COVID-19 versus Other Disease Etiologies as the Cause of ARDS in Patients Necessitating Venovenous Extracorporeal Membrane Oxygenation-A Comparison of Patients' Data during the Three Years of the COVID-19 Pandemic.

Considering the characteristics of coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS), we compared the clinical course and outcomes of patients with ARDS who received venovenous extracorporeal membrane oxygenation (VV ECMO) based on the etiology of ARDS. This retrospective single-center study included adult patients with severe ARDS necessitating VV ECMO during the COVID-19 pandemic. Among 45 patients who received VV ECMO, 21 presented with COVID-19. COVID-19 patients exhibited lower sequential organ failure assessment scores (9 [8-12.75] versus 8 [4-11.5], p = 0.033) but longer duration of VV ECMO support (10.5 days [3.25-29.25] versus 28 days [10.5-70.5] p = 0.018), which was accompanied by an weaning off rate from VV ECMO in 12/24 (50%) versus 12/21 (57.1%) and 28-day mortality in 9/24 [37.5%] versus 2/21 [9.5%] in non-COVID-19 and COVID-19 patients (p = 0.767, p = 0.040), respectively. Finally, in the adjusted Cox regression model for hospital mortality, the hazard ratio of COVID-19 was not significant (hazard ratio 0.350, 95% confidence interval 0.110-1.115, p = 0.076). Although the VV ECMO period was longer, COVID-19 did not significantly impact ECMO weaning off and mortality rates. Nonetheless, judicious patient selections based on risk factors should be followed.

Intrinsically stretchable three primary light-emitting films enabled by elastomer blend for polymer light-emitting diodes.

Intrinsically stretchable light-emitting materials are crucial for skin-like wearable displays; however, their color range has been limited to green-like yellow lights owing to the restricted stretchable light-emitting materials (super yellow series materials). To develop skin-like full-color displays, three intrinsically stretchable primary light-emitting materials [red, green, and blue (RGB)] are essential. In this study, we report three highly stretchable primary light-emitting films made from a polymer blend of conventional RGB light-emitting polymers and a nonpolar elastomer. The blend films consist of multidimensional nanodomains of light-emitting polymers that are interconnected in an elastomer matrix for efficient light-emitting under strain. The RGB blend films exhibited over 1000 cd/m2 luminance with low turn-on voltage (<5 Von) and the selectively stretched blend films on rigid substrate maintained stable light-emitting performance up to 100% strain even after 1000 multiple stretching cycles.

Dual-functional quantum-dots light emitting diodes based on solution processable vanadium oxide hole injection layer.

Dual-functional quantum-dots light emitting diodes (QLEDs) have been fabricated using solution processable vanadium oxide (V2O5) hole injection layer to control the carrier transport behavior. The device shows selectable functionalities of photo-detecting and light-emitting behaviors according to the different operating voltage conditions. The device emitted a bright green light at the wavelength of 536 nm, and with the maximum luminance of 31,668 cd/m2 in a forward bias of 8.6 V. Meanwhile, the device could operate as a photodetector in a reverse bias condition. The device was perfectly turned off in a reverse bias, while an increase of photocurrent was observed during the illumination of 520 nm wavelength light on the device. The interfacial electronic structure of the device prepared with different concentration V2O5 solution was measured in detail using x-ray and ultraviolet photoelectron spectroscopy. Both the highest occupied molecular orbital and the gap state levels were moved closer to the Fermi level, according to increase the concentration of V2O5 solution. The change of gap state position enables to fabricate a dual-functional QLEDs. Therefore, the device could operate both as a photodetector and as a light-emitting diode with different applied bias. The result suggests that QLEDs can be used as a photosensor and as a light-emitting diode for the future display industry.

Improving the performance of quantum-dot light-emitting diodes via an organic-inorganic hybrid hole injection layer.

Poly(3,4-ethylenedioxythiophene):poly(styrene-sulfonate) (PEDOT:PSS) is a commonly used material for the hole injection layer (HIL) in quantum-dot light-emitting diodes (QLEDs). In this work, we improved the performance of the QLED by using an organic-inorganic hybrid HIL. The hybrid HIL was prepared by mixing PEDOT:PSS with vanadium oxide (V2O5), which is a transition-metal oxide (TMO). The hole injection properties of PEDOT:PSS were improved according to the amount of V2O5 mixed into the PEDOT:PSS. The maximum luminance and current efficiency were 36 198 cd m-2 and 13.9 cd A-1, respectively, when the ratio of PEDOT:PSS and V2O5 was 10 : 1. Moreover, the operating lifetime exceeded 300 h, which is 10 times longer than the lifetime of the device with only PEDOT:PSS HIL. The improvement was analyzed using ultraviolet and X-ray photoelectron spectroscopy. We found that the density of state (DOS) of PEDOT:PSS near the Fermi energy level was increased by mixing V2O5. Therefore, the increase of DOS improved the hole injection and the performance of QLEDs. The result shows that the hybrid HIL can improve the performance and the stability of QLEDs.

Thoracomyoplasty for Chronic Empyema and Osteoradionecrosis of the Chest Wall

Herein, we report a case in which thoracomyoplasty was performed to manage chronic postlobectomy empyema (PLE). A 54-year-old male patient with a surgical history of right upper lobectomy and thymectomy 35 years previously who had undergone adjuvant radiotherapy presented with purulent discharge on the anterior chest wall. The patient was diagnosed with chronic PLE with ascending infection and concurrent osteonecrosis of the parasternum. Proper drainage was performed for local infection control and the dead spaces were successfully closed with muscle flaps. There have been no complications to date.

Left Hemitruncus Treated Along with Ventricular Septal Defect in a Neonate.

Hemitruncus arteriosus is a rare cardiovascular malformation in which one of the pulmonary arteries anomalously originates from the aorta. Left hemitruncus arteriosus, defined as the origination of the left pulmonary artery from the aorta, is less common than right hemitruncus arteriosus. In this study, we report the case of a neonate diagnosed with left hemitruncus arteriosus, ventricular septal defect, and atrial septal defect who underwent successful surgical treatment.

Aortic Valve-Sparing Surgical Treatment of Supravalvar Aortic Stenosis in a 65-Year-Old Adult.

Supravalvar aortic stenosis (SVAS) is a rare congenital cardiac disease that usually co-occurs with Williams syndrome. In the adult population, a few SVAS cases have been reported in patients affected by homozygous familial hypercholesterolemia. However, because of the rarity of this disease entity, there is no standard surgical treatment for SVAS. Here, we present a case of successful surgical treatment using an autologous excised aortic patch in a 65-year-old patient with SVAS.

How small is enough for the left heart decompression cannula during extracorporeal membrane oxygenation?

BACKGROUND: Left ventricular (LV) distension is a recognizable problem accompanied by subsequent complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression has been established, and no minimal flow requirement has been designated. Thus, we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression during VA-ECMO in adult patients. METHODS: Left heart decompression was performed when severe pulmonary edema was detected on chest radiography or when no generation of pulse pressure followed severe LV dysfunction in patients receiving VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath into the left atrium via the femoral vein. The sheath was connected to the venous catheter used for ECMO. The catheter was maintained during VA-ECMO. RESULTS: The left heart decompression procedure was performed in seven of 35 patients who received VA-ECMO between February 2017 and June 2018. Three patients had acute myocardial infarction; three, fulminant myocarditis; and one, dilated cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an increase in pulse pressure of >20 mm Hg within 24 hours from the left heart decompression procedure. All seven patients were successfully weaned from VA-ECMO. No complications related to the left heart decompression procedure occurred. CONCLUSIONS: An 8-Fr sheath may be a possible option for left heart decompression in adult patients with LV distension under VA-ECMO who are expecting recovery of LV function.

Aortic Reconstruction Using a Main Pulmonary Artery Flap in an Isolated Aortopulmonary Window.

Aortopulmonary window (APW) is a rare cardiac anomaly that was reported to occur in only 43 cases over 33 years at a large-volume cardiac center. It can present as an isolated anomaly or in combination with another cardiac anomaly. The surgical technique for APW has evolved from simple ligation to separation of the 2 great arteries. However, because of the rarity of APW, there is no standard surgical treatment for this disease entity. Herein, we present successful aortic reconstruction using a main pulmonary artery flap after separation of the 2 great arteries in a neonate with isolated APW.

Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period.

BACKGROUND: Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. METHODS: Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 µg/kg for 10 min and then maintained in dosages of 0.3-1 µg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. RESULTS: The times for anesthesia, operation and emergence were significantly shorter in SA than GA. Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. CONCLUSIONS: Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.

Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome.

BACKGROUND: First rib resection is a surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, extrathoracic approaches have used a posterior, supraclavicular, or transaxillary incision to remove the first rib. In this report, we demonstrate video-assisted thoracoscopic surgery for intrathoracic first rib resection (VATS-IFRR). METHODS: Between 2009 and 2014, eight patients underwent VATS-IFRR for TOS. Surgery was performed through two 5-mm ports and one 10-mm port. Endoscopic graspers, a hook-type electrocautery probe, a long peapod intervertebral disc rongeur, and Kerrison punches were used. The types of disease, operative times, chest tube indwelling days, lengths of hospital stay after operation, perioperative complications, postoperative pain scale ratings, and postoperative symptom recurrence rates at provocation tests were reviewed. The surgical outcomes were compared to published outcomes of extrathoracic approaches and other VATS approaches. RESULTS: The eight patients (3 right ribs, 5 left ribs) exhibited neurogenic (1 patient), combined type (2 patients), arterial (4 patients), and venous type (1 patient) TOS. The mean operative time was 190 (range 155-310) minutes. No mortalities or major complications occurred. The mean chest tube indwelling duration was 6 (range 3-10) days, and the mean postoperative hospital stay was 9 (range 4-21) days. The mean immediate postoperative pain numeric rating scale (NRS) score was 2.7/10 (range 2-4). No recurrence was observed during follow-up (median 25.5 months, range 10-64 months) in any patient. CONCLUSIONS: VATS-IFRR was safe and had several advantages. Thus, VATS-IFRR is a minimally invasive surgical option suitable for treating selective cases of TOS.

Deep-seated intramuscular lipoma penetrates the intercostal muscle.

Deep-seated intramuscular lipomas are rare, and most exhibit an infiltrating behavior. This study reports serial radiographs of a lipoma in chest wall muscles which penetrated the intercostal muscle for a 6-year period. Although this lipoma did not involve the parietal pleura, it compressed lung. To the authors' knowledge, the present study is the first report to show the growth of a deep-seated chest wall lipoma into the thoracic cavity through serial radiographs. We consider the surgical treatment is needed before deep-seated intramuscular chest wall lipoma compress intrathoracic structures.

Non-intubated single port thoracoscopic procedure under local anesthesia with sedation for a 5-year-old girl.

Medical thoracoscopy is a feasible procedure for the diagnosis or treatment of thoracic diseases, and it can be performed under local anesthesia without tracheal intubation in cooperative adult patients. However, for younger than school aged patients, even simple procedures require general anesthesia with tracheal intubation. In this case report, we demonstrated the safe performance of a single port thoracoscopic procedure without tracheal intubation in a 5-year-old girl under local anesthesia and sedation. Local anesthesia around the site of a previous chest tube and sedation with intravenous (IV) dexmedetomidine and ketamine were applied. In the aspect of not only minimal injection of local anesthetics but also enhanced visualization of the thoracic structures, the non-intubated single port thoracoscopic surgery under local anesthesia with sedation was a good option for performing a simple thoracoscopic procedure in this 5-year-old patient.

Tracheal metastasis from rectal cancer: a case report and review of the literature.

The trachea is an uncommon site of metastasis from colorectal carcinoma. A few cases have been reported in the literature, but these focused mostly on the clinical aspects without detailing radiologic and histologic findings. The authors describe a 70-year-old woman who was diagnosed with tracheal metastasis from a primary rectal cancer. We present the contrast-enhanced chest computed temography (CT), including volume-rendered image, as well as bronchoscopic findings.

Endovascular repair of growing chronic type B aortic dissection with a vascular plug.

We report the successful endovascular repair of a growing chronic type B aortic dissection using an Amplatzer Vascular Plug II. A 44-year-old man, with previous medical history of aortic surgery and stenting complained of vague back pain. An approximately 5-mm entry remained in the stented segment of the aorta on computed tomography (CT). Endovascular closure of the entry with a Vascular Plug was uneventful. A 3-month follow-up CT showed no leak, complete false lumen thrombosis in the thoracic segment, shrinkage of the false lumen, and a reduced diameter of thoracic aorta.

Hemiarthroplasty in a patient with pigmented villonodular synovitis of the shoulder.

We report the 2-year follow-up results of a hemiarthroplasty in a 29-year-old patient with pigmented villonodular synovitis (PVNS) with extra-articular extension and severe bony destruction. The patient presented with diffuse pain and swelling of the right shoulder for several years. Radiographs showed severe osteolytic lesions in the humeral head and neck, greater tuberosity, and a small osteolytic lesion in the glenoid neck area. Further examination with magnetic resonance imaging of the shoulder joint showed a large, lobulated soft tissue mass extending from the subdeltoid area to the chest wall invading the adjacent bony structures. The operative findings included a large, multilobulated, yellowish-brown mass extending from the subdeltoid area to the axillary pouch, subacromial space, and thoracic wall. The mass invaded the anatomical neck area of the humeral head and caused a fracture of the humeral head. We observed a complete rupture of the long head of the biceps tendon, supraspinatus tendon, and infraspinatus tendon, but the subscapularis tendon was partially ruptured. We performed the complete excision and cemented hemiarthroplasty. At 2-year follow-up, no signs of local recurrence were present. The patient had no significant pain and achieved a good functional result.To the best of our knowledge, 1 report with shoulder hemiarthroplasty in PVNS of the shoulder has been published in the English literature. For PVNS of the shoulder with a large extra-articular extension and bony destruction, shoulder arthroplasty with total synovectomy produces the lowest recurrence rates because of better access and excision to the posterior location of the PVNS lesion.

True Neurogenic Thoracic Outlet Syndrome Following Hyperabduction during Sleep - A Case Report -.

True neurogenic thoracic outlet syndrome (TOS) is an uncommon disease and is difficult to diagnose at the early stage and then completely cure. We experienced a case of true neurogenic TOS with typical clinical symptoms and electrophysiologic findings as a result of repetitive habitual sleep posture. A 31-year-old woman who had complained of progressive tingling sensation on the 4th and 5th fingers with shoulder pain was diagnosed of brachial plexopathy at the lower trunk level by electrodiagnostic studies. There was no other cause of brachial plexopathy except her habit of hyperabduction of shoulder during sleep. This case demonstrated that the habitual abnormal posture can be the only major cause of neurogenic TOS. It is of importance to consider TOS with the habitual cause because simple correction of the posture could stabilize or even reverse disease progress.

Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach.

OBJECTIVE: Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults. METHODS: We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique. RESULTS: The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3%). A total of 576 patients (49.2%) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5% vs 4.3% vs 0.8%; P < .001) and bar displacement rate (3.8% vs 2.3% vs 0.5%; P = .002). Reoperation rate also decreased (4.8% vs 2.5% vs 0.8%; P = .002). Satisfaction outcomes were excellent in 92.7%, good in 5.9%, and fair in 1.4% of patients. After bar removal, 3 patients (0.6%) had minor recurrences. CONCLUSION: Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.