Residual mitral regurgitation after repair for posterior leaflet prolapse- Importance of preoperative anterior leaflet tethering

Background Carpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation ( MR ) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair. Methods and Results We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P =0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR . In multivariate regression analysis, smaller anteroposterior mitral annular diameter ( P &lt;0.001) and lower left ventricular ejection fraction ( P =0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation. Conclusions Anterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3‐dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy. </jats:sec

Experimental verification of a fully inseparable tripartite continuous-variable state

A continuous-variable tripartite entangled state is experimentally generated by combining three independent squeezed vacuum states and the variances of its relative positions and total momentum are measured. We show that the measured values violate the separability criteria based on the sum of these quantities and prove the full inseparability of the generated state.Comment: 5 pages, 4 figure

Experimental demonstration of quantum teleportation of a squeezed state

Quantum teleportation of a squeezed state is demonstrated experimentally. Due to some inevitable losses in experiments, a squeezed vacuum necessarily becomes a mixed state which is no longer a minimum uncertainty state. We establish an operational method of evaluation for quantum teleportation of such a state using fidelity, and discuss the classical limit for the state. The measured fidelity for the input state is 0.85$\pm$ 0.05 which is higher than the classical case of 0.73$\pm$0.04. We also verify that the teleportation process operates properly for the nonclassical state input and its squeezed variance is certainly transferred through the process. We observe the smaller variance of the teleported squeezed state than that for the vacuum state input.Comment: 7 pages, 1 new figure, comments adde

Efficacy of soft palatal augmentation prosthesis for oral functional rehabilitation in patients with dysarthria and dysphagia: a protocol for a randomised controlled trial

Introduction Palatal augmentation prosthesis (PAP) is used in patients with articulation and swallowing disorders caused by postoperative loss of tongue tissue due to tongue cancer, cerebrovascular disease sequelae and age-related hypofunction. We have previously reported a newly designed soft PAP fabricated using an thermoplastic material that is particularly appropriate for early intervention. However, the effect of soft PAP on oral function improvement remains to be elucidated. The aim of this study is to investigate whether soft PAP can improve dysarthria and dysphagia occurring as cerebrovascular disease sequelae. Methods and analysis This prospective, randomised, controlled trial will compare the immediate and training effects of rehabilitation using soft PAP with those of rehabilitation without using it. Primary outcomes are the single-word intelligibility test score and pharyngeal transit time (PTT). Secondary outcomes are tongue function (evaluated based on maximum tongue pressure, repetitions of tongue pressure and endurance of tongue pressure), articulation function (evaluated based on speech intelligibility, oral diadochokinesis, Voice-Related Quality of Life (V-RQOL)) and swallowing function (evaluated using Eating Assessment Tool-10). The study results will help determine the efficacy of Soft PAP in improving functional outcomes of word intelligibility and PTT. We hypothesised that early rehabilitation using Soft PAP would more effectively improve articulation and swallowing function compared with conventional rehabilitation without using soft PAP. Ethics and dissemination Ethical approval was obtained from the Okayama University Certified Review Board. The study findings will be published in an open access, peer-reviewed journal and presented at relevant conferences and research meetings

A case of facial paralysis with swallowing disorder in the pharyngeal phase

　Facial nerve paralysis leads to swallowing disorder in the oral and oropharyngeal phases. However, swallowing disorders in the pharyngeal phase have also been reported. We report a case of a male adult patient who was diagnosed with herpetic pharyngolaryngitis and right auricular shingles and prescribed an anti-herpes drug. Fourteen days later, right facial nerve paralysis was observed. He was diagnosed with Hunt syndrome, and steroid pulse therapy was started on the same day. A fluoroscopy swallow study revealed that the hyoid bone was leaning to the right when moving forward (lateral view) and that the shadow of the liquid in the pharyngeal cavity was lower on the right (anteroposterior view). The patient was instructed to perform facial massage and swallowing exercises. Approximately 3 months after the onset of facial nerve paralysis, the inclination of the hyoid bone and the shadow of the liquid in the pharyngeal cavity disappeared, and the facial nerve paralysis was cured. We believe that the elevation of the hyoid bone was impaired on the paralyzed side because of posterior abdominal digastric and stylohyoid muscle paralysis. When evaluating the swallowing function in patients with facial nerve paralysis, both the oral and pharyngeal phases should be evaluated