Surgical strategy for intravenous leiomyomatosis spreading from uterine to the right atrium presenting with recurrent syncope.

Uterine leiomyoma invading internal iliac vein and consequently disseminating into the right atrium is an extremely rare condition, and surgical strategy is controversial. Here, we reported a specific case with successful surgical resection through one-stage total hysterectomy, bilateral oophorectomy, and the intracardiovascular lesion. This procedure would be an optimal choice for uterine leiomyoma invading inferior vena cava and spreading to right atrium.

A proof-of-concept study: advantages of the subxiphoid over the lateral intercostal approach.

OBJECTIVES: The study was designed to evaluate the superiority of the subxiphoid approach compared with the lateral intercostal approach during the operation and other perioperative indices. METHODS: Patients diagnosed with anterior mediastinal disease in our hospital between January 2018 and October 2019 were prospectively assigned to 2 groups; 1 group underwent the lateral intercostal approach and 1 group underwent the subxiphoid approach of video-assisted thoracoscopic surgery to resect the diseased tissue. The PaCO2, SaO2, PaO2 and circulation changes were recorded during the operation; the neutrophil-to-lymphocyte ratio and other perioperative outcomes, including clinical and surgical results, operating time, blood loss, postoperative complication and postoperative pain score were compared. RESULTS: A total of 59 patients diagnosed with an anterior mediastinal tumour or myasthenia gravis underwent a video-assisted thoracoscopic resection. Thirty-one patients were treated via the subxiphoid approach, and 28 patients were treated via the lateral intercostal approach. The PaCO2 increased significantly and the SaO2 remained stable in the subxiphoid group during the operation, whereas PaCO2 increased significantly and SaO2 decreased at the same time in the lateral intercostal group. Operations were more frequently interrupted for the hypoxia or circulation disturbance during the process of dissecting the thymus in the lateral intercostal approach. Compared with the lateral intercostal approach, patients treated via the subxiphoid approach experienced less inflammation and exhibited lower pain scores and shorter postoperative hospital stays. There were no significant differences in postoperative complications between the 2 groups. All of the patients recovered well when discharged. CONCLUSIONS: Our study results suggested that the subxiphoid approach has less of an influence on the pulmonary circulation than the lateral intercostal approach, that the whole procedure is safer and easier and that the subxiphoid approach may be the ideal choice for patients with anterior mediastinal disease.

Video assisted thorascopic assisted correction of left partial anomalous pulmonary venous connection: one case report.

INTRODUCTION: The left partial anomalous pulmonary vein connection is a rare congenital heart disease, especially with intact atrial septum. Now we reported a case of the left superior pulmonary vein drainage to left innominate vein through a vertical vein, and corrected with video assisted thoracoscopy. CASE PRESENTATION: A-59-years old man diagnosed left anomalous partial pulmonary vein connection with presentation of short breathiness and palpation, and diagnosed with computer tomography pulmonary angiography. The operation was carried out under video assisted thoracoscopy with one manipulation incision and one observational incision, the vertical vein was dissected and anastomosis with left atrial appendage. The patients recovered smoothly and postoperative CTPA showed anastomosis ostium was unobstructed. CONCLUSION: The left lateral thoracotomy and video assisted thoracoscopic surgery is a feasible for correction of left PAPVC with intact interatrial septum without using CPB.

MnOx -Decorated Nickel-Iron Phosphides Nanosheets: Interface Modifications for Robust Overall Water Splitting at Ultra-High Current Densities.

Exploring highly active and stable bifunctional water-splitting electrocatalysts at ultra-high current densities is remarkably desirable. Herein, 3D nickel-iron phosphides nanosheets modified by MnOx nanoparticles are grown on nickel foam (MnOx /NiFeP/NF). Resulting from the electronic coupling effect enabled by interface modifications, the intrinsic activities of the hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) are improved. Meanwhile, 3D nanosheets provide abundant active sites for HER and OER, leading to accelerating the reaction kinetics. Besides, the shell-protection characteristic of MnOx improves the durability of MnOx /NiFeP/NF. Therefore, MnOx /NiFeP/NF shows exceptional bifunctional electrocatalytic activities toward HER (an overpotential of 255 mV at 500 mA cm-2 ), OER (overpotentials of 296 and 346 mV at 500 and 1000 mA cm-2 , respectively), and overall water splitting (cell voltages of 1.796 and 1.828 V at 500 and 1000 mA cm-2 , respectively). Furthermore, it owns remarkably outstanding stability for overall water splitting at ultra-high current densities (120 and 70 h at 500 and 1000 mA cm-2 , respectively), which outperforms almost all of the non-noble metal electrocatalysts. This work presents efficient strategies of interface modifications, 3D nanostructures, and shell protection to afford ultra-high current densities.

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report.

INTRODUCTION: Cardiac herniation is a rare complication after pulmonary surgery, and there are only a few reports about it. We now report a case of cardiac herniation presenting as superior vena cava obstruction after pneumonectomy. CASE PRESENTATION: A-52-years old woman diagnosed right pulmonary squamous cell carcinoma was carried out right pneumonectomy, the pulmonary artery and right superior pulmonary vein were dissected and ligated intrapericardial. The patient developed tachycardia arrhythmias, hypotension, followed by loss of consciousness at about 18 h after operation. After resuscitation, the patient was conscious but developed cyanosis of the superior vena cava drainage area, uropenia, and hypotension (80/30 mmHg). Bedside-echocardiography showed that the SVC was obstructed due to thrombus formation. Chest radiography a shift of the heart into right hemithorax. Rethoracotomy was performed and the herniated heart was replaced into the pericardium, and the pericardium was repaired with Gore Tex patch. The patient recovered smoothly after the second surgery. CONCLUSION: Cardiac herniation is a rare and fatally complication after thoracic surgery, and the prompt recognition with timely intervention is life-saving. Cardiac herniation is a rare but fatal complication of pneumonectomy. The increasing frequency of surgical resection for locally advanced thoracic carcinoma has led to a renewed emphasis regarding early diagnosis and treatment for cardiac herniation. Here we discuss a case of cardiac herniation presented with acute superior vena cava obstruction syndrome and hemodynamic instability after intrapericradial right pneumonectomy.

Atrial fibrillation and alteration of heart rate variability after video-assisted pulmonary lobectomy versus thoracotomy pulmonary lobectomy.

OBJECTIVE: To compare the incidence of atrial fibrillation (AF) and alteration of heart rate variability (HRV) after pulmonary lobectomy through video assisted thoracic surgery or thoracotomy, and to explore the role of autonomic nerves in the pathogenesis of atrial fibrillation after pulmonary lobectomy. METHODS: In a single institution, 224 patients (age > 60) with normal sinus rhythm were enrolled in the study. Experienced surgeons and anesthetists carried out operation and anesthesia according to the same procedure. The hearts were monitored using Holter for more than 96 h. Any new-onset AF was recorded and HRV was analyzed at different time intervals. RESULTS: One hundred twelve patients undergoing video-assisted thoracic surgery (VATS) and 112 patients undergoing thoracotomy (THOR) were matched for age and gender. Atrial fibrillation occurred in 39 patients, with a similar incidence between the two groups (VATS: 19/112, 16.9% and THOR: 20/112, 17.9%, P = 0.82). The post-operational heart variability at different time intervals was comparable between the two groups. CONCLUSION: Pulmonary lobectomy through video assisted thoracic surgery does not reduce the postoperative atrial fibrillation. Autonomic nerve mechanism may be involved in the pathogenesis of postoperative atrial fibrillation.