Automated CT quantification of interstitial lung abnormality in patients with resectable stage I non-small cell lung cancer: Prognostic significance.

BACKGROUND: In patients with non-small cell lung cancer (NSCLC), interstitial lung abnormalities (ILA) have been linked to mortality and can be identified on computed tomography (CT) scans. In the present study we aimed to evaluate the predictive value of automatically quantified ILA based on the Fleischner Society definition in patients with stage I NSCLC. METHODS: We retrospectively reviewed 948 patients with pathological stage I NSCLC who underwent pulmonary resection between April 2009 and October 2022. A commercially available deep learning-based automated quantification program for ILA was used to evaluate the preoperative CT data. The Fleischner Society definition, quantitative results, and interdisciplinary discussion led to the division of patients into normal and ILA groups. The sum of the fibrotic and nonfibrotic ILA components constituted the total ILA component and more than 5%. RESULTS: Of the 948 patients with stage I NSCLC, 99 (10.4%) patients had ILA. Shorter overall survival and recurrence-free survival was associated with the presence of ILA. After controlling for confounding variables, the presence of ILA remained significant for increased risk of death (hazard ratio [HR] = 3.09; 95% confidence interval [CI]: 1.91-5.00; p < 0.001) and the presence of ILA remained significant for increased recurrence (HR = 1.96; 95% CI: 1.16-3.30; p = 0.012). CONCLUSIONS: The automated CT quantification of ILA, based on the Fleischner Society definition, was significantly linked to poorer survival and recurrence in patients with stage I NSCLC.

A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation.

PURPOSE: Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT). MATERIALS AND METHODS: In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups. RESULTS: The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (p=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (p=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; p=0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group. CONCLUSION: Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.

Association of positive pre-transplant angiotensin II type 1 receptor antibodies with clinical outcomes in lung transplant recipients.

INTRODUCTION: Autoantibodies against the angiotensin II type 1 receptor (AT1R-Ab) have been previously associated with de novo donor-specific antibody (DSA) formation in lung transplantation. However, data regarding the clinical significance of AT1R-Ab in long-term graft function after lung transplantation are lacking. METHODS: Seventy-one patients who underwent lung transplantation between July 2016 and January 2020 were enrolled in this study. We examined the relationship between pre-transplant AT1R-Ab levels and graft function, clinical outcomes, and human leukocyte antigen (HLA) DSA levels during the first 3 years post-transplantation. RESULTS: Seventeen (23.9%) patients were AT1R-Ab-positive, and 54 (76.1%) were AT1R-Ab-negative. The median antibody value of the AT1R-Ab-positive group was 18 [18-22.5] U/mL, while that of the AT1R-Ab-negative group was 5.1 [3.5-8.0] U/mL (p < 0.001). There was no significant difference in the median acute cellular rejection (ACR) scores between the two groups (median [interquartile range] 1 [0.8-3] vs. 0.7 [0-1]; p = 0.145). However, there was a significant difference in the distribution of the ACR scores between the two groups (p = 0.015). Most (41.2%) patients in the pre-transplant AT1R-positive group scored above 1. The incidence of de novo DSA was also higher in AT1R-Ab-positive than in AT1R-Ab-negative patients (52.9% vs. 20.4%, p = 0.009). The incidence of chronic lung allograft dysfunction (CLAD) within 3 years was significantly higher in AT1R-Ab-positive than in AT1R-Ab-negative patients (58.3% vs. 11.8%; p < 0.001). In the multivariate Cox regression analysis, AT1R-Ab positivity (hazard ratio, 9.46; 95% confidence interval, 2.89-30.94; p < 0.001) was significantly associated with early CLAD. Furthermore, Kaplan-Meier analysis showed that AT1R-Ab-positive patients had a shorter survival time (χ2 = 39.62, p < 0.001). CONCLUSION: High AT1R-Ab levels in the pre-transplant serum of lung recipients were associated with the development of de novo HLA-DSA, ACR, early CLAD, and short survival.

Prevalence and Clinical Implications of Incidental Aortic Arch Abnormalities on Contrast-Enhanced Neck MR Angiography: A Single-Center Experience.

Background and Objectives: Vascular abnormalities within the anatomical coverage are frequently encountered in imaging studies. The aortic arch is often overlooked as an anatomical blind spot, especially in neck magnetic resonance (MR) angiography. This study investigated the prevalence of incidental aortic arch abnormalities. We also estimated the potential clinical significance of aortic arch abnormalities as blind spots detected on contrast-enhanced neck MR angiography. Materials and Methods: Between February 2016 and March 2023, 348 patients were identified based on contrast-enhanced neck MR angiography reports. The clinical and radiological characteristics of the patients and the presence of additional imaging studies were assessed. The aortic arch abnormalities and coexisting non-aortic arterial abnormalities were classified into two categories according to their clinical significance. We performed the χ2 test and Fisher's exact test for group comparisons. Results: Of the 348 study patients, only 29 (8.3%) had clinically significant incidental aortic arch abnormalities. Among these 348 patients, 250 (71.8%) and 136 (39%) had intracranial and extracranial abnormalities, respectively; the clinically significant intracranial abnormalities in the two groups were 130 lesions (52.0%) and 38 lesions (27.9%), respectively. In addition, there was a significantly higher tendency of clinically significant aortic arch abnormalities (13/29, 44.8%) in the patients who had clinically significant coexisting non-aortic arterial abnormalities than in the other group (87/319, 27.3%) (p = 0.044). The patient groups with clinically significant intracranial or extracranial arterial abnormalities had higher rates of clinically significant aortic abnormalities (31.0% and 17.2%), but there was no statistical significance (p = 0.136). Conclusions: The incidence of clinically significant aortic arch abnormalities was 8.3% on neck MR angiography, with a significant association between aortic and coexisting non-aortic arterial abnormalities. The findings of this study could improve the understanding of incidental aortic arch lesions on neck MR angiography, which is of crucial clinical importance for radiologists to achieve accurate diagnoses and management.

Multivariate Analysis of Risk Factor for Mortality and Feasibility of Extracorporeal Membrane Oxygenation in High-Risk Thoracic Surgery.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as intraoperative cardiorespiratory support during lung transplantation is well known, but use for other types of surgery are limited. To assess risk factor for mortality after high-risk thoracic surgery and feasibility of ECMO, we reviewed. METHODS: This study was an observational study. Between January 2011 and October 2018, 63 patients underwent thoracic surgery with ECMO for severe airway disease, pulmonary insufficiency requiring lung surgery, and other conditions. RESULTS: In all, 46 patients remained alive at 30 days after surgery. The mean patient age was 50.38 ± 16.16 years. ECMO was most commonly used to prevent a lethal event (34 [73.9%]) in the Survival (S) group and rescue intervention (13 [76.5%]) in the Non-survival (N) group. In all, 11 patients experienced arrest during surgery (S vs N: 2 [4.3%] vs 9 [52.9%], p ≤0.001). The multivariate analysis revealed that arrest during surgery (odds ratio [OR], 24.44; 95% confidence interval [CI], 1.82-327.60; p = 0.016) and age (OR, 7.47; 95% CI, 1.17-47.85; p = 0.034) were independently associated with mortality. CONCLUSIONS: ECMO provides a safe environment during thoracic surgery, and its complication rate is acceptable except for extracorporeal cardiopulmonary resuscitation (ECPR).

Successful treatment of catamenial hemoptysis by single-incision thoracoscopic left S9 + 10 segmentectomy using indocyanine green injection-assisted targeting.

Catamenial hemoptysis is a rare condition. A 28-year-old woman presented with a 1-year history of repetitive hemoptysis occurring on the first day of her menstrual period. Chest computed tomography revealed catamenial hemoptysis during her menstrual period. The patient underwent single-incision thoracoscopic left S9 + 10 segmentectomy using indocyanine green injection-assisted targeting. The endometriosis lesions would not be enhanced by perfusion defects during ICG injection due to the lung contusion. Surgical resection with accurate localization of catamenial hemoptysis was a fundamental treatment method. The localization of lesions using indocyanine green effectively enabled a minimally invasive surgery.

Is the pleating technique superior to the invaginating technique for plication of diaphragmatic eventration in infants?

BACKGROUNDS: The pleating technique is widely used in plication but is difficult to perform with thoracoscopy because of its complex procedure and the limited surgical space. Thus, the invaginating technique was introduced to facilitate thoracoscopic surgery and is now widely used in video-assisted thoracoscopic surgery (VATS) plication. However, the usefulness of the invaginating technique in children has not been established because of the lack of data on long-term outcomes after surgery using the technique. METHODS: From March 2007 to December 2017, 21 patients who were surgically treated for congenital diaphragmatic eventration and phrenic nerve palsy after congenital cardiac surgery were divided into 2 groups according to the surgical method used (pleating technique: 10 patients, invaginating technique: 11 patients). We evaluated the patients for postoperative outcomes and recurrence of diaphragmatic eventration over 5 years. Postoperative recurrence of diaphragmatic eventration was confirmed by calculating the ratio of the eventration level between the eventrated and normal diaphragms. RESULTS: In the 21 patients who underwent diaphragmatic plication, the pleating and invaginating techniques were used in 10 and 11 patients, respectively. The mean follow-up duration was 63.4 ±â€¯48.4 months (pleating group [P] vs invaginating group [I]: 89.1 ±â€¯52.4 vs 40.1 ±â€¯30.8 months, p = 0.022). The mean eventration rates in the 21 patients was 26.7% ±â€¯9.1% (P vs I: 26.6% ±â€¯6.1% vs 26.9% ±â€¯11.3%, p = 0.945) before operation and -2.1% ±â€¯7.3% (-2.8% ±â€¯7.5% vs -1.5% ±â€¯7.4%, p = 0.695) in the immediate postoperative period. From the first to the fifth postoperative year, no recurrence of diaphragmatic eventration was found in any of the groups during the follow-up. CONCLUSIONS: The invaginating technique was easier to perform but showed a similar long-term result as compared with the pleating technique in terms of the growth and development of the chest cavity in the pediatric patients in this study. Thus, we recommend that the invaginating technique be applied in VATS plication for children as an alternative to the pleating technique. LEVEL OF EVIDENCE: Level III.

Interhospital Transport System for Critically Ill Patients: Mobile Extracorporeal Membrane Oxygenation without a Ventilator.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been successfully used as a method for the interhospital transportation of critically ill patients. In South Korea, a well-established ECMO interhospital transport system is lacking due to limited resources. We developed a simplified ECMO transport system without mechanical ventilation for use by public emergency medical services. METHODS: Eighteen patients utilized our ECMO transport system from December 2011 to September 2015. We retrospectively analyzed the indications for ECMO, the patient status during transport, and the patient outcomes. RESULTS: All transport was conducted on the ground by ambulance. The distances covered ranged from 26 to 408 km (mean, 65.9±88.1 km) and the average transport time was 56.1±57.3 minutes (range, 30 to 280 minutes). All patients were transported without adverse events. After transport, 4 patients (22.2%) underwent lung transplantation because of interstitial lung disease. Eight patients who had severe acute respiratory distress syndrome showed recovery of heart and lung function after ECMO therapy. A total of 13 patients (70.6%) were successfully taken off ECMO, and 11 patients (61.1%) survived. CONCLUSION: Our ECMO transport system without mechanical ventilation can be considered a safe and useful method for interhospital transport and could be a good alternative option for ECMO transport in Korean hospitals with limited resources.

Right-Side Paratracheal Lymph Node Dissection during Single-Incision Thoracoscopic Surgery Featuring Placement of a Bidirectional Retraction Suture.

In single-incision thoracoscopic surgery (SITS), multiple instruments are inserted through a single working window and at least three hands must move within the limited operative field. When lobectomy is required, SITS has not been preferred for right-side paratracheal lymph node dissection because of instrument collisions. We used our bidirectional traction suture technique to eliminate the need for an azygos vein retractor during dissection, and thereby overcame the instrument collision problem.

Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum.

A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a case of a pharyngeal diverticulum after an ACDF, which was misdiagnosed as a typical Zenker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum.

Single-Suture Neochorda-Folding Plasty for Mitral Regurgitation.

The single-suture neochorda-folding plasty technique is a modification of existing mitral valve repair techniques. In the authors' experience, its simplicity, reliability, and versatility make it a useful technique for mitral valve repair, especially when a minimally invasive approach is used.

Modified incision and closure techniques for single-incision thoracoscopic lobectomy.

Single-incision video-assisted thoracoscopic surgery (VATS) lobectomy has recently gained attention due to its various advantages. However, this technique requires direct insertion of the chest tube into the thoracic cage; thus, leakage of intrathoracic fluid or air around the tube frequently occurs. Additionally, cosmetic problems may develop due to direct fixation of the chest tube at the site of the skin incision. To solve these problems we designed new incision and closure techniques for VATS lobectomy. In our technique the skin is incised lower than an intercostal muscle incision, and the chest tube transpierces the chest wall muscle about 1 cm below the incision. Finally, nylon is used for tube fixation and is anchored through the subcutaneous suture.

Induced airway obstruction under extracorporeal membrane oxygenation during treatment of life-threatening massive hemoptysis due to severe blunt chest trauma.

Simultaneous improvement in respiratory maintenance and bleeding control increases survival of patients with life-threatening hemoptysis. Endobronchial blockade is an effective method and is preferred for emergency hemostasis. However, when the volume of hemoptysis is high, emergency hemostasis and airway maintenance are impossible due to flooding of blood into the airway. We used extracorporeal membrane oxygenation (ECMO) to overcome these limitations in a patient with massive hemoptysis due to severe blunt trauma and succeeded in saving the life by inducing a near-total airway obstruction.

Facile synthesis of ZnO-poly(2-hydroxyethyl methacrylate) nanocomposites by surface-initiated ARGET atom transfer radical polymerization.

The covalent attachment of poly(2-hydroxyethyl methacrylate) on ZnO nanoparticles (NPs) has been achieved by ARGET ATRP. The polymer chains were grown from the surface of ATRP-initiator modified ZnO NPs with a copper (II) catalyst under activation of zerovalent copper as a reducing agent. FT-IR, FE-SEM, TEM and TGA were employed for the characterization of the nanocomposites. GPC was used to determine the molecular weight and PDI of the cleaved polymer. The covalent attachment of polymer chains onto the surface of ZnO NPs was sufficiently confirmed by FT-IR. In addition, the formation of the polymer encapsulating ZnO cores was demonstrated from TEM and SEM images. It was found that the growing of polymer brushes from the ZnO surface could be induced even though the catalyst amount was reduced to 10 ppm without loss of inherent control manner. This report contributed to demonstrate the versatility and feasibility of ATRP-based surface-initiated polymerization for the preparation of inorganic/polymer nanocomposites.

One-pot synthesis of conducting poly(3-methylthiophene)-grafted-graphene nanosheets.

We report a simple one-pot synthesis of graphene nanosheets wrapped poly(3-methylthiophene) (GNs-f-P3MT) composites. At first, natural graphite was oxidized using the Hummer's method followed by chemical reduction with hydrazine monohydrate to yield GNs. Subsequently, in-situ chemical oxidative polymerization of 3-methylthiophene was carried out to obtain noncovalently bonded GNs-f-P3MT composites. The morphology and microstructure of the composites together with pure graphene oxide and GNs were characterized using XPS, XRD, FT-IR, FESEM, HRTEM and TGA. The microscopic results indicated the homogeneous dispersion of GNs throughout the polymer matrix. Furthermore, thermogravimetric results illustrated that the addition of GNs into the P3MT matrix led to improvement in the thermal stability of the composites.

Water soluble graphene oxide/poly(1-vinylimidazole) composites: synthesis and characterization.

Modified graphene oxide/poly(1-vinylimidazole) (mGO/PVIm) composites were prepared via surface-initiated free radical graft polymerization. First, the hydroxyl-enriched GO sheets were functionalized with 3-methacryloxypropyltrimethoxysilane to introduce active-vinyl groups on the GO surfaces. Subsequently, 1-vinylimidazole was chemically grafted and polymerized in the presence of mGO. The chemical structures and morphology of the covalently bonded composites were characterized using FTIR, XPS, TGA, HRTEM, FESEM and XRD measurements. The mGO/PVIm composites exhibit a stable dispersion in water and show high storage stability (>10 days). Furthermore, the morphological analysis showed that mGO was homogeneously dispersed in the polymer matrix.

Dual temperature and thiol-responsive POEOMA-multisegmented polydisulfides: synthesis and thermoresponsive properties.

New thermoresponsive polydisulfides of POEOMA multiblocks linked with disulfide bonds having redox-responsive properties are reported. These POEOMA-multisegmented polydisulfides were synthesized by a new method employing a combined RAFT/aminolysis and reversible thiol-disulfide redox reaction that centers on the synthesis of new disulfide-labeled difunctional RAFT agent. RAFT polymerization proceeded in living fashion, yielding well-defined POEOMA copolymers with middle disulfides and terminal RAFT species. They were then used as precursors for thiol-disulfide polyexchange induced by aminolysis and reductive reaction followed by oxidation: these polydisulfides with different molecular weights and end groups exhibited tunable thermoresponsive properties and thiol-responsive degradation.

Fabrication of conducting poly(3-thiophene boronic acid)-grafted multi-walled carbon nanotubes by oxidative polymerization.

Composite materials of multi-walled carbon nanotubes (MWNTs) and a conducting polymer, poly(3-thiophene boronic acid) (PTBA) were prepared by in-situ oxidative polymerization of TBA in the presence of MWNTs and potassium dichromate. The MWNTs which were previously surface functionalized with acid chloride groups were reacted with TBA using a simple "chemical grafting" technique. It was observed that the nanotubes were dispersed uniformly in the pi-conjugated polymer matrix and entrapped by the polymer. The conductivity of the composites was higher than that of the pure polymer from a conventional four-probe technique, which indicates that the fabrication of MWNTs into the polymer matrix significantly improves the conductivity of the polymer due to the intrinsic properties of MWNTs.