Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock.

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients' mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11-0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63-0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.

Intracardiac Thymoma with Superior Vena Cava and Left Brachiocephalic Vein Extension: A Case Report.

Thymomas are common anterior mediastinal tumors with a relatively favorable prognosis compared to that of other types of thoracic malignancies. However, thymomas that invade surrounding structures, such as the heart or vena cava, have been infrequently reported, and intracardiac thymomas are exceedingly rare. Treatment of invasive thymoma is difficult because the high rate of incomplete resection results in a high rate of recurrence. Herein, we present a rare case of a thymoma that originated in the right atrium and extended into the superior vena cava and brachiocephalic vein.

Surgical Experience with Descending Necrotizing Mediastinitis: A Retrospective Analysis at a Single Center.

Background: We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods: This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results: Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion: DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.

Silicone Granuloma Mimicking a Lymphatic Metastasis in a Lung Cancer Patient: A Case Report.

Silicone granulomas are rare, benign lesions that may occur after breast augmentation. Occasionally, a careful differential diagnosis is necessary because lymphadenopathy or malignancy is suspected based on an imaging study. A 56-year-old woman who visited the hospital due to a lung nodule in the left upper lobe (LUL) underwent a staging work-up with the suspicion of lung cancer. Positron emission tomography/computed tomography and chest computed tomography revealed the LUL nodule and a lesion in the left internal mammary chain (IMC), suggesting lymphadenopathy. Diagnostic wedge resection was performed, followed by curative surgery. The final biopsy result confirmed that the LUL nodule was pathologic stage IB adenocarcinoma; unexpectedly, the lesion in the left IMC was a silicone granuloma.

Multiscale landscaping of droplet wettability on fibrous layers of facial masks.

Liquid mobility is ubiquitous in nature, with droplets emerging at all size scales, and artificial surfaces have been designed to mimic such mobility over the past few decades. Meanwhile, millimeter-sized droplets are frequently used for wettability characterization, even with facial mask applications, although these applications have a droplet-size target range that spans from millimeters to aerosols measuring less than a few micrometers. Unlike large droplets, microdroplets can interact sensitively with the fibers they contact with and are prone to evaporation. However, wetting behaviors at the single-microfiber level remain poorly understood. Herein, we characterized the wettability of fibrous layers, which revealed that a multiscale landscape of droplets ranged from the millimeter to the micrometer scale. The contact angle (CA) values of small droplets on pristine fibrous media showed sudden decrements, especially on a single microfiber, owing to the lack of air cushions for the tiny droplets. Moreover, droplets easily adhered to the pristine layer during droplet impact tests and then yielding widespread areas of contamination on the microfibers. To resolve this, we carved nanowalls on the pristine fibers by plasma etching, which effectively suppressed such wetting phenomena. Significantly, the resulting topographies of the microfibers managed the dynamic wettability of droplets at the multiscale, which reduced the probability of contamination with impact droplets and suppressed the wetting transition upon evaporation. These findings for the dynamic wettability of fibrous media will be useful in the fight against infectious droplets.

Temporal differences in eye-hand coordination between children and adults during manual action on objects.

BACKGROUND/OBJECTIVE: Eye-hand coordination, which is essential for activities of daily living, develops with age. The objective of this study was to investigate the temporal patterns of visual fixation coupled with hands during manual action on objects in children and young adults. METHODS: Twelve eight-year-old children and 12 young adults performed the Jebsen-Taylor Hand Function Test (JTT) wearing eye-tracking glasses. The interval from the eye arrival time to the hand arrival time on an object was measured as eye-hand arrival span. The interval between the eye departure time and the hand departure time from the object was measured as eye-hand departure span. Eye-hand arrival span, eye-hand departure span and the performance time to complete the JTT were compared between children and young adults. Correlation between eye-hand arrival span and eye-hand departure span was analysed to identify the mechanism of eye-hand coordination. RESULTS: Compared with young adults, children showed longer performance time but shorter eye-hand arrival span and eye-hand departure span in the JTT. The difference in mean eye-hand arrival span of overall JTT between children and young adults was significant for both hands, whereas differences in the mean eye-hand departure span on the overall JTT and the total performance time were significant for the non-dominant hand. The eye-hand arrival span was positively correlated with the eye-hand departure span. CONCLUSION: This study demonstrated temporal differences in eye-hand coordination between children and young adults. Temporal patterns of visual fixation coupled to object manipulation could be useful information about the sensorimotor system in the field of occupational therapy.

Enhanced therapeutic efficacy of an adenovirus-PEI-bile-acid complex in tumors with low coxsackie and adenovirus receptor expression.

Adenovirus (Ad) is a potential vehicle for cancer gene therapy. However, cells that express low levels of the coxsackie and adenovirus receptor (CAR) demonstrate poor Ad infection efficiency. We developed a bile acid-conjugated poly(ethyleneimine) (DA3)-coated Ad complex (Ad/DA3) to enhance Ad transduction efficiency. The size distribution and zeta potential of Ad/DA3 increased to 324 ± 3.08 nm and 10.13 ± 0.21 mV, respectively, compared with those of naked Ad (108 ± 2.26 nm and -17.7 ± 1.5 mV). The transduction efficiency of Ad/DA3 increased in a DA3 polymer concentration-dependent manner. Enhanced gene transfer by Ad/DA3 was more evident in CAR-moderate and CAR-negative cancer cells. Competition assays with a CAR-specific antibody revealed that internalization of Ad/DA3 was not mediated primarily by CAR but involved clathrin-, caveolae-, and macropinocytosis-mediated endocytosis. Cancer cell death was significantly increased when oncolytic Ad and DA3 were complexed (RdB-KOX/DA3) compared to that of naked oncolytic Ad and was inversely proportional to CAR levels. Importantly, RdB-KOX/DA3 significantly enhanced apoptosis, reduced angiogenesis, reduced proliferation, and increased active viral replication in human tumor xenografts compared to that of naked Ad. These results demonstrate that a hybrid vector system can increase the efficacy of oncolytic Ad virotherapy, particularly in CAR-limited tumors.

anti-9,10-Di(1-naphth-yl)anthracene pyridine disolvate.

In the title compound, C(34)H(22)·2C(5)H(5)N, there is a crystallographic inversion center in the middle of the anthracene ring system. The dihedral angle between the mean planes of the anthracene and naphthalene ring systems is 83.96 (4)°. The crystal structure is stabilized by weak inter-molecular C-H⋯N and C-H⋯π inter-actions.