron oxide nanoparticles for breast cancer MR imaging.

Superparamagnetic iron oxide nanoparticles are widely used as nanoprobes for magnetic resonance imaging (MRI). Water-soluble iron oxide nanoparticles were synthesized by coating iron oxide nanoparticles with a hydrophilic, biocompatible, biodegradable poly(amino acid) derivative, poly(2-hydroxyethyl aspartamide) graft copolymer for negative contrast enhancement on T2 weighted MRI. HER2/neu antibodies were conjugated on the surface of poly(amino acid) coated iron oxide nanoparticles for the detection of breast cancer. The antibody-grafted iron oxide nanoparticles (PAION-Ab) were about 31.1 nm in diameter. The T2 relaxivity of PAION-Ab was 246 L·mmol(-1)·sec(-1) greater than that of the commercial product such as Feridex. PAION-Ab showed low cytotoxicity even at relatively high concentrations. Furthermore, Prussian blue staining and in vitro MRI study with SKBR-3, breast cancer cells overexpressing HER2/neu receptors indicated that PAION-Ab exhibited excellent cancer cell detection ability and enhanced signal intensities in the T2-weighted image.

Chemical pleurodesis with Viscum album L. extract for secondary spontaneous pneumothorax in elderly patients.

BACKGROUND: Secondary spontaneous pneumothorax is generally managed by surgery, if pneumothorax was not improved following chest tube insertion or in the event of persistent air leakage lasting more than 5 days. However, if surgery is not an option, chemical pleurodesis with sclerosants can be performed. Several sclerosants have been used in the chemical pleurodesis of secondary spontaneous pneumothorax, However, there is still controversy for what is the ideal sclerosant for Secondary spontaneous pneumothorax. The use of Viscum album L. for chemical pleurodesis in patients with secondary spontaneous pneumothorax aged >65 years has not been described to date, despite its extensive use. The authors tried to find out the effect of Viscum album L. for sclerosant for Secondary spontaneous pneumothorax in elder. METHODS: This retrospective analysis examined 25 patients (aged >65 years) with secondary spontaneous pneumothorax with persistent air leakage who underwent chemical pleurodesis with Abnova Viscum-F® (V. album L.). RESULTS: The duration of chest tube drainage was 5.08 days after chemical pleurodesis. Adverse effects related to chemical pleurodesis with Abnova Viscum-F® were fever (7/25), pain (4/25), leukocytosis (10/25), and dyspnea with desaturation (7/25); however all the patients recovered without sequela and were subsequently discharged. CONCLUSIONS: The present study demonstrated the successful use of chemical pleurodesis with V. album L. in the management of elderly patients with secondary spontaneous pneumothorax. Because of the high probability of dyspnea with desaturation in the elderly, caution must be exercised.

Controlled aggregates of magnetite nanoparticles for highly sensitive MR contrast agent.

We have prepared a magnetite encapsulated polymer nanocomposite (MEPN) by an emulsification-diffusion technique and found that the encapsulation efficiency could be precisely controlled according to the portion of magnetite and the capping ligand that covers the surface of the magnetite nanoparticles. The field-dependence and temperature dependence on magnetization, measured by a superconducting quantum interference device, demonstrate that there was no size effect of the magnetite nanoparticles on the encapsulation behavior. The size distribution and T2 relaxivity of prepared MEPNs were measured using magnetic resonance imaging for analysis of the effect of aggregation and it was verified that aggregates of the magnetite nanoparticles provide enhanced relaxation ability.

Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department.

BACKGROUND: For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes. METHODS: We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission. RESULTS: The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient's Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018-1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570-2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118-1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010-1.130; p=0.021) were significantly associated with in-hospital mortality. CONCLUSION: The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.

Management of acute type A aortic dissection with acute lower extremities malperfusion.

BACKGROUND: Acute type A aortic dissection complicated by malperfusion is a life - threatening emergency. The optimal management strategy for malperfusion remains controversial. CASE PRESENTATION: A 46-year-old man presented to another institution with acute type A aortic dissection with abdominal aorta occlusion. Motor and sensory grade of both lower extremities were zero. Immediate antegrade distal perfusion of both lower extremities was achieved, and total arch replacement with left axillo-bifemoral bypass was performed. At the time of discharge, motor and sensory grades of both lower extremities were 2 and 3, respectively. CONCLUSION: This case demonstrates many of the techniques in the management of acute type A aortic dissection with abdominal aorta occlusion. In this case, direct antegrade perfusion of both lower extremities and axillo-bifemoral bypass may be helpful for patients presenting with severe malperfusion of both lower extremities with acute type A aortic dissection.

Quantitative severity of pulmonary emphysema as a prognostic factor for recurrence in patients with surgically resected non-small cell lung cancer.

BACKGROUND: Pulmonary emphysema is a major component of chronic obstructive pulmonary disease and lung cancer. However the prognostic significance of quantitative emphysema severity in patients with lung cancer is unclear. We analyzed whether numerical emphysema value is a prognostic factor for recurrence in patients with surgically resected non-small cell lung cancer. METHODS: We quantified emphysema severity of the whole lung and regional lobes in 45 patients (mean age 68.0 years) using an automated chest computed tomography-based program. Predictive factors for recurrence were investigated using a Cox proportional hazards model. Recurrence-free and overall survival was compared after dichotomization of patients according to whole lung emphysema severity. RESULTS: The mean percentage emphysema ratio of the whole lung was 1.21 ± 2.04. Regional lobar emphysema severity was highest in the right middle lobe (1.93 ± 0.36), followed by right upper (1.35 ± 2.50), left upper (1.34 ± 2.12), left lower (1.05 ± 2.52), and right lower (0.78 ± 2.28) lobes. The low severity group showed significantly longer overall survival compared to the high severity group (log-rank test, P = 0.018). Quantitative emphysema severity of the whole lung (hazard ratio 1.36; 95% confidence interval 1.0-1.73) and stage III (hazard ratio 6.17; 95% confidence interval 1.52-25.0) were independent predictors of recurrence after adjusting for age, gender, smoking status, and forced expiratory volume in one second. CONCLUSION: The severity of whole lung emphysema was independently associated with recurrence. Patients with non-small cell lung cancer and marginal pulmonary emphysema at lower severity survive longer after curative-intent surgery.

Perforation of inferior vena cava and duodenum by strut of inferior vena cava filter: A case report.

INTRODUCTION: An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS: A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS: We performed a laparotomy to remove the IVC filter. OUTCOMES: Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS: There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.