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Background: Lung herniation is a rare complication of heart–lung transplantation that can be fatal owing to vascular compromise and airway obstruction. To date, only five cases of lung herniation related to heart–lung transplantation have been reported in the literature; however, to the best of our knowledge, this is the first worldwide report of heart–lung transplantation‐related lung herniation in an infant. Methods: We describe the case of lung herniation as a rare heart–lung transplantation‐related complication in an infant. A 12‐month‐old female baby developed severe bronchopulmonary dysplasia with severe pulmonary hypertension, and she underwent extracorporeal membrane oxygenation for cardiac collapse and lung support. Then, we performed heart–lung transplantation to manage the irreversible deterioration of her lung function. After the heart‐lung transplantation, we found the radiological abnormalities persisted on follow‐up chest radiographs until the 13th postoperative day diagnosed as lung herniation of the right lower lobe on chest computed tomography. Results: After the relocation of the herniated lung, the clinical condition of the patient improved, and the patient is currently growing without any respiratory symptoms. Conclusions: In this case report, we emphasize that clinical awareness and high suspicion of this rare complication are needed for early diagnosis and proper treatment to prevent post‐transplantation morbidity and mortality related to potential ischemic injury. [ABSTRACT FROM AUTHOR]

Background: To determine the effectiveness of ethanol (EtOH) washing on porcine pulmonary artery (PA) wall decellularization using sodium dodecyl sulfate (SDS), we compared three different washing methods (phosphate‐buffered saline [PBS], pH 9 alkali, and EtOH washing). Methods: Fresh porcine PA walls were decellularized using 0.5% SDS and 0.5% sodium deoxycholate (SDC). The decellularized tissues were rinsed using three different washing techniques. Histological, biochemical, and mechanical analyses were conducted. Implantation into the subcutaneous tissue of rats and patch implantation into the carotid artery of dogs were performed as preliminary in vivo studies. Results: The decellularization protocol based on SDS and SDC effectively removed the cells. The major extracellular matrix (ECM) structures (collagen, elastic fiber, and glycosaminoglycan) were properly preserved with the 75% EtOH‐washing method. Significantly reduced residual SDS content was identified in EtOH‐washed tissues compared to that in the other methods. No significant difference in the mechanical strength test was observed between the washing methods, and the EtOH‐washing method showed better results in the metabolic activity test compared to the PBS‐washing method. In the rat study model, no acute rejection or massive calcification was observed. The in vivo preliminary canine study showed better cell repopulation in the EtOH‐washed group. Conclusion: EtOH washing of SDS‐based decellularized porcine PA wall can reduce the residual SDS content and preserve ECM structures, especially the elastin content, and could also enhance cell repopulation after re‐implantation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Staggered bilateral total knee arthroplasty, two procedures performed 4–7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post‐operative single, high‐dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients. Materials and Methods: We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non‐FCM group did not receive intravenous iron. The transfusion rate and post‐operative complications were compared between the groups. The anaemia rate was evaluated pre‐operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty. Results: The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0–2] vs. 0 [0–0], p = 0.001) was significantly lower in the FCM group than in the non‐FCM group. Although both groups' pre‐operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p < 0.001). More non‐FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p < 0.001). The mortality and complication rates were not significantly different. Conclusions: Immediate post‐operative, high‐dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patients who undergo total knee arthroplasty (TKA) have a risk of postoperative anaemia. This observational study evaluated whether single‐dose intravenous ferric carboxymaltose (FCM) administered immediately after TKA facilitates the correction of anaemia. Materials and Methods: We retrospectively analysed 722 patients who underwent primary TKA. The FCM group receiving 1000 mg intravenous FCM within one postoperative hour was compared with the non‐FCM group that did not receive the medication. A propensity score matching with multiple logistic regression analysis was used to minimize intergroup differences in the baseline characteristics and postoperative blood loss. The rate and severity of postoperative anaemia were compared between the groups, along with haemoglobin (Hb) value, transfusion rate and complications. Results: After propensity score matching, 231 patients were included in each group. In the FCM group, the rate of anaemia at postoperative day (POD) 7 (p = 0.021) and postoperative week (POW) 5 (p < 0.001) and the transfusion rate were significantly lower (p = 0.008). The rate of moderate to severe anaemia at POW‐5 was also significantly lower in the FCM group (p < 0.001). In patients without preoperative anaemia (n = 322), the transfusion rate and rate and severity of anaemia at POD‐7 and POW‐5 were significantly lower in the FCM group than in the non‐FCM group. Conclusion: Postoperative intravenous FCM administration facilitated recovery of surgery‐related anaemia by improving Hb and may reduce the need for transfusion in TKA patients. Preoperative non‐anaemic patients could also benefit from accelerated recovery by intravenous iron treatment. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to identify the optimal lower limb position for an ultrasound (US)‐guided anterior approach to a sciatic nerve block. Methods: We included 45 patients who met the following criteria: American Society of Anesthesiologists physical status of 1 to 3, age between 18 and 80 years, and scheduled to undergo knee surgery that required a sciatic nerve block. The lower limbs of each patient were placed in the following 4 positions: N, neutral; ER, external rotation of the hip (angle, 45°); ER/F15, ER (angle, 45°) and flexion (angle, 15°) of the hip; and ER/F45, ER (angle, 45°) and F (angle, 45°) of the hip. An investigator acquired US scans of the sciatic nerve in each position, and the visibility score and depth of the sciatic nerve from the skin were analyzed. Results: The visibility scores were significantly higher in positions ER/F15 and ER/F45 than in positions ER and N (P <.0001). However, there was no difference between the visibility scores in positions ER/F15 and ER/F45 (P =.0959). The depth of the sciatic nerve from the skin decreased with ER and an increase in the F angle of the hip (overall P <.0001). Conclusions: Based on the visibility score and depth from the skin, ER of the hip to 45° with a greater F angle (45° versus 15°) of the hip appears to be the optimal position for an US‐guided anterior approach to a sciatic nerve block. [ABSTRACT FROM AUTHOR]

A generalized fiber beam element formulation is proposed to accurately capture the formation of multiple plastic regions with a coarse mesh, which usually occurs in the process of structural collapses. The strong gradient of displacement near plastic regions in a fiber beam element can be accurately described using a special plastic enrichment function. The two types of the plastic enrichment functions are suggested for the cases where the plastic region is located fully inside an element and spread over a node, respectively. In this approach, the optimal shape of the plastic enrichment function can be updated by reflecting plastic deformation at the previous loading step. Furthermore, if plastic regions appear in multiple locations in an element, the corresponding plastic enrichment function can be adaptively reconstructed on the basis of plastic region distribution without introducing additional degrees of freedom. The effectiveness of the proposed method is investigated in terms of accuracy and computational cost through several numerical experiments. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm in the left ventricular outflow tract is a rare complication occurring after cardiac surgery. We report on the successful percutaneous device closure of a pseudoaneurysm in the left ventricular outflow tract, which developed in a 23-month-old girl after resection of a subaortic ridge. The pseudoaneurysm was closed using an Amplatzer Vascular Plug II. [ABSTRACT FROM AUTHOR]

Nasopharyngeal carcinoma ( NPC) is a distinct type of head and neck cancer which is prevalent in southern China, south-east Asia and northern Africa. The development and stepwise progression of NPC involves accumulation of multiple gross genetic changes during the clonal expansion of Epstein-Barr virus ( EBV)-infected nasopharyngeal epithelial cell population. Here, using paired-end whole-transcriptome sequencing, we discovered a number of chimeric fusion transcripts in a panel of EBV-positive tumour lines. Among these transcripts, a novel fusion of ubiquitin protein ligase E3 component n-recognin 5 ( UBR5) on 8q22.3 and zinc finger protein 423 ( ZNF423) on 16q12.1, identified from the NPC cell line C666-1, was recurrently detected in 12/144 (8.3%) of primary tumours. The fusion gene contains exon 1 of UBR5 and exons 7-9 of ZNF423 and produces a 94 amino acid chimeric protein including the original C-terminal EBF binding domain ( ZF29-30) of ZNF423. Notably, the growth of NPC cells with UBR5-ZNF423 rearrangement is dependent on expression of this fusion protein. Knock-down of UBR5-ZNF423 by fusion-specific siRNA significantly inhibited the cell proliferation and colony-forming ability of C666-1 cells. The transforming ability of UBR5-ZNF423 fusion was also confirmed in NIH3T3 fibroblasts. Constitutive expression of UBR5-ZNF423 in NIH3T3 fibroblasts significantly enhanced its anchorage-independent growth in soft agar and induced tumour formation in a nude mouse model. These findings suggest that expression of UBR5-ZNF423 protein might contribute to the transformation of a subset of NPCs, possibly by altering the activity of EBFs (early B cell factors). Identification of the oncogenic UBR5-ZNF423 provides new potential opportunities for therapeutic intervention in NPC. © 2013 The Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

The article discusses a case of an 11-month-old male infant, who was diagnosed with Kabuki syndrome (KS) with left ventricle (LV) diverticulum (LVD). A computed tomography (CT) of the patient reveals a small lesion on the LV, while a two-dimensional (2-D) echocardiography shows LVD near the lesion. A redo median sternotomy with cannulation preparation was performed and the LVD has been removed without complications.

Background: Left pulmonary vein (PV) obstruction can occur due to compression between the left atrium (LA) and the descending aorta (DA). One of the effective solutions for this problem is posterior aortopexy. In this study, we have reported five cases of posterior aortopexy to relieve left PV obstruction between the LA and the DA., Methods: Since August 2012, five patients have undergone posterior aortopexy for compression of the left PV between the LA and the DA. The median age and weight of the patients at the time of operation were 5.5 months (range, 1-131 months) and 5.2 kg (range, 4.2-29.5 kg), respectively. The left PV obstruction was initially diagnosed on echocardiography in four patients and computed tomography angiography in one patient. The median peak pressure gradient across the obstructed left PV was 7.3 mmHg (range, 4-20 mmHg). Concomitant procedures were ventricular septal defect closure in one patient and patent ductus arteriosus ligation in one patient., Results: There was no PV obstruction on echocardiography in any of the patients after the operation except in the case of one patient who had diffuse pulmonary vein stenosis. The median follow-up duration was 34 months (range, 14-89 months), and during follow-up no incidence of the left PV obstruction was observed in any of the surviving patients., Conclusions: The posterior aortopexy technique could be a good surgical option for the left PV obstruction caused by compression between the LA and the anteriorly positioned DA., (© 2021 Wiley Periodicals LLC.)

We developed a modified Senning procedure in the double-switch operation for the patients with congenitally corrected transposition of the great arteries (ccTGA). In our technique, the right atrial (RA) free wall is not used as a baffle for draining systemic venous blood to the left atrium. Instead, a patch material is used for the baffling. A wide communication between the pulmonary venous chamber and RA is created by making the triangular double door with the RA-free wall, and the window is closed with in situ pericardial flap. We have successfully adopted this technique in our recent two consecutive ccTGA patients., (© 2020 Wiley Periodicals LLC.)

Background and Aim to Read: We report the results of a bicuspid expanded polytetrafluoroethylene (ePTFE) valved conduit used for right ventricular outflow tract reconstruction (RVOTR)., Methods: Between November 2005 and February 2009, 12 conduits were used for RVOTR. The mean age and weight of patients were 43.5 ± 46.4 months and 13.4 ± 8.6 kg. The main diagnosis was tetralogy of Fallot with pulmonary atresia in eight patients. The most common conduit size was 18 mm. The mean follow-up was 88.0 ± 35.9 months., Results: There were no operative and late mortalities. At discharge, the mean peak systolic pressure gradient across the RVOT was 14.1 ± 11.3 mmHg. There was no conduit valve regurgitation in nine patients. At the latest echocardiography (mean follow-up: 84.3 ± 35.5 months), the mean peak systolic pressure gradient across the RVOT was 59.7 ± 20.2 mmHg, and there was no conduit valve regurgitation in six patients. Freedom from conduit malfunction was 100% and 83.3%, at 1 and 8 years, respectively. Two conduits were explanted due to sternal compression and four from conduit malfunction. Freedom from explantation was 83.3% and 74.2% at 2 and 8 years, respectively., Conclusions: ePTFE bicuspid valved conduit has good late function in terms of valve regurgitation, but the pressure gradient across the conduit increases with time, which is the main cause of conduit failure and explantation., (© 2018 Wiley Periodicals, Inc.)

A patient with pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries without an intrapericardial pulmonary artery (PA) underwent a one-stage total correction, including both branch PA reconstructions, with a bovine pericardial roll at the age of 42 months. She was readmitted 54 months after the operation because of extracardiac conduit bacterial endocarditis and pulmonary infarction. The bovine pericardial roll between the right and left PAs was enucleated, and the surrounding fibrotic tissue (peel) was used as a new branch PA vascular conduit. A cardiac catheterization performed 86 months after the peel operation showed no aneurysmal dilatation, stenosis, or thrombotic occlusion., (© 2017 Wiley Periodicals, Inc.)