[Ruptured chordae tendineae of tricuspid valve in neonate with intractable persistent pulmonary hypertension: a case report and literature review].

Objective: To analyze the clinical characteristics and treatment of tricuspid valve prolapse caused by chordal rupture complicated with persistent pulmonary hypertension in neonates. Methods: The clinical data of a male neonate with tricuspid valve prolapse complicated with persistent pulmonary hypertension admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province in November 2018 was analyzed retrospectively. Related literature up to September 2020 was searched with the strategy of "(neonate OR newborn) AND (tricuspid valve prolapse) AND (rupture OR necrosis) AND (papillary muscle OR chordae tendineae) AND (pulmonary hypertension)" in Wanfang, CNKI and PubMed database in Chinese and English. The characteristics of the disease were summarized. Results: A male full-term neonate was admitted due to presenting severe cyanosis for 9 hours. He was born by caesarean section and presented severe cyanosis and dyspnea at 10 min of ages, unresponsive to the positive airway pressure resuscitation. After 9 hours of mechanical ventilation, there was no improvement. Thus he was transferred to Children's Hospital of Hebei Province. On admission, the initial blood gas analysis showed an arterial partial pressure of oxygen of 22.5 mmHg (1 mmHg=0.133 kPa). The echocardiography revealed prolapsed anterior leaflet of tricuspid valve, severe tricuspid regurgitation (TR) and pulmonary artery hypertension, and right to left shunt via a patent foramen ovale. The arterial duct was closed. The chest X-ray was normal. The boy was treated with nitric oxide, milrinone, and continued mechanical ventilation initially. Addition of prostacyclin analog (treprostinil) on day 3 led to significant improvement of pulmonary blood flow, oxygenation, and stabilization, so that the extracorporeal membrane oxygenation therapy was avoided. At 11 months after birth, the boy underwent cardiac surgery. At surgery, the rupture of chordal tendineae in anterior leaflet of tricuspid valve was found. Tricuspid annuloplasty, valvuloplasty and repair of patent foramen ovale were successfully performed. The follow-up echocardiogram at postoperative 3 months showed only mild tricuspid insufficiency. The boy was well at last follow-up at 22 months of age with normal cognitive skill development. According to literature, 20 cases of papillary muscle or chordae tendineae rupture in neonates had been reported in 12 English papers. Among the total 21 neonates, there were 12 male infants and only one premature infant with gestational age of 33 weeks. They presented with profound cyanosis soon after birth. All of them received endotracheal intubation and mechanical ventilation. Other treatments included inhalation of nitric oxide, intravenous milrinone, vasoactive drugs, diuretics and prostacyclin, etc. Extracorporeal membrane oxygenation (ECMO) was used in 6 infants as a bridge to surgical treatment. Two cases reported earlier death of cardiopulmonary failure without operation and the rest 19 survived after surgery. The followed surgery or autopsy revealed that all of them had tricuspid valve prolapse, rupture of papillary muscle or chordae tendineae. Conclusions: The severe TR resulting from rupture of papillary muscle or chordate tendineae in neonates is rare and could cause severe hypoxemia. Early recognition, adequate cardiopulmonary support to stabilize the hemodynamic status and timely surgery can significantly reduce the mortality.

[Factors affecting intraoperative changes in regional cerebral tissue oxygen saturation in elderly patients undergoing laparoscopic hysterectomy].

Objective: To explore the factors that affect the fluctuation of intraoperative regional cerebral oxygen saturation (rSctO2) in elderly patients undergoing laparoscopic hysterectomy. Methods: A retrospective analysis of 39 elderly patients undergoing elective laparoscopic hysterectomy in Yale New Haven Hospital from October 2016 to February 2017 was performed. Factors including patients' demographic data, past medical history, intraoperative monitoring index and rSctO2 index (baseline, maximum, minimum, maximum-baseline, baseline-minimum) were recorded. Pearson correlation analysis was used to analyze the correlation between rSctO2 indexes and preoperative and intraoperative factors. Independent sample t-test was used to compare the differences of rSctO2 indexes between hypertension group and the group without hypertension, as well as diabetes group and the group without diabetes. Taking diabetes as the stratification factor, the relationship between rSctO2and factors including age, body mass index, hypertension were analyzed using multivariate analysis. Results: The age of the patients was (67.6±5.6) years old. The baseline value of rSctO2 was (71.2±3.9)% in the left frontal lobe and (70.8±4.1)% in the right frontal lobe. Results from univariate analysis showed that the left and right maximum-baseline value of rSctO2 were (12.9±4.5)% and (12.8±4.4)%, which were significantly lower than (16.3±4.2)% and (16.2±4.9)% in the group without hypertension (t=2.329, 2.266, all P<0.05). The right baseline-minimum in the group with hypertension was (5.3±3.7)%, which was significantly higher than (2.7±4.2)% in the group without hypertension (t=-2.061, P<0.05). The left minimum value of rSctO2 in diabetic group was (64.4±4.2)%, and the maximum value of rSctO2on the left and right sides were (81.7±4.0)% and (81.9±4.5)%, which were lower than (68.4±4.1)%, (86.7±4.2)% and (86.0±3.7)% in the group without diabetes (t=2.623, 3.297, 2.850, all P<0.05). The results of multivariate analysis showed the influence of age (t=2.866, P<0.05) and hypertension on left maximum-baseline (t=-4.530, P<0.01) was statistically significant. The influence of hypertension on right maximum-baseline was statistically significant (t=-4.629,P<0.01). Conclusion: Preoperative diabetes and hypertension are factors significantly affecting the intraoperative rSctO2 of elderly patients with laparoscopic hysterectomy.

[Preliminary experience of transoral robotic surgery in laryngeal and hypopharyngeal tumors with da Vinci surgical system].

Objective:The purpose of this study was to summarize preliminary clinical experience of transoral robotic surgery (TORS) in laryngeal and hypopharyngeal tumors with da Vinci surgical system.Method:Twelve patients were reviewed who were diagnosed with laryngeal (n=7) and hypopharyngeal tumors (n=5) and treated with TORS in Beijing Anzhen Hospital from July 1, 2016 to January 31, 2018.Result:Ten cases were male and two cases were female. The median age was 58 years old (ranging from 30 to 81 years). The robotic surgeries were performed successfully on all of the 12 patients. The average surgical time was 31.7 min. The average blood loss was 12.3 ml. The average recovery time for oral intake was 4.6 day. All surgical resection margins were free of carcinoma. Eight cases received neck dissection and 7 cases received adjuvant radiotherapy. There were no perioperative complications. There was no local recurrence, metastasis or death except 1 regional recurrence with a follow-up of 3 to 20 months.Conclusion:TORS is a feasible, safe, minimally invasive, and effective surgical procedure in selected laryngeal and hypopharyngeal tumors.

[Assistant cooperation and therapeutic effect analysis in transoral robotic surgery with da Vinci surgical system].

Objective:The purpose of this study was to summarize the therapeutic effect and key points and skills of assistant cooperation in transoral robotic surgery (TORS) with da Vinci surgical system.Method:Forty patients were reviewed who were treated with TORS in Beijing Anzhen Hospital from June 1, 2016 to May 30, 2018. Key points of assistant cooperation, docking time, incidence of transit to open approach, mechanical failure, complications, and negative surgical margin were analyzed.Result:Docking time was shortened from 50 to 15 min after 10 cases. The robotic surgeries were performed successfully on all of the 40 patients. There were no mechanical failure or perioperative complications. All surgical resection margins were free of carcinoma.Conclusion:In order to achieve professional cooperation with the surgeon and improve the efficiency, the assistant should be familiar with the steps and key points of TORS.

[Exploration of feasibility and safety of transoral robotic surgery in pharyngolaryngeal tumors].

Objective: To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. Methods: Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). Results: The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). Conclusion: Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.

[A preliminary analysis on potentially targeted genes of induced chemotherapy in supraglottic laryngeal squamous cell carcinoma].

OBJECTIVE: To analyze the differentially expressed genes produced by paclitaxel, cisplatin and 5-fluorouracil(TPF) regimen induction chemotherapy and the potentially functionally targeted genes of the induced chemotherapy in supraglottic laryngeal squamous cell carcinoma. METHODS: A total of 11 tissue samples from patients diagnosed as supraglottic carcinoma who didn't receive any treatment before were analyzed with microarray. The patients were divided into two groups based on their responses to the induction chemotherapy: 7 were sensitive to chemotherapy and 4 were non-sensitive. Gene expressions were detected by Illumina Human HT-12 BeadChip. The bioinformatics analysis online was used to analyze the differentially expressed genes. RESULTS: A total of 1 554 differentially expressed genes related to chemosensitivity were found. Analyzed with GO database, the up-regulated genes included the functional sets of biological adhesion, immune system development and stem cell proliferation, and the down-regulated genes included the functional sets of cell junction organization, phosphorus metabolic process and cell morphogenesis involved in differentiation. Analyzed with KEGG database, the up-regulated pathways included p53, cell adhesion and Ras signaling pathways, and the down-regulated pathways included focal adhesion, endocytosis and ErbB signaling pathways. There were statistically significant differences in the expressions of MAPK10, PIK3R5 and JUN genes, which had biological significance, between sensitive patients and non-sensitive patients. CONCLUSION: MAPK10, PIK3R5 and JUN may be considered as potentially functional genes of the induced chemotherapy in supraglottic carcinoma.

[Analysis of life-threatening complications during perioperative period in patients undergoing radical cystectomy with orthotopic neobladder].

OBJECTIVE: To investigate the factors influencing life-threatening complications during perioperative period in patients undergoing traditional cystectomy with orthotopic neobladder. METHODS: To retrospectively analyze the clinical data of 206 cases who underwent radical cystectomy with orthotopic neobladder. Logistic regression analysis was used to analyze the significance of the factors such as age, amount of bleeding, pathological stage, effective supplement of albumin, cardiovascular disease, diabetes mellitus, operation duration, intestinal preparation, etc., on the occurrence of severe complications. RESULTS: Among the 206 patients who underwent radical cystectomy with orthotopic neobladder, 22 cases (10.7%) had life-threatening complications (intestinal fistula, hemorrhagic shock, severe infection) during the perioperative period, and 9 cases died (mortality rate 4.4%). Logistic regression analysis showed that the elderly age, long operation duration, lack of effective supplement of albumin, diabetes mellitus are independent factors influencing the occurrence of life-threatening complications during the perioperative period of radical cystectomy with orthotopic ileal neobladder (P<0.05 for all), and are risk factors positively correlated with the severe complications. CONCLUSION: The elderly age, long operation duration, lack of effective supplement of albumin, and diabetes mellitus are risk factors of the occurrence of life-threatening complications during the perioperative period in patients undergoing radical cystectomy with orthotopic ileal neobladder, therefore, attention should be paid to this issue.

Effect of sample preparation on components and liver toxicity of Polygonum multiflorum.

It was shown that different extracts had significant differences in the toxicity of Polygonum multiflorum. In this study, the effect of sample preparation on components and liver toxicity of different extracts from P. multiflorum were determined. Hepatoxic components were discovered based on biomembrane extraction. Comparative chemistry and toxicology between ethanol and water extracts were also performed. The results showed that ethanol extract had much stronger hepatotoxicity, the content of emodin-8-O-ß-d-glucopyranoside, physcion-8-O-ß-d-glucopyranoside, emodin and physcion was significantly higher in ethanol extract than in water extract, while the human hepatocytes extraction showed that 2,3,5,4'-tetrahydroxystilbene-2-O-ß-d-glucopyranoside, emodin-8-O-ß-d-glucopyranoside, physcion-8-O-ß-d-glucopyranoside, emodin and physcion had interaction with human hepatocytes. The hepatotoxic effect of these components was investigated on human hepatocytes LO2 cells and emodin-8-O-ß-d-glucopyranoside, physcion-8-O-ß-d-glucopyranoside, emodin and physcion were finally confirmed to be, at least partial, hepatotoxic components. The results showed that sample preparation has significant effect on components in extracts of P. multiflorum especially the components related to hepatotoxicity. Water extract, the conventional administration form of Chinese herbs, is prefer for phytotherapy before well understanding their chemistry and biological activities.

Sustained diurnal photosynthetic depression in uppermost-canopy leaves of four dipterocarp species in the rainy and dry seasons: does photorespiration play a role in photoprotection?

Diurnal and seasonal changes in gas exchange and chlorophyll fluorescence of the uppermost-canopy leaves of four evergreen dipterocarp species were measured on clear days. The trees, that were growing in a plantation stand in southern Yunnan, China, had canopy heights ranging from 17 to 22 m. In the rainy season, Dipterocarpus retusus Bl. had higher photosynthetic capacity (A(max)) than Hopea hainanensis Merr. et Chun, Parashorea chinensis Wang Hsie and Vatica xishuangbannaensis G.D. Tao et J.H. Zhang (17.7 versus 13.9, 11.8 and 7.7 micromol m(-2) s(-1), respectively). In the dry season, A(max) in all species decreased by 52-64%, apparent quantum yield and dark respiration rate decreased in three species, and light saturation point decreased in two species. During the diurnal courses, all species exhibited sustained photosynthetic depression from midmorning onward in both seasons. The trees were able to regulate light energy allocation dynamically between photochemistry and heat dissipation during the day, with reduced actual photochemistry and increased heat dissipation in the dry season. Photorespiration played an important role in photoprotection in all species in both seasons, as indicated by a continuous increase in photorespiration rate in the morning toward midday and a high proportion of electron flow (about 30-65% of total electron flow) allocated to oxygenation for most of the day. None of the species suffered irreversible photoinhibition, even in the dry season. The sustained photosynthetic depression in the uppermost-canopy leaves of these species could be a protective response to prevent excessive water loss and consequent catastrophic leaf hydraulic dysfunction.