Maintaining safe lung cancer surgery during the COVID-19 pandemic in a global city.

BACKGROUND: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. METHODS: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. FINDINGS: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35-86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3-4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). INTERPRETATION: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients. FUNDING: This work did not receive funding.

Determination of Hafnium Zirconium Oxide Interfacial Band Alignments Using Internal Photoemission Spectroscopy and X-ray Photoelectron Spectroscopy.

Doped ferroelectric HfO2 is highly promising for integration into complementary metal-oxide semiconductor (CMOS) technology for devices such as ferroelectric nonvolatile memory and low-power field-effect transistors (FETs). We report the direct measurement of the energy barriers between various metal electrodes (Pt, Au, Ta, TaN, Ti/Pt, Ni, Al) and hafnium zirconium oxide (Hf0.58Zr0.42O2, HZO) using internal photoemission (IPE) spectroscopy. Results are compared with valence band offsets determined using the three-sample X-ray photoelectron spectroscopy (XPS) as well as the two-sample hard X-ray photoelectron spectroscopy (HAXPES) techniques. Both XPS and IPE indicate roughly the same dependence of the HZO barrier on metal work function with a slope of 0.8 ± 0.5. XPS and HAXPES-derived barrier heights are on average about 1.1 eV smaller than barrier heights determined by IPE, suggesting the presence of negative charge in the HZO.

Demonstration of Fowler-Nordheim Tunneling in Simple Solution-Processed Thin Films.

The production of high-quality thin-film insulators is essential to develop advanced technologies based on electron tunneling. Current insulator deposition methods, however, suffer from a variety of limitations, including constrained substrate sizes, limited materials options, and complexity of patterning. Here, we report the deposition of large-area Al2O3 films by a solution process and its integration in metal-insulator-metal devices that exhibit I- V signatures of Fowler-Nordheim electron tunneling. A unique, high-purity precursor based on an aqueous solution of the nanocluster flat-Al13 transforms to thin Al2O3 insulators free of the electron traps and emission states that commonly inhibit tunneling in other films. Tunneling is further confirmed by the temperature independence of device current.

Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula.

A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients' nutrition as well as optimal timing for surgical intervention.

Enhanced NMR with Optical Pumping Yields 75As Signals Selectively from a Buried GaAs Interface.

We have measured the 75As signals arising from the interface region of single-crystal semi-insulating GaAs that has been coated and passivated with an aluminum oxide film deposited by atomic layer deposition (ALD) with optically pumped NMR (OPNMR). Using wavelength-selective optical pumping, the laser restricts the volume from which OPNMR signals are collected. Here, OPNMR signals were obtained from the interface region and distinguished from signals arising from the bulk. The interface region is highlighted by interactions that disrupt the cubic symmetry of the GaAs lattice, resulting in quadrupolar satellites for nuclear [Formula: see text] isotopes, whereas NMR of the "bulk" lattice is nominally unsplit. Quadrupolar splitting at the interface arises from strain based on lattice mismatch between the GaAs and ALD-deposited aluminum oxide due to their different coefficients of thermal expansion. Such spectroscopic evidence of strain can be useful for measuring lattice distortions at heterojunction boundaries and interfaces.

Endobronchial valve migration.

Endobronchial valves are increasingly used as a treatment modality as a less invasive alternative to lung volume reduction surgery in patients with severe emphysema. Endobronchial valves have also been used to treat patients with persistent pulmonary air leaks and those with bronchopleural fistulae. We report a case of a 61-year-old male with severe bullous emphysema. Following video-assisted thoracoscopic surgery and giant bullectomy, he had a persistent air leak. We inserted two endobronchial valves (in the lingular lobe and the anterior segment of the upper lobe) and the air leak ceased immediately. However, over the subsequent 5 months following the insertion of the endobronchial valves, the patient suffered recurrent chest infections and the endobronchial valves were found to have migrated to the orifice of the basal segment of the left lower lobe and the orifice of the basal segments of the right lower lobe.