The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung

Background:

Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block.

Methods:

All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded.

Results:

There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038).

Conclusion:

Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.

The Learning Curves of Uniportal Video-Assisted Thoracoscopic Surgery Lobectomy: A Single Center Experience

Backgrounds: The aim of our study is to describe the learning curve for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy from our single center's experience for adopting it because uniportal VATS is generally considered a technically difficult procedure. Methods: A retrospective review of all 164 consecutive patients who underwent uniportal VATS lobectomy between June 2015 and February 2020 was done. A cumulative summation (CUSUM) method was applied to evaluate the learning curves of the operation time. Results: Among the 164 patients, the CUSUM value inflected at the 31st case. Ninety-five consecutive patients underwent uniportal VATS upper lobectomy. The other 69 consecutive patients underwent uniportal VATS lower lobectomy. The operation time CUSUM learning curve analysis revealed that the curves descended from the 21st case in upper lobectomy group and the 12th case in lower lobectomy group. Conclusion: Operators are required to experience at least 21 cases for upper lobectomy and 12 cases for lower lobectomy until the operation time is stabilized.

Subxiphoid single-port thymectomy: six-year experience of a single center

BACKGROUND

The subxiphoid single-port approach for thymectomy has several advantages compared with conventional lateral transthoracic approaches. However, perioperative outcomes of subxiphoid single-port thymectomy are still lacking. The objective of this study is to present our 6-year experience of subxiphoid single-port thymectomy, including our learning curve.

METHODS

All consecutive 49 patients undergoing subxiphoid single-port thymectomy between August 2014 and September 2020 were reviewed retrospectively.

RESULTS

We analyzed data of 49 patients (27 males and 22 females) with a median age of 58 years (range 49-68). Two patients presented postoperative complications. The conversion to a different approach was required in four cases. The median follow-up time was 17 months (range 3-35) and locoregional recurrence was observed in one patient. There were no intraoperative deaths and postoperative mortality. The operation time cumulative summation learning curve analysis revealed that the curves descended from the 24th case.

CONCLUSIONS

The subxiphoid single-port approach for thymectomy is a safe and feasible modality with few complications.

Successful Repair of Bronchoesophageal Fistula Through Uniportal Video-Assisted Thoracoscopic Surgery

This report describes a case of successful repair of bronchoesophageal fistula through uniportal video-assisted thoracoscopic surgery. A 79-year-old female patient presented with persistent cough and aspiration pneumonia. Chest computed tomography and esophagography showed a bronchoesophageal fistula at right side wall of mid to lower esophagus. Esophagogastroduodenoscopy confirmed a fistula in the esophageal diverticulum. Surgical treatment was planned. The operation was performed through uniportal video-assisted thoracoscopic surgery. The patient was discharged 6 days postoperatively without any complication. No recurrence has been observed during 3 months follow-up in the outpatient clinic to date.

Cardiac tamponade due to ruptured cystic teratoma: report of two cases

We report the rare two cases of cardiac tamponade due to ruptured cystic teratoma. In both cases, a chest computed tomography scan showed large cystic mass with large amount of pericardial effusion. Transthoracic echocardiogram revealed cardiac tamponade physiology. En bloc resection of the mass was performed and pathologic examination showed mature cystic teratoma. The postoperative course of patients was uneventful. A cystic mediastinal teratoma should be considered in the differential diagnosis of pericardial effusion.

Large pulmonary sclerosing pneumocytoma in a young female: A rare lung tumor

We report a case of a 28‐year‐old female who presented with a solid mass lesion in the right middle lobe (RML). A chest computed tomography (CT) scan showed a 3.5 cm sized round and solid mass between the medial and lateral segment of the RML. The patient underwent a percutaneous lung biopsy with CT scan guidance and pathological examination showed pulmonary sclerosing pneumocytoma. RML lobectomy was performed for definitive treatment. Here, we describe this rare lung disease which presented as a large homogeneous lesion. Pulmonary sclerosing pneumocytoma should be considered in the differential diagnosis of solitary lung tumor, even if the patient is young.

Primary Pulmonary Undifferentiated Pleomorphic Sarcoma: A Rare Malignant Lung Tumor

We report a case of a 56-year-old man with persistent right upper lobe cavitary mass. A chest computed tomography scan showed about 4-cm-sized mass with internal low attenuation and peripheral enhancement in right upper lobe apical segment. The lesion size increased over 1 month. Right upper lobectomy was performed with the intention to treat the lesion. Pathological examination showed primary pulmonary undifferentiated pleomorphic sarcoma. We describe this rare lung disease to remind that primary pulmonary undifferentiated pleomorphic sarcoma could be the differential diagnosis of pulmonary cavitary mass lesions.

Single center experience of uniportal VATS anatomical lung resections: Mid-term oncological outcomes

Background

Uniportal video‐assisted thoracoscopic surgery (VATS) anatomical lung resection has become widely accepted for its favorable outcomes with regard to pain. However, oncological outcomes, especially mid‐ or long‐term outcomes, are still lacking. The objective of this study was to present our eight‐year experience of uniportal VATS anatomical lung resection, including mid‐term oncological outcomes.

Methods

All consecutive patients undergoing uniportal VATS anatomical lung resection between June 2012 and February 2020 were reviewed retrospectively.

Results

We analyzed data of 170 patients (100 male and 70 female), with a median age of 67 years. The median follow‐up time was 21 months (range 11–41). The DFS of the entire cohort was 66.3 months. Stage‐correlated DFS was 73.1 months for stage I, 42.6 months for stage II, 30.6 months for stage III and 12.5 months for stage IV. The OS of the entire court was 67 months. Stage‐correlated OS was 75.6 months for stage I, 50.2 months for stage II, 31.7 months for stage III and 12.5 months for stage IV.

Conclusions

Uniportal VATS anatomical lung resection for lung cancer can be performed with satisfactory mid‐term histology‐ and stage‐related outcomes, which is consistent with prior results of traditional VATS or thoracotomy.

Surgical treatment of micronodular thymoma with lymphoid stroma

This case was about a 71‐year‐old man presented to our clinic for an anterior mediastinal mass found on routine chest computed tomography (CT). CT scan showed a lobulating contoured mass in the anterior mediastinum. A preliminary diagnosis was thymoma. The patient underwent subxiphoid uniportal video‐assisted thoracoscopic surgery for the extended thymectomy and complete excision of the tumour. The pathological examination showed a micronodular thymoma with lymphoid stroma (MTWLS). In conclusion, this report described an extremely rare tumour, MTWLS, and MTWLS might be considered in the differential diagnosis of mediastinal tumour, especially thymoma.

Mediastinal venolymphatic malformations mimicking thymic carcinoma

This report was about a 60‐year‐old asymptomatic female patient who presented to our clinic with an anterior mediastinal mass found on routine chest computed tomography (CT). Chest CT revealed an irregular poorly enhanced anterior mediastinal mass which showed signs of infiltration to adjacent structures with sparse calcifications. The preliminary diagnosis was thymic carcinoma. The patient underwent extended thymectomy via median sternotomy and complete excision of the tumor. A small draining vein to the left brachiocephalic vein and phleboliths were identified in the tumor. A definitive diagnosis was made of mediastinal venolymphatic malformation (VLM). The patient had an uneventful clinical course and was discharged without further complication. This report highlights that it is possible to misdiagnose mediastinal VLM as thymic carcinoma and could serve as a useful reminder to physicians in the future.

Successful sleeve resection of bronchial carcinoid under veno-venous ECMO

Here, we report a case of a bronchial tumor in the proximal left mainstem bronchus in a 19‐year‐old male. Diagnosis of the tumor was typical carcinoid, which was established by bronchoscopic biopsy preoperatively. Under femoral veno‐venous extracorporeal membrane oxygenation (ECMO), the patient underwent left mainstem bronchus sleeve resection through median sternotomy. The surgical resection margins were confirmed to be tumor‐free on frozen section and all lymph nodes were free of tumor. This report describes a carcinoid in the proximal mainstem bronchus which was successfully resected without lobectomy or pneumonectomy and concludes that sleeve resection under extracorporeal membrane oxygenation should be considered in the surgical treatment of mainstem bronchial carcinoid.

Placental transmogrification of the lung presenting as a consolidative lesion with bronchiectasis

We report a case of a 37‐year‐old man with a persistent consolidative lesion in the right lower lobe. A chest computed tomography scan showed a 2 cm focal consolidative lesion in the lateral basal segment of the right lower lobe. The size of lesion had slightly increased over four months. Wedge resection of the right lower lobe was performed with the intention to diagnose the lesion. Pathological examination showed placental transmogrification of the lung. We describe this rare lung disease, which presented with the unusual radiologic findings of a consolidative lesion. Placental transmogrification of the lung should be considered in the differential diagnosis of pulmonary consolidative lesions.

A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax

Background

Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention.

Methods

This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table.

Results

Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was 2.1±1.8 days and 5.4±3.6 days, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates.

Conclusion

Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.

Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock

Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

A New Root-Strengthening Technique for Acute Aortic Dissection with a Weakened Aortic Root: The Neo-Adventitia Technique

Background

Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the “neo-adventitia” technique to strengthen the weakened aortic root.

Methods

From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS.

Results

There were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period.

Conclusion

This technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.

Feasibility and Safety of Single-Port Video-Assisted Thoracic Surgery for Primary Lung Cancer

Background

The feasibility of single-port video-assisted thoracic surgery (SPVATS) for primary lung cancer is not well understood. In this study, we compared SP and multi-port (MP) VATS for the surgical treatment of patients with primary lung cancer.

Methods

Surgical treatment was performed in 181 patients with primary lung cancer at Inje University Haeundae Paik Hospital between June 2012 and December 2015. A propensity-matched analysis was used to compare the postoperative outcomes and to evaluate the comparative feasibility and safety of SPVATS and MPVATS.

Results

There were 37 patients in the SPVATS group and 67 patients in the MPVATS group. Propensity matching produced 32 pairs. The operation time (210 minutes versus 200 minutes, p=0.11), volume of the estimated blood loss (170 mL versus 160 mL, p=0.19), duration of chest tube drainage (5 days versus 6 days, p=0.66), and length of hospital stay (9 days versus 10 days, p=0.89) were similar between the 2 groups.

Conclusion

In our study, SPVATS for primary lung cancer was safe and feasible in well selected patients. A prospective, randomized study with a large group and long-term follow-up is necessary to evaluate the clinical feasibility and the advantages of SPVATS for primary lung cancer.

Acute Limb Ischemia and Coronary Artery Disease in a Case of Kimura's Disease

Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.

High-resolution electrohydrodynamic inkjet printing of stretchable metal oxide semiconductor transistors with high performance

As demands for high pixel densities and wearable forms of displays increase, high-resolution printing technologies to achieve high performance transistors beyond current amorphous silicon levels and to allow low-temperature solution processability for plastic substrates have been explored as key processes in emerging flexible electronics. This study describes electrohydrodynamic inkjet (e-jet) technology for direct printing of oxide semiconductor thin film transistors (TFTs) with high resolution (minimum line width: 2 μm) and superb performance, including high mobility (∼230 cm² V^-1 s^-1). Logic operations of the amplifier circuits composed of these e-jet-printed metal oxide semiconductor (MOS) TFTs demonstrate their high performance. Printed In₂O TFTs with e-jet printing-assisted high-resolution S/D electrodes were prepared, and the direct printing of passivation layers on these channels enhanced their gate-bias stabilities significantly. Moreover, low process temperatures (<250 °C) enable the use of thin plastic substrates; highly flexible and stretchable TFT arrays have been demonstrated, suggesting promise for next-generation printed electronics.

Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion

BACKGROUND AND PURPOSE

Although intracranial atherosclerotic disease is often encountered during endovascular treatment for acute vertebrobasilar occlusions, its clinical implication is not well-known. We aimed to evaluate whether intracranial atherosclerotic disease influences the clinical outcomes following endovascular treatment of acute vertebrobasilar occlusive stroke.

MATERIALS AND METHODS

Fifty-one patients with acute vertebrobasilar occlusive stroke were included. The onset-to-groin puncture time was ≤12 hours, and aspiration- or stent-based thrombectomy was used as the primary treatment method. Following primary endovascular treatment, intracranial atherosclerotic disease (IAD group) was angiographically diagnosed when a fixed focal stenosis was observed at the occlusion site, whereas embolism (embolic group) was diagnosed if no stenosis was observed. Clinical and treatment variables were compared in both groups, and IAD was evaluated as a prognostic factor for clinical outcomes.

RESULTS

The baseline NIHSS score tended to be lower (14 versus 22, P = .097) in the IAD group (n = 19) than in the embolic group (n = 32). The procedural time was longer in the IAD group (96 versus 61 minutes, P = .002), despite similar rates of TICI 2b-3 (89.5% versus 87.5%, P = 1.000). The NIHSS score at 7 days was higher (21 versus 8, P = .060) and poor outcomes (mRS 4-6 at 3 months) were more frequent in the IAD group (73.7% versus 43.8%, P = .038). IAD (odds ratio, 5.469; 95% CI, 1.09-27.58; P = .040) was independently associated with poor outcomes.

CONCLUSIONS

An arterial occlusion related to IAD was associated with a longer procedural time and poorer clinical outcome. Further studies are warranted to elucidate the appropriate endovascular strategy.

Muscle profiling to improve the value of retail meat cuts

Nutrition and meat quality are always important to consumers, but vary by individual muscle or muscle groups in retail meat cuts. Muscle profiling of nutrient content and palatability for all retail beef cuts is necessary to suggest healthy and tasty beef cuts and to inform consumers of the benefits of beef consumption. The current paper reviews numerous studies that provide muscle profiles for nutrients and palatability attributes of muscles or muscle groups in retail beef cuts. The composition of nutrients including protein, fat, moisture, vitamins, and minerals in beef cuts is documented as well as the nutritive role as a part of a healthy diet. In addition, this review presents knowledge in relation to innovative carcass fabrication and value-added cuts to improve the value of beef carcass. Finally, the current work emphasize the palatability assessment of individual beef muscles, and concludes that all retail beef cuts should be merchandised for proper cooking according to the palatability profiles of beef muscles.

Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy

In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.

Benign Mature Teratoma in Anterior Mediastinum

Teratoma of mediastinum is rare germ cell tumor. Anterior mediastinum is the most common extragonadal site. Benign mediastinal teratoma accounts for 60% of all mediastinal germ cell tumors. Benign mature teratoma has excellent prognosis after surgical excision. We present a case of 20-year-old woman diagnosed as benign mature teratoma which compressed main pulmonary trunk. The patient underwent surgical excision.

Early results of modified aortic-valve sparing partial root replacement in acute type A aortic dissection with an intimal tear in the aortic sinuses

We describe a modified aortic valve-sparing partial root replacement (AVSPRR) technique for acute type A aortic dissection with an intimal tear (IT) in the aortic sinus. This procedure consists of selective replacement of the sinus containing an IT with a rectangular patch. If an IT exists in any coronary sinus, the coronary button was reimplanted to the neo-sinus and an external wrapping of the noncoronary sinus was added. Modified AVSPRR may be considered a feasible short-term outcome, and may be considered as an option in selected patients.

Three different situations and approaches in the management for anomalous origin of the right coronary artery from the left coronary sinus: case report

Anomalous origin of the right coronary artery from the left coronary sinus is rare but potentially dangerous if any ischemic signs are present. Multiple therapeutic options were advocated so far. We experienced three different situations and surgical approaches to these anomalies, and reviewed retrospectively. For the first case, we made a neo-ostium on the right sinus of Valsalva and anastomosed with the right coronary artery after arteriotomy. For the second and third cases, we applied coronary artery bypasses emergently: patient 2 the gastroepiploic artery during off-pump coronary artery bypass and patient 3 the left internal thoracic artery during surgery for acute aortic dissection. For the better outcomes, it is important to understand anatomic and hemodynamic characteristics of each patient and select the surgical options considering each characteristic.

A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report

Despite marvelous advances in repair for acute type A aortic dissection over past decades, it remains challenging to repair the aortic root when aortic dissection extended to the sinuses causes the fragile root because of its thinner layers, which are susceptible to suture trauma. Here, we describe a modified Florida sleeve technique to strengthen the weakened aortic root. After mobilization of the aortic root and the coronary arteries, a designed Dacron tube graft was wrapped outside the sinuses as neo-adventitia to reinforce the dissected weakened wall. During surgery for aortic dissection, our technique is easy and effective to reinforce a weakened root and avoid bleeding. Furthermore, this might be an alternative technique to restore and maintain the geometry of the aortic root.

Giant cell tumor arising from anterior arc of the rib

A primary giant cell tumor of the rib is very rare. The most common site of a giant cell tumor arising from the rib is the posterior arc. A giant cell tumor arising from the anterior arc of the rib is extremely rare. The treatment of a giant cell tumor of the rib is not well defined. Generally, a complete surgical resection is performed in a patient with a primary giant cell tumor of the rib. We report a case of a giant cell tumor arising from the anterior arc of the rib that was treated with a wide excision and chest wall reconstruction.

Stanford type A aortic dissection secondary to infectious aortitis: a case report

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Optimal formation of genetically modified and functional pancreatic islet spheroids by using hanging-drop strategy

BACKGROUND

Rejection and hypoxia are important factors causing islet loss at an early stage after pancreatic islet transplantation. Recently, islets have been dissociated into single cells for reaggregation into so-called islet spheroids. Herein, we used a hanging-drop strategy to form islet spheroids to achieve functional equivalence to intact islets.

METHODS

To obtain single islet cells, we dissociated islets with trypsin-EDTA digestion for 10 minutes. To obtain spheroids, we dropped various numbers of single cells (125, 250, or 500 cells/30 μL drop) onto a Petri dish, that was inverted for incubation in humidified air containing 5% CO(2) at 37 °C for 7 days. The aggregated spheroids in the droplets were harvested for further culture.

RESULTS

The size of the aggregated islet spheroids depended on the number of single cells (125-500 cells/30 μL droplet). Their morphology was similar to that of intact islets without any cellular damage. When treated with various concentrations of glucose to evaluate responsiveness, their glucose-mediated stimulation index value was similar to that of intact islets, an observation that was attributed to strong cell-to-cell interactions in islet spheroids. However, islet spheroids aggregated in general culture dishes showed abnormal glucose responsiveness owing to weak cell-to-cell interactions. Cell-to-cell interactions in islet spheroids were confirmed with an anti-connexin-36 monoclonal antibody. Finally, nonviral poly(ethylene imine)-mediated interleukin-10 cytokine gene delivered beforehand into dissociated single cells before formation of islet spheroids increased the gene transfection efficacy and interleukin-10 secretion from islet spheroids >4-fold compared with intact islets.

CONCLUSION

These results demonstrated the potential application of genetically modified, functional islet spheroids with of controlled size and morphology using an hanging-drop technique.

Cox-Maze III procedure with valvular surgery in an autopneumonectomized patient

Destructive pulmonary inflammation can leave patients with only a single functional lung, resulting in anatomical and physiological changes that may interfere with subsequent cardiac surgeries. Such patients are vulnerable to perioperative cardiopulmonary complications. Herein, we report the first case, to our knowledge, of an autopneumonectomized patient who successfully underwent a modified Cox-Maze III procedure combined with valvular repairs. The three major findings in this case can be summarized as follows: (1) a median sternotomy with peripheral cannulations, such as femoral cannulations, can provide an optimal exposure and prevent the obstruction of vision that may occur as a result of multiple cannulations through a median sternotomy; (2) a modified septal incision combined with biatrial incisions facilitate adequate exposure of the mitral valve; and (3) the aggressive use of intraoperative ultrafiltration may be helpful for the perioperative managements as decreasing pulmonary water contents, thereby avoiding the pulmonary edema associated with secretion of inflammatory cytokines during a cardiopulmonary bypass. We also provide several suggestions for achieving similar satisfactory surgical outcomes in patients with a comparable condition.

Effect of thermal annealing on the efficiency of heterojunction photovoltaic cells fabricated using poly(3-hexylthiophene) and methanofullerene, [6,6]-phenyl C61-butyric acid methyl ester

The effects of thermal annealing on the efficiency of heterojunction photovoltaic (PV) cells that were fabricated using poly(3-hexylthiophene) (P3HT) and methanofullerene, [6,6]-phenyl C61-butyric acid methyl ester (PCBM) were investigated. The absorption spectra showed that the absorption intensity of the P3HT:PCBM layer that was annealed for 5 min had the highest value among the several samples with different annealing temperatures. The atomic force microscopy image showed that the P3HT:PCBM layer that was annealed for 5 min had the best surface morphology. The X-ray photoelectron spectroscopy demonstrated that the P3HT:PCBM layer that was annealed at 140 degrees C for 10 min enhanced the PCBM aggregation on the surface Al layer that was covered by the P3HT:PCBM layer. The efficiencies of the PV cells that were annealed at 3, 5, and 10 min were approximately 2.7, 4.2, and 3.5%, respectively. Based on the experiment results, the variations in the efficiency of the PV cells due their thermal treatment were described.

Late simultaneous presentation of left ventricular pseudoaneurysm and tricuspid regurgitation after blunt chest trauma

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.

Application of PTFE membrane for ammonia removal in a membrane contactor

The feasibility of a membrane contactor system for ammonia removal was studied. The mass transfer coefficient was used to quantitatively compare the effect of various operation conditions on ammonia removal efficiency. Effective removal of ammonia was possible with a Polytetrafluoroethylene (PTFE) membrane contactor system at all tested conditions. Among the various operation parameters, contact time and solution pH showed significant effect on the ammonia removal mechanism. The overall ammonia removal rate was not affected by influent suspended solution concentration unlike other pressure driven membrane filtration processes. Also the osmotic distillation phenomena which deteriorate the mass transfer efficiency can be minimized by preheating of influent wastewater. A membrane contactor system can be a possible alternative to treat high strength nitrogen wastewater by optimizing operation conditions such as stripping solution flow rate, influent wastewater temperature, and influent pH.

Fate of nitrogen species in nitrate reduction by nanoscale zero valent iron and characterization of the reaction kinetics

This study investigates the fate of nitrogen species during nitrate reduction by nanoscale zero valent iron (NZVI) as well as the related kinetics. The NZVI used for the experiments was prepared by chemical reduction without a stabilizing agent. The pseudo first order kinetic constant of nitrate reduction at 30 degrees C with an NZVI/nitrate ratio of 1.25:1, which were the reference conditions of this study, was 4.08 h(-1) (R(2)=0.955). A nitrogen mass balance was established by quantitative analysis of aqueous-phase and gas-phase nitrogen species. The results confirm that the nitrate was converted to ammonium ion, that ammonia stripping subsequently occurred under a strong alkaline condition, and that the total amount of aqueous nitrogen was consequently reduced. The nitrate reduction rate also increased with a lower pH and a higher temperature when microscale ZVI was used. However, in contrast to the reaction by microscale ZVI, the nitrate reduction rate by NZVI was higher for an unbuffered condition, possibly due to the abundance of surface atoms and the smaller size.

Discoloration characteristics of 3 major muscles from cattle during cold storage

Discoloration characteristics of 3 major muscles (LD, Longissimus dorsi; PM, Psoas major; SM, Semimemebranosus) from Korean native cattle (Hanwoo) were monitored during 7 d of cold storage at 4 degrees C. The muscles were obtained from 12 Hanwoo carcasses at 24 h postmortem. Meat color (CIE L*, a*, b*), myoglobin (Mb) concentration, chemical form, metmyoglobin (MetMb) reducing ability (MRA), mitochondria concentration, and thiobarbituric acid reactive substance (TBARS) were measured at 1, 3, 5, and 7 d of storage. Although there were no significant differences in CIE a* and b*-values between the 3 muscles at day 1, the values of PM muscle were significantly (P < 0.05) lower than those of LD and SM muscles at day 5 and 7. PM muscle showed a rapid decrease in the oxymyoglobin (OxyMb) and an increase in MetMb, which resulted in a significantly (P < 0.05) higher percentage of MetMb in PM muscle compared to LD and SM muscles. Also, the Mb and mitochondria concentration of PM muscle was significantly (P < 0.05) higher than those of LD and SM muscles. However, there were no significant differences in MRA, pH, or TBARS between the 3 muscles during 7 d of cold storage. It was concluded that rapid discoloration (that is, MetMb accumulation) in PM muscle of Hanwoo could be due to its higher contents of Mb and mitochondria.

Effect of chilling temperature of carcass on breast meat quality of duck

An experiment was carried out to investigate whether variations in chill water temperature affect muscle shortening and meat quality in duck breast. Three chill water temperatures were applied to duck carcasses at 20 min postmortem for 30 min, including in ice water at 0 degrees C, in cold water at 10 degrees C, and in water at 20 degrees C. Results revealed that carcass temperatures were different (P < 0.05) at 50 and 120 min of postmortem with lower temperatures at the 0 degrees C treatment (P < 0.05). The pH over the first 24 h postmortem was not different (P > 0.05) among treatments, with the exception of 50 min postmortem. The pH of breast meat in the 0 degrees C treatment was higher (P < 0.05) than that of 20 degrees C treatment at 50 min postmortem (just after chilling). No other differences (P > 0.05) in pH existed among treatments. Drip loss, cooking loss, and moisture content were not different for breast meat samples that were chilled at different temperatures. Differences (P < 0.05) were found in CIE (L, a, and b) color values. Lightness (L) increased, whereas redness (a) decreased as the chill water temperature increased. Lower yellowness (b) was found in the breast meat samples at the 10 degrees C chill water temperature. However, shear force, sarcomere length, and protein solubility were not different (P > 0.05) among the breast meat samples chilled at different chill water temperatures. It may be concluded that chilling duck carcasses at different temperature ranges from 0 to 20 degrees C did not influence muscle shortening or meat quality, except in regard to breast meat color.

Neuro-mediators as predictors of paediatric atopic dermatitis

BACKGROUND

Attempts to identify predictors of atopic dermatitis (AD) have focused on genetic and immunologic factors. However, the role of neuro-mediators remains to be elucidated.

OBJECTIVE

To evaluate nerve growth factor (NGF) and vaso-active intestinal peptide (VIP) in predicting paediatric AD and assess their correlation with intrinsic and extrinsic types of AD.

METHODS

We performed a nested case-control study in the prospective Taiwan birth panel cohort study. Cord and maternal plasma and questionnaires were gathered at birth. During follow-up, we identified 40 available AD cases, which were matched to 80 unaffected controls chosen from this cohort. The concentrations of IgE, NGF, and VIP in cord and maternal plasma of these subjects were performed by ELISA. Receiver-operating characteristic (ROC) curves were generated to see how well each biomarker could predict AD.

RESULTS

The NGF levels were significantly higher in AD patients than controls (mean+/-SD: 65.47+/-44.45 vs. 49.21+/-12.18 pg/mL for cord plasma and 89.68+/-41.04 vs. 66.96+/-23.05 pg/mL for maternal plasma) (P<0.05). VIP levels were also higher but not statistically significant. Plasma NGF may be a better biomarker than IgE in detecting paediatric AD (area under the ROC curve=0.65 vs. 0.61 for cord plasma and 0.69 vs. 0.61 for maternal plasma). Maternal NGF levels were significantly higher in patients with both intrinsic (96.18+/-48.15 pg/mL) and extrinsic (86.18+/-37.23 pg/mL) types of AD compared with controls (66.96+/-23.05 pg/mL) (P<0.05). We assessed a significant correlation between self-reported stress during pregnancy and maternal NGF levels (r=0.22, P=0.02).

CONCLUSION

Our results suggest that NGF is a good alternative biomarker in predicting children with a risk of AD.

Angiographic examination of spontaneous putaminal hemorrhage

BACKGROUND

This study was carried out to examine indications for angiographic evaluation in the case of spontaneous putaminal hemorrhage.

METHODS

Angiographic examinations were performed on 62 consecutive adults with spontaneous putaminal hemorrhage without remarkable subarachnoid hemorrhage. Most patients were evaluated using conventional catheter angiography except for hypertensive patients over the age of 60 who underwent a magnetic resonance angiogram or a computed tomography angiogram. Computed tomography and clinical factors such as age and hypertension were correlated with the angiographic findings.

RESULTS

Nine of the 62 patients (15%) exhibited angiographic abnormalities, including middle cerebral artery aneurysm (n = 1), arteriovenous malformations (n = 3), moyamoya disease (n = 2), and the moyamoya phenomenon associated with a proximal middle cerebral artery occlusion (n = 3). The angiographic yield was significantly higher (1) among patients at or below the median age of 55 compared with those above (9/33, 27%, versus 0/29, 0%; p < 0.01), and (2) among patients without hypertension compared with those with hypertension (5/9, 56%, versus 4/53, 8%; p < 0.01).

CONCLUSIONS

Although our data could be biased due to the patient selection procedure, they suggest that angiographic evaluation is highly useful for spontaneous putaminal hemorrhage regardless of volume and shape of the hematomas, excepting hypertensive patients over 55 years of age.

PKD2 gene mutation analysis in Korean autosomal dominant polycystic kidney disease patients using two-dimensional gene scanning

Autosomal dominant polycystic kidney disease (ADPKD) is genetically heterogeneous and is caused by mutations in the PKD1 or PKD2 genes. ADPKD caused by PKD2 mutations is characterized by a longer survival and a later onset of end-stage renal disease than ADPKD caused by PKD1 mutations. PKD2 encodes a 2.9-kb messenger RNA and is derived from 15 exons. Two-dimensional gene scanning (TDGS) is more efficient in detecting mutations in genes such as PKD2 because it can scan the whole coding regions simultaneously. In order to determine the prevalence of Korean PKD2 patients, all the coding sequences of PKD2 were screened using TDGS and direct sequencing in 46 randomly selected ADPKD patients (group 1). Another 45 ADPKD patients (group 2), who were presumed to be PKD2 patients, were screened in order to identify the type of mutation in the Korean PKD2 patients. Eight novel different mutations and three known mutations in the PKD2 gene were detected in 17 patients: 6 patients (13.0%) in group 1 and 11 patients (24.4%) in group 2. Considering the sensitivity of TDGS, the prevalence of PKD2 in Korean population might be greater than 18.6%. Both known and novel mutations were identified by TDGS in Korean PKD2 patients. Overall, these results showed that TDGS might be useful for diagnosing PKD2.

Fatty acids, inhibitors for the DNA binding of c-Myc/Max dimer, suppress proliferation and induce apoptosis of differentiated HL-60 human leukemia cell

c-Myc is instrumental in the progression of Burkitt's lymphoma including HL-60 human leukemia cells. We tested fatty acids for their inhibitory effect on the DNA binding of c-Myc/Max dimeric proteins of human origin, prepared as recombinant proteins encompassing DNA binding (basic) and dimerization (HLHZip) domain, and found that those suppress proliferation and induce apoptosis of DMSO-differentiated HL-60 cells. The analyzed IC50 values of myristic acid, stearic acid, gamma-linolenic acid, linoleic acid, linolenic acid and arachidonic acid by EMSA were 97(+/-3), 2.2(+/-1.2), 55(+/-5), 32(+/-2), 62(+/-12), 22(+/-2)microM for DNA binding of recombinant c-Myc/Max, respectively. According to the results shown by XTT assay, their influence on proliferation was quite different from the rank order of IC50. Whereas the degree of influence of the unsaturated fatty acids on the proliferation of DMSO-differentiated HL-60 cells was similar, the influence of saturated fatty acids, stearic acid in particular, was very weak at same concentrations. In addition, we confirmed that these fatty acids have no influence on the expression of c-Myc in DMSO-differentiated HL-60 cells. Our experiments demonstrated that the inhibitors for the DNA binding of c-Myc/Max contribute to the downregulation of Myc-dependent proliferation and to the inducement of apoptosis, and serve as an exploration of potent new inhibitors.

Biofeedback therapy for rectal intussusception

BACKGROUND

Surgery for isolated internal rectal intussusception is controversial due to high morbidity. Therefore, there is interest in other forms of treatment that are safe and effective. The aim of this study was to determine outcome and identify predictors for success of biofeedback therapy in patients with rectal intussusception.

METHODS

We retrospectively evaluated the results of electromyography (EMG)-based biofeedback in 34 patients with rectal intussusception without any other major pelvic floor or colonic physiologic disorder.

RESULTS

A total of 34 patients (7 men) had undergone at least 2 biofeedback sessions. The patients had a mean age of 68.5 years (SD=11.4 years). In the 27 patients with constipation, the frequency of weekly spontaneous bowel movements (mean+/-SD) was 2.0+/-6.8 before and 4.1+/-4.6 after biofeedback (p<0.05). The frequency of weekly assisted bowel movements decreased from 3.8+/-3.5 before to 1.5+/-2.2 after therapy (p<0.005). The number of patients who experienced incomplete evacuation decreased from 17 (63%) to 9 (33%) (p<0.05). Thirty-three percent of patients had complete resolution of the symptoms, 19% had partial improvement, and 48% had no improvement. Patients with constipation lasting less than nine years had a 78% success rate vs. 13% in patients who were constipated more than 9 years (p<0.01). In seven patients with incontinence, the frequency of daily incontinence episodes decreased from 1.0+/-0.7 before to 0.07+/-0.06 after biofeedback (p<0.05). The fecal incontinence score decreased from 13.1+/-4.2 before to 4.6+/-3.6 after treatment (p<0.005). Two patients (29%) were completely continent following biofeedback, 2 had partial improvement, and 3 (43%) had no significant improvement. There was no mortality in either group.

CONCLUSIONS

Biofeedback is a safe and effective treatment option for constipation and fecal incontinence due to rectal intussusception in patients who are willing to complete the course of treatment. Long-standing constipation is less effectively cured by biofeedback.

Epidemiology of otitis media in Chinese children

From May to July 2001, 3013 Chinese children, aged 3-6 years old, from 19 kindergartens in Kaohsiung were examined for the prevalence of otitis media. A senior paediatric otolaryngologist performed examinations. Tympanometric and otoscopic records were combined for assessment of middle ear status. The prevalence rate of otitis media was 9.82% for all children, 5.24% for middle ear effusion and 5.34% for retracted tympanic membrane. The prevalence rates of otitis media in different age groups were as follows: 11.3% for 3-year-olds, 12.4% for 4-year-olds, 11.8% for 5-year-olds, and 6.1% for 6-year-olds. Considering the genetic factors and the previous history of otitis media, there was a significant difference between the normal group and the sick group.