Differences in Treatment Outcomes According to the Insertion Method Used in Extracorporeal Cardiopulmonary Resuscitation: A Single-Center Experience.

Background: Venoarterial extracorporeal membrane oxygenation (ECMO) is a key treatment method used with patients in cardiac arrest who do not respond to medical treatment. A critical step in initiating therapy is the insertion of ECMO cannulas. Peripheral ECMO cannulation methods have been preferred for extracorporeal cardiopulmonary resuscitation (ECPR). Methods: Patients who underwent ECPR at Daegu Catholic University Medical Center between January 2017 and May 2023 were included in this study. We analyzed the impact of 2 different peripheral cannulation strategies (surgical cutdown vs. percutaneous cannulation) on various factors, including survival rate. Results: Among the 99 patients included in this study, 66 underwent surgical cutdown, and 33 underwent percutaneous insertion. The survival to discharge rates were 36.4% for the surgical cutdown group and 30.3% for the percutaneous group (p=0.708). The ECMO insertion times were 21.3 minutes for the surgical cutdown group and 10.3 minutes for the percutaneous group (p<0.001). The factors associated with overall mortality included a shorter low-flow time (hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.019-1.071; p=0.001) and whether return of spontaneous circulation was achieved (HR, 0.317; 95% CI, 0.127-0.787; p=0.013). Low-flow time was defined as the time from the start of cardiopulmonary resuscitation to the completion of ECMO cannula insertion. Conclusion: No statistically significant difference in in-hospital mortality was observed between the surgical and percutaneous groups. However, regardless of the chosen cannulation strategy, reducing ECMO cannulation time was beneficial, as a shorter low-flow time was associated with significant benefits in terms of survival.

Two Cases of Robot-Assisted Totally Minimally Invasive Esophagectomy with Colon Interposition for Gastroesophageal Junction Cancer: Surgical Considerations.

This case report presents 2 patients with gastroesophageal junction cancer who both underwent totally minimally invasive esophagectomy with colon interposition. Patients 1 and 2, who were 43-year-old and 78-year-old men, respectively, had distinct clinical presentations and medical histories. Patient 1 underwent minimally invasive robotic esophagectomy with a laparoscopic total gastrectomy, colonic conduit preparation, and intrathoracic esophago-colono-jejunostomy. Patient 2 underwent completely robotic total gastrectomy, colon conduit preparation, and intrathoracic esophago-colono-jejunostomy. The primary challenge in colon interposition is assessing colon vascularity and ensuring an adequate conduit length, which is critical for successful anastomosis. In both cases, we used indocyanine green fluorescence angiography to evaluate vascularity. Determining the appropriate conduit is challenging; therefore, it is crucial to ensure a slightly longer conduit during reconstruction. Because totally minimally invasive colon interposition can reduce postoperative pain and enhance recovery, this surgical technique is feasible and beneficial.

Surgical outcomes of 500 robot-assisted minimally invasive esophagectomies for esophageal carcinoma.

Background: In 2003, robot-assisted minimally invasive esophagectomy (RAMIE) was first reported to overcome the technical limitations of minimally invasive esophagectomy. RAMIE requires repeated modifications to set up the robotic system, and sufficient experience is required to gain technical proficiency. This study aimed to identify the learning periods and the outcomes of RAMIE for esophageal carcinoma. Methods: We retrospectively reviewed 500 consecutive RAMIE cases for esophageal cancer from December 2008 to February 2021. The learning curve for RAMIE was identified using cumulative sum analysis. Results: In a total of 500 RAMIE patients, the Ivor Lewis and McKeown operation were performed in 267 patients (53.4%) and 192 patients (38.4%), respectively. We classified learning periods into the learning phase (first 50 cases), the developing phase (51-150 case), and the stable phase (151-500 case). The rates of vocal cord palsy (42.0% vs. 28.4%) and anastomotic leakage (10.0% vs. 6.4%) were reduced after the learning phase. The mean total operative time (420 vs. 373 min), the mean length of stay (21.6 vs. 16.7 days), and the rate of anastomotic stricture (27.0% vs. 12.4%) were significantly reduced after reaching stable phase. In the stable phase, the proportion of the Ivor Lewis operation (26.0% vs. 67.1%), neoadjuvant chemoradiation therapy (14.0% vs. 25.7%), and bilateral cervical node dissection cases (12.0% vs. 22.0%) were significantly increased. Conclusions: Fifty procedures might be needed to achieve early proficiency, and extensive experience of more than 150 procedures is needed for quality stabilization.

Treatment of phlegmonous esophagitis in various patients: a case series.

Acute phlegmonous esophagitis (APE) is a rare and fatal disease. Phlegmonous infection involves the submucosal layer and muscularis propria but not the mucosal layer. Because surgery is not the first treatment option for this disease, an accurate diagnosis is crucial. Herein, we report three cases of APE with various clinical features. All patients were successfully treated with antibiotics and appropriate medical procedures.

Removal effect of Candida albicans biofilms from the PMMA resin surface by using a manganese oxide nanozyme-doped diatom microbubbler.

To prevent oral candidiasis, removal of the Candida biofilms from dentures is important. However, common denture cleaners are insufficiently effective in removing biofilms. A manganese oxide (MnO2) nanozyme-doped diatom microbubbler (DM) can generate oxygen gas microbubbles by a catalase-mimicking activity in hydrogen peroxide (H2O2). DM can invade and destroy biofilms with the driving force of continuously generated microbubbles. In this study, the Candida biofilm removal efficiency by co-treatment of DM and H2O2 was investigated. Diatom particles were reacted with (3-aminopropyl)triethoxysilane to prepare amine-substituted diatom particles. These particles were reacted with potassium permanganate to fabricate DMs. The morphology and components of DM were analyzed by using a scanning electron microscope (SEM). Four types of denture base resin specimens on which biofilms of Candida albicans were formed were treated with phosphate-buffered saline (PBS group), Polident 5-Minute (Polident group), 0.12% chlorhexidine gluconate (CHX group), 3% H2O2 (H2O2 group), and co-treatment of 3 mg/mL of DM and 3% H2O2 (DM group). The biofilm removal effect of each group was quantitatively analyzed by crystal violet assay, and the results were visually confirmed by SEM images. After each treatment, the remaining C. albicans were stained with Hoechst 33342/propidium iodide, and observed with confocal laser scanning microscopy (CLSM) to evaluate the viability. MnO2 nanozyme sheets were successfully doped on the surface of the fabricated DM. Although biofilms were not effectively removed in the Polident and CHX groups, CLSM images showed that CHX was able to effectively kill C. albicans in the biofilms on all resin specimen types. According to the crystal violet analysis, the H2O2 groups removed the biofilms on heat-activated and 3D-printed resins (P < .01), but could not remove the biofilms on autopolymerizing and milled resins significantly (P = .1161 and P = .1401, respectively). The DM groups significantly removed C. albicans from all resin specimen types (P < .01).

Evaluation of the prognostic significances of γ-secretase genes in pancreatic cancer.

With the growing requirement for novel prognostic biomarkers for pancreatic cancer, many studies have focused on clinical and/or genomic variables. Although many studies have been performed, carbohydrate antigen 19-9 is the only biomarker in clinical use. Therefore, the present study examined whether γ-secretase genes, including presenilin (PSEN), nicastrin (NCSTN), presenilin enhancer protein 2 (PSENEN), and anterior pharynx-defective 1 (APH1-), could serve as prognostic factors for pancreatic cancer. The cohorts selected included >100 pancreatic cancer patients. Patient data were downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GSE21501). The prognostic roles of the γ-secretase genes were analyzed by several survival analysis methods. Among the γ-secretase genes, the prognosis tended to be worse in the 2 cohorts with increasing expression of PSEN1, APH1A, and PSENEN, while the remaining genes were the opposite in the 2 cohorts. Notably, although the patient characteristics were quite different, APH1A was statistically significantly associated with prognosis in the 2 cohorts. The hazard ratio of APH1A for overall survival was 1.598 (TCGA) and 2.724 (GSE21501). These results contribute to the study of γ-secretase in pancreatic cancer. We believe that γ-secretase, particularly APH1A, will be a new prognostic biomarker for pancreatic cancer.

The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair.

BACKGROUND: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). METHODS: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. RESULTS: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2±17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. CONCLUSION: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

Selective Carotid Shunting Based on Intraoperative Transcranial Doppler Imaging during Carotid Endarterectomy: A Retrospective Single-Center Review.

BACKGROUND: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. METHODS: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. RESULTS: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. CONCLUSION: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

Successful management of a recurrent primary malignant fibrous histiocytoma of the lung: report of a case.

We describe herein an extremely rare case of a recurrent primary pulmonary malignant fibrous histiocytoma 3 months after operation that occurred in a 55-year-old man who was treated with chemotherapy and radiotherapy successfully. Until now, 36 months later, the patient has shown no evidence of tumor recurrence. The clinical, radiographic, and pathologic features are reported here together with a brief review of the literature.