Ruptured hepatoblastoma with massive internal bleeding in an adult

Background: The extracorporeal life support (ECLS) and temporary bilateral ventricular assist device (t-BiVAD) are commonly applied in patients with cardiogenic shock. Prolonged cardiopulmonary resuscitation (CPR) has poor prognosis. Herein, we report our findings on a combined ECLS and t-BiVAD approach to salvage cardiogenic-shock patients with CPR for more than one hour. Methods: Fifty-nine patients with prolonged CPR and rescued by ECLS and subsequent t-BiVAD were retrospectively collected between January 2015 and December 2019. Primary diagnoses included ischemic, dilated cardiomyopathy, acute myocardial infarction, post-cardiotomy syndrome, and fulminant myocarditis. The mean LVEF was 16.9% ± 6.56% before t-BiVAD. The median ECLS-to-VAD interval is 26 h. Results: A total of 26 patients (44%) survived to weaning, including 13 (22%) bridged to recovery, and 13 (22%) bridged to transplantation. Survivors to discharge demonstrated better systemic perfusion and hemodynamics than non-survivors. The CentriMag-related complications included bleeding (n = 22, 37.2%), thromboembolism (n = 5, 8.4%), and infection (n = 4, 6.7%). The risk factors of mortality included Glasgow Coma Scale (Motor + Eye) ≤ 5, and lactate ≥ 8 mmol/L at POD-1, persistent ventricular rhythm or asystole, and total bilirubin ≥ 6 mg/dL at POD-3. Mortality factors included septic shock (n = 11, 18.6%), central failure (n = 10, 16.9%), and multiple organ failure (n = 12, 20.3%). Conclusions: Combined ECLS and t-BiVAD could be a salvage treatment for patients with severe cardiogenic shock, especially for those already having prolonged CPR. This combination can correct organ malperfusion and allow sufficient time to bridge patients to recovery and heart transplantation, especially in Asia, where donation rates are low, as well as intracorporeal VAD or total artificial heart being seldom available.

Tuberculosis (TB) can cause chronic inflammation. The occurrence of aortic aneurysm (AA) and aortic dissection (AD) may be associated with chronic inflammatory disease, but whether TB increases the risk of AA and AD remains to be determined. This study aimed to investigate the association between TB and the development of AA and AD. We conducted a population-based cohort study using data obtained from the Taiwan National Health Insurance Database. We selected 31,220 individuals with TB and 62,440 individuals without TB by matching the cohorts according to age, sex, and index year at a ratio of 1:2. Cox regression analysis revealed that the TB cohort had a 1.711-fold higher risk of AA and AD than the non-TB cohort after adjustment for sex, age, socioeconomic status, and comorbidities (adjusted hazard ratio = 1.711; 95% confidence interval = 1.098–2.666). Patients with pulmonary, extrapulmonary, and miliary TB had a 1.561-, 1.892-, and 8.334-fold higher risk of AA and AD, respectively. Furthermore, patients with TB at <6 months, 6–12 months, and 1–5 years of follow-up had a 6.896-, 2.671-, and 2.371-fold risk of AA and AD, respectively. Physicians should consider the subsequent development of AA and AD while treating patients with TB.

High-efficiency capture, release, and reculture of circulating tumor cells (CTCs) can significantly advance individualized cancer treatments. To achieve efficient CTC release without compromising their viability for subsequent reculture, an effective CTC capture/release system was developed. Nylon-6 (N6) and a cross-linked alginate hydrogel with Ca(II) were used as the shell and core, respectively, to prepare N6/Ca-Alg immunofiber mats using coaxial electrospinning. A 3 wt% concentration of Ca(II) was used to increase the viscosity of the alginate solution and generate a degradable coating on the N6 fiber. After modification with streptavidin and anti-EpCAM, the N6/Ca-Alg immunofiber mat was embedded within a disposable microfluidic chip to investigate the capture capacity of CTCs. The maximum adsorption capacity of CTCs was approximately 34 cells per mm², while the viability of the captured cells was 95.1% after being released from the fibrous mats. The outer Ca-alginate hydrogel coating effectively enhanced the viability of the released cells for reculture. In spiked blood samples, our microfluidic system was able to specifically identify DLD1 cells from 10 mL of human whole blood at a concentration of 65.6 cells per mL with 67.9% efficiency within 30 minutes. Under the flow of alginate lyase solution at 0.4 mg mL⁻¹, the reculture efficiency of the released cells after 7 days reached 274.5%. Our proposed method provides an ideal fibrous mat to be embedded within a microfluidic chip for capturing and releasing CTCs for precision medicine applications, using recultured CTCs in individualized anti-tumor therapies.