Successful management using airway pressure release ventilation for severe postoperative pulmonary edema

AbstractIntroductionPostoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery.Presentation of caseA 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning. Initial chest radiograph showed right-sided patchy opacities and interstitial infiltrates. A transthoracic echocardiogram demonstrated normal cardiac function. With worsening respiratory failure on mechanical ventilation, APRV was attempted. His condition and blood gas was subsequently improved. Over the following 3days, the patient experienced an uneventful postoperative course and was discharged to home on postoperative day 14.DiscussionExtracorponeal membrane oxygenation (ECMO) is the most effective for severe hypoxia with pulmonary edema; however, ECMO is associated with hemorrhage and infectious complications. Alteratively, APRV was required for the successful management for severe hypoxia with pulmonary edema.ConclusionAPRV could be effective for severe hypoxia with pulmonary edema after a cardiac surgery

Human cord blood-MNC transplantation improves PH

Objectives : To investigate the effects of human umbilical cord blood-derived mononuclear cell (hUCB-MNC) transplantation on pulmonary hypertension (PH) induced by monocrotaline (MCT) in immunodeficient mice and their distribution. Methods :MCT was administered to BALB/c Slc-nu/nu mice, and PH was induced in mice 4 weeks later. Fresh hUCB-MNCs harvested from a human donor after her delivery were injected intravenously into those PH mice. The medial thickness of pulmonary arterioles, ratio of right ventricular to septum plus left ventricular weight (RV/S+LV), and ratio of acceleration time to ejection time of pulmonary blood flow waveform (AT/ET) were determined 4 weeks after hUCB-MNC transplantation. To reveal the incorporation into the lung, CMTMR-labeled hUCB-MNCs were observed in the lung by fluorescent microscopy. DiR-labeled hUCB-MNCs were detected in the lung and other organs by bioluminescence images. Results : Medial thickness, RV/S+ LV and AT/ET were significantly improved 4 weeks after hUCB-MNC transplantation compared with those in mice without hUCB-MNC transplantation. CMTMR-positive hUCB-MNCs were observed in the lung 3 hours after transplantation. Bioluminescence signals were detected more strongly in the lung than in other organs for 24 hours after transplantation. Conclusions : The results indicate that hUCB-MNCs are incorporated into the lung early after hUCB-MNC transplantation and improve MCT-induced PH

Efficacy and Optimal Timing of TEVAR for Type B-AD

Objectives: To determine the efficacy and the optimal timing of thoracic endovascular aortic repair (TEVAR) for closing the primary entry in uncomplicated patients with chronic type B aortic dissection and a patent false lumen (FL). Methods: Thirteen patients underwent TEVAR for aortic dissection between 2008 and 2012. These patients had chronic dissection with a patent FL and expansion of the aorta. Early TEVAR was performed for five patients within 1–7 months from the index dissection (TEVAR-EC group) and delayed TEVAR was performed for eight patients within 1–16 years (TEVAR-DC group). Changes in the diameters and volumes of the true lumen (TL) and FL and the aortic remodeling were assessed by multidetector computed tomography for 3 years after TEVAR. Results: The reduction rate of FL in the thoracic aorta was notably higher in the TEVAR-EC group than in the TEVAR-DC group regardless of the presence or absence of distal retrograde flow. There was a significant TL expansion despite different timings of TEVAR. Conclusions: Early TEVAR resulted in good prognosis and preferable aortic remodeling in uncomplicated patients with chronic type B aortic dissection and a patent FL, and we recommend early TEVAR within seven months after the index dissection

Systemic Activation of Biomarkers by Varix

Objective: To evaluate the relationship between systemic inflammatory biomarkers and efficacy of surgical treatment of primary varicose veins of the lower extremities. Methods: Total 12 patients who underwent endovenous laser ablation or stripping of varicose veins and six healthy subjects were enrolled. Structural and molecular changes of varices were assessed by immunohistochemical staining with anti-monocyte chemotactic protein-1 (MCP-1). MCP-1 and interleukin-6 (IL-6) levels in systemic antecubital blood were measured before and at 12 weeks after treatment. Results: Immunohistochemical staining revealed prominent manifestation of MCP-1-positive endothelial cells in the walls of varices. Preoperative serum MCP-1 and IL-6 levels in the patients were significantly higher than those in the control (166±12 pg/mL vs 99±10 pg/mL, p=0.003; 5.1±0.95 pg/mL vs 0.0±0.0 pg/mL, p=0.001, respectively). The values were significantly correlated with the severity of chronic venous insufficiency (CVI). Postoperative serum MCP-1 level significantly decreased compared with the preoperative level (152±10 pg/mL vs 166±12 pg/mL, p=0.048). The values after endovenous laser ablation did not significantly decrease compared with those after stripping. Conclusion: Varicose veins with CVI increase inflammatory biomarker levels in the local tissue and systemic blood. Appropriate treatment of symptomatic varicose veins decreases inflammatory biomarker levels

IPNB ノ 1セツジョレイ

A ６２-year-old man was seen for repeated cholangitis. After further examination, he was performed an operation under the diagnosis of mucin producing bile duct tumor in left hepatic lobe. There was no evidence of malignancy, but we performed a left hepatic lobectomy with lymph node dissection, because mucin producing bile duct tumors reported tend to be malignant. On pathology, a diagnosis of intraductal papillary neoplasm of the bile duct（IPNB）was made. IPNB is equivalent to IPMN in the biliary tract, and more and more IPNB cases have been reported. We are not certain of all of the differences between IPNBs and known diseases（e.g., mucin producing bile duct tumors）. Although not all cases of IPMN are indicated for operation, we should consider resection in every case of IPNB regardless of its malignant potential, because it can cause severe complications（e.g., cholangitis and jaundice）. Our case underscores the need for suspection of IPNB in cases of repeated cholangitis

IPNB ノ 1セツジョレイ

A ６２-year-old man was seen for repeated cholangitis. After further examination, he was performed an operation under the diagnosis of mucin producing bile duct tumor in left hepatic lobe. There was no evidence of malignancy, but we performed a left hepatic lobectomy with lymph node dissection, because mucin producing bile duct tumors reported tend to be malignant. On pathology, a diagnosis of intraductal papillary neoplasm of the bile duct（IPNB）was made. IPNB is equivalent to IPMN in the biliary tract, and more and more IPNB cases have been reported. We are not certain of all of the differences between IPNBs and known diseases（e.g., mucin producing bile duct tumors）. Although not all cases of IPMN are indicated for operation, we should consider resection in every case of IPNB regardless of its malignant potential, because it can cause severe complications（e.g., cholangitis and jaundice）. Our case underscores the need for suspection of IPNB in cases of repeated cholangitis

Long-term Results After Open Mitral Commissurotomy for a One-Month-Old Infant With Mitral Stenosis

The strategy for an infant with congenital mitral stenosis should be determined by three important factors : left ventricular volume, the degree of the systemic outflow tract obstruction, and the type of mitral valve dysfunction. A successful staged biventricular repair in early infancy for a patient who had congenital mitral stenosis with short chordae, hypoplastic left ventricle and coarctation of the aorta, and the long-term results are described. There were the following important hemodynamic factors that led to the successful biventricular repair in the patient. Total systemic output was barely supplied through the hypoplastic left ventricle after closure of the ductus arteriosus on admission. The neonate underwent repair of coarctation of the aorta alone as the initial stage at 9 days after birth. Also, spontaneous closure of the foramen ovale following repair of coarctation of the aorta accelerated the progressive left ventricular growth. Open mitral commissurotomy with an interatrial fenestration using the modified Brawley’s approach was performed for a 40-day-old infant. Good left ventricular growth and good mitral valve function have been observed for 18 years after open mitral commissurotomy. Appropriate early augmentation of left ventricular inflow through the mitral valve might be effective for growth of a hypoplastic left ventricle

Comparison of Deep Neural Network Models and Effectiveness of EMG Signal Feature Value for Estimating Dorsiflexion

Robotic ankle–foot orthoses (AFO) are often used for gait rehabilitation. Our research focuses on the design and development of a robotic AFO with minimum number of sensor inputs. However, this leads to degradation of gait estimation accuracy. To prevent degradation of accuracy, we compared a few neural network models in order to determine the best network when only two input channels are being used. Further, the EMG signal feature value of average rate of change was used as input. LSTM showed the highest accuracy. However, MLP with a small number of hidden layers showed results similar to LSTM. Moreover, the accuracy for all models, with the exception of LSTM for one subject (SD), increased with the addition of feature value (average rate of change) as input. In conclusion, time-series networks work best with a small number of sensor inputs. However, depending on the optimizer being used, even a simple network can outrun a deep learning network. Furthermore, our results show that applying EMG signal feature value as an input tends to increase the estimation accuracy of the network