Quantitative analysis of the isolation area after larger-size laser balloon ablation

Background

The visually guided laser balloon ablation is a balloon-based catheter ablation technology used for atrial fibrillation (AF) ablation in recent years. This balloon catheter consists of a compliant balloon that has the capability of real-time endoscopic visualization of the targeted pulmonary vein (PV). The sizeable balloon is usually inflated to obtain optimal PV occlusion. The isolation area after laser balloon (LB) ablation was reported to be smaller than that after cryoballoon ablation. However, when LB is inflated with its maximum pressure, it can visualize wide-area PV antrum. Thereby, we suspected that larger-size LB can create wider isolation area.

Purpose

The aim of this study is to quantitatively evaluate the isolation area after LB ablation at the size larger than appropriate size for ablation in the pulmonary vein carina region.

Methods

We assessed 66 patients with AF who underwent LB ablation at the larger inflation size in our hospital during the period from July 2018 to July 2019. After LB ablation, we created voltage maps with a circular mapping catheter and calculated isolation areas with CARTO system.

Results

Figure shows a larger LB with its maximum pressure. PV antrum isolation was extended to the posterior wall in all patients. The left- and right-sided pulmonary vein antrum isolation area were 15.1±3.9 and 19.4±4.3 cm2, respectively.

Conclusion

LB at the larger inflation size with its maximum pressure can isolate wider-area circumferential PV antrum than previously reported. This method may be a new way of pulmonary vein antrum isolation.

Left atrial voltage mapping after PVI.

Funding Acknowledgement

Type of funding source: None

Pulmonary vein isolation under direct visual identification of the left atrium-pulmonary vein junction using intra-cardiac echography

INTRODUCTION

Intra-cardiac echocardiography (ICE) which has some benefits, can be used to obtain detailed anatomy of the heart chambers or large vessels, and the catheter positions, and it has been considered useful for improving the outcome of the ablation. In the present study, we performed pulmonary vein isolation (PVI) under real time monitoring of ICE imaging utilizing an ICE catheter placed at the junction of the left atrium (LA) and PVs (LA-PV junction).

METHODS

PVI for atrial fibrillation (AF) was performed in 30 cases with drug-resistant AF (mean age: 66-years-old; including 22 males). An ICE catheter utilizing a 9 MHz frequency was inserted into the LA via the atrial septum, and placed at the LA-PV junction. Circumferential ablation was performed in the LA outside of the PV ostium, encircling both the superior and inferior ostia together under ICE imaging.

RESULTS

The anatomy of the LA to the PVs and catheter sites were clearly identified by the ICE during the procedure, which enabled a precise and safe catheter manipulation with minimal fluoroscopy. Further, the wall thickness of the PV and LA, and position of the esophagus could be obtained by ICE, facilitating care in adjusting the power and/or duration of the current delivery.

CONCLUSION

ICE imaging of the LA-PV junction permitted real time monitoring of the target sites for PVI during the ablation procedure, and was considered a useful technique for performing PVI.

A new walking orthosis for paraplegics: hip and ankle linkage system

For paraplegics, two major disadvantages of hip-knee-ankle-foot orthotic systems that have a medial single hip joint are the short stride and horizontal rotation of the pelvis. The authors consider the pelvic rotation is caused by two factors; one is the lack of a mechanism to assist hip flexion, and the other is fixed ankle joints that cause instability when the step length becomes longer. Users must rotate their pelvis to initiate a swing in their legs and to achieve stability by making their two legs as parallel as possible in order to avoid losing balance. To overcome those disadvantages, the authors developed a new orthosis named "HALO" (Hip and Ankle Linked Orthosis), which has a linking mechanism that connects both ankle joints with a medial single hip joint. This new orthosis allows users to keep both feet always parallel to the floor while walking, and assists the swinging of the leg when the contralateral ankle is flexed dorsally by loading. Gait analysis revealed that the pelvic rotation with "HALO" either in parallel bars or with Lofstrand crutches was within 20 degrees, which was within the physiologically normal level.

[St. Luke's College of Nursing: student's motivation for selecting both nursing program and St. Luke's College for study]

In 1989, we published "A Study of Students' Motivation for Selecting a Nursing Program". Now, as the circumstances surrounding nursing education and the social situation are changing, we studied this matter again. The purpose of this survey is a) to find the motive for selecting a nursing program as well as this college, and b) to compare the results with those of the previous study. The questionnaire delineating reasons for selecting a nursing program and St. Luke's College were distributed to the 392 students who entered this college from 1989 to 1995. The response rate was 93.9%. The findings were as follows: 1) Many students selected a nursing program as an occupational choice. Responses noted that "nursing is worth while work", "nursing provide a service to people". They also selected nursing as "a way of life" so that "they would be able to grow" and "be useful to others". These results were almost the same as those of the previous study. 2) In the last two years, students demonstrated a tendency to choose two or three reasons for selecting a nursing program. The number of students who chose the reason "for myself" and "as a study" also increased. 3) "Christianity" was a unique reason for choosing this college. "Good quality of education", "high estimation of graduated", "recommendation of others" were also main reasons. Over the last 13 years, there was no change in motivation for selecting a nursing program. However, students showed a tendency to provide several reasons for choosing nursing. There was an increase in the number of students who were 1) interested in nursing for their own satisfaction and 2) who saw nursing as a intellectual study.

[A case of hepatic metastasis of rectal cancer with familial adenomatous polyposis treated by transarterial administration of low-dose leucovorin and 5-FU]

A 37-year-old man was diagnosed as having a rectal cancer with familial adenomatous polyposis, with the mutation of APC gene, and gastric polyposis, hypertrophy of the retinal pigment epithelium and a lipoma of the left arm. The patient underwent a total colectomy for the rectal cancer and a partial resection of the liver for metastasis (S3) which was detected on laparotomy, followed by cannulation in the hepatic artery. After the operation, 5-FU alone and low doses of CDDP and 5-FU were administered, but the level of serum CEA elevated and CT scanning showed multiple liver metastases. Then, low doses of leucovorin (30 mg/body bolus) and 5-FU (500 mg/body/h) were injected through an injection port every week. After 6 months, the level of serum CEA reduced and CT scanning showed minor response (about 30% on the decrease rate), without side effects, including diarrhea, stomatitis and bone marrow suppression.

[Understanding of informed consent by elderly patients]

Fifty patients, aged 60 years or more, who had been admitted to a hematology ward for more than 1 month, were studied in regard to their understanding of informed consent. The doctors informed 74% of their patients about the disease for which they were being treated. The rate of informing patients remained low in those with advanced age or with malignant tumors. However, only 42% of the patients realized that they had been informed of their diagnosis and clinical condition. The comprehension rate remained low at 43.2% even in patients who were informed by their doctors. While 60% of patients declared that they understood what the doctors described, only 36% could write something about the name or the state of their disease. Even among the patients who could understand the doctor's explanation, the comprehension rate was 43.3%. Sixty-six percent of patients demonstrated their wish to have a correct explanation of their diagnosis, 36% of patients wanted to be treated according to their own wishes, and 48% of patients left the decisions regarding their treatment to the doctors.

Intradural neurenteric cyst of the cervical spine misdiagnosed as a psychogenic disorder in a 7-year-old-child

The patient is a 7-year-old Japanese female child with an intradural neurenteric cyst of the cervical spine. She had been misdiagnosed as having a psychogenic disorder due to the absence of neurological changes and bony anomalies. Subjective recovery followed the removal of the cyst.

Localization and expression of a collecting duct water channel, aquaporin, in hydrated and dehydrated rats

The cellular and subcellular localization and expression of a kidney collecting duct water channel, aquaporin (AQP)-CD, were examined in the kidneys of hydrated and dehydrated rats by immunostaining, Northern blot analysis, and radioimmunoassay. In hydrated rat kidneys, AQP-CD was selectively found in the collecting duct principal cells and inner medullary collecting duct cells, but not in the intercalated cells. At a light microscopic level, AQP-CD was diffusely present in a granular pattern throughout the cytoplasm of the collecting duct cells with a preferential accumulation in subapical regions. By immunoelectron microscopy, AQP-CD was frequently demonstrated along membranes of small vesicles in the subapical cytoplasm and occasionally along the basolateral membranes of these cells. However, immunolabeling was sparse on the apical membranes. In dehydrated rats, AQP-CD immunostaining was intensified in the subapical cytoplasm of the collecting duct cells, along with increases in the number and size of AQP-CD-bearing vesicles in the subapical regions and with increment of labeling along the apical membranes. The increase in the amount of AQP-CD in the collecting duct cells of dehydrated rat kidneys was quantitatively confirmed by elevation of AQP-CD at mRNA and protein levels. The AQP-CD localization is consistent with the predicted site of the antidiuretic hormone (ADH)-regulated water channel in the collecting ducts and the increase in AQP-CD at mRNA and protein levels by dehydration may account for high concentration of urine in dehydrated subjects.

Separation and characterization of the C-terminal half molecule of bovine lactoferrin

The C-terminal half molecule (C lobe) of bovine lactoferrin was isolated by mild tryptic hydrolysis of lactoferrin followed by gel filtration and ion-exchange chromatography. The identity of the fragment was established by determining its N-terminal and C-terminal amino acid sequences and comparing them with the amino acid sequence of intact lactoferrin. The isoelectric point of the C lobe ranged between pH 6.2 and 6.5 as measured by isoelectric focusing on polyacrylamide gels. The circular dichroic spectrum in the range of 250 to 350 nm of the C lobe differed slightly from that of intact lactoferrin. The pattern of lectin reactivity was similar for both the C lobe and intact lactoferrin. The C lobe showed partial antigenic identity with intact lactoferrin as demonstrated by the double immunodiffusion method, and pH dependence of iron binding of C lobe is the same as that of intact lactoferrin molecule.

[Respiratory care with prone position for diffuse atelectasis in critically ill patients]

Diffuse atelectasis often occurs in the dorsal region of the lung of critically ill patients under long term mechanical ventilation. Conventional physical therapies (ex. PEEP, Sigh) have little effect on diffuse dorsal atelectasis. We provided respiratory care with prone position for 7 patients with severe respiratory distress (Two patients were treated twice). Improvement of their Respiratory Indexes (RI, mean 2.97) was obtained in the prone position for 6-163 (mean 35.8) hours. Ventilation efficiency also improved. Static lung compliance didn't change. It was assumed that the prone position was the factor responsible for the improvement of pulmonary V/Q ratio, the change of movement pattern of the diaphragm, and the ease of postural drainage of sputum. There were no complications. We conclude that prone position respiratory care has high utility for critically ill patients with diffuse dorsal atelectasis.

[Survey on clinical isolates from 13 hospitals in Akita Prefecture--changes in frequency and susceptibility of isolates by scale of hospital. Survey Group for Clinical Isolates, Chemotherapy Research Committee of Akita Prefecture]

Isolates from various clinical materials in 13 hospitals in Akita prefecture and their drug susceptibility were investigated by the Chemotherapy Research Committee of Akita Prefecture during the period from Dec., 1987 to Feb., 1988. The results were as follows: 1. The total number of isolates was 8,387, including Staphylococcus aureus (18.9%), Pseudomonas aeruginosa (10.9%), Staphylococcus epidermidis (7.3%) and Enterococcus faecalis (6.6%). S, aureus and P. aeruginosa were detected more frequently in the larger hospitals. 2. The detection frequency of S. aureus from the sputum, throat swab and pus exudate was also very high. There was a diversity in isolates from the urine and the frequency of Escherichia coli was low. More than half of the isolates from the blood were S. epidermidis and S. aureus. Many kinds of bacteria were detected from pleural fluid and ascites, but the isolate showed no particular tendency. 3. The susceptibility of S. aureus to oxacillin were variable in hospitals, and the susceptibility to cefazolin were even lower. Low susceptibility were also seen with norfloxacin. S. aureus showed the highest susceptibility to minocycline. The susceptibility was lower for inpatients than for outpatients. P. aeruginosa showed low susceptibility to cefsulodin. The number of ampicillin-resistant Haemophilus influenzae isolates tended to decrease. Enterobacter cloacae showed a low susceptibility for cephems. Serratia marcescens showed low susceptibility to many drugs. Based on the above results, we concluded that attention should be paid to S. aureus, P. aeruginosa and Enterobacter in clinical practice.

[Characterizing cancers in elderly patients]

High differentiation, slow growth and relatively well delineated growth pattern have been pointed out as characterizing cancers in the elderly. Although, there are not infrequently exceptions, these features encourage more drastic access in treating cancers of the old age. Factors inducing such features are discussed from the viewpoint of experimental carcinogenesis.

Atypical polysplenia only with absence of the hepatic segment of inferior vena cava in a middle-aged

An autopsy case of polysplenia with absence of the hepatic segment of the inferior vena cava in a 53-year-old female is reported. The venous blood from the lower parts of the body was drained through the azygos vein and the superior vena cava into the right atrium. Other than acquired pathological change, the heart was found to be normal. Except for the partial absence of the inferior vena cava, isomerism of asymmetric organs, and heterotaxia of abdominal organs, characteristic of typical polysplenia, were not present. This case of atypical polysplenia suggests the presence of a transitional form in the complex.

Pathomorphological studies on carcinoma of the prostate in Japan

Latent carcinoma of the prostate in Japan is reviewed in terms of its prevalence and frequency in different age groups. Analysis of mortality rates in different geographic regions of Japan reflect a predominance of younger men in industrialized areas. Results of combination therapy (radiotherapy and hormonal therapy) are reviewed.

Neuroendocrine cells in serially passaged rat stomach cancers induced by MNNG

Five gastric carcinomas, induced in inbred Wistar rats by oral administration of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) dissolved in drinking water, were successfully transplanted to isologous rats. The transplants grew to a size of 10 to 35 mm in diameter within 8 to 25 weeks of implantation. In one case, serial transplantation were maintained up to the 11th generation, with occurrence of distant metastasis in the 3rd generation. Histological histochemical, and electron microscopical comparison of the original and transplanted tumors revealed that (1) the original tumors were quite well differentiated, forming either papillary or tubular structures, whereas the transplants were more anaplastic and pleomorphic showing often solid nests; and (2) tumor cells with gastrointestinal differentiation and cells with neuroendocrine differentiation were present and evenly distributed in both the original and the serially transplanted tumors. As it is unlikely that the normal and neoplastic neuroendocrine cells are growing side-by-side with and independently of the epithelial neoplastic components in the present series of transplants, the findings strongly suggest (1) the multidirectional potency of the inbred rat stomach carcinoma cells and (2) the common neoplastic origin of the epithelial and neuroendocrine components.

[Intracranial surgery under hemodialysis (author's transl)]

A case of pituitary adenoma operated on under hemodialysis was reported. The patient was a 43-year-old male who had been obliged to hemodialysis since April 1975 because of chronic renal failure. He was admitted in February 21, 1976 because of progressive visual symptoms. Neurological examination revealed decreased visual acuity and bitemporal hemianopsia. Radiology showed enlarged sella turcica and calcified mass in the suprasellar region. Laboratory examination disclosed severe anemia and the operation was postponed until the hematocrit improved up to 39% by blood transfusion. The operation was performed in March 17, 1976 under conventional GOF anesthesia. The tumor was covered by a calcified capsule and after nibbling off the calcified covering, the tumor was removed. Postoperative course was uneventful. Peritoneal dialysis was continued for three days immediately after operation. Urinary volume of the patient increased up to 600 ml per day after operation, probably due to the postoperative diabetes insipidus. The diabetes insipidus was rather favorable sequela in this case because the patient was released from the severe restriction of water intake.

Heterotransplantation of cell lines derived from human malignant neoplasms into golden hamsters treated with antithymocyte serum

Thirteen cell lines of tissue culture originated from human malignant neoplasms were transplanted into cheek pouches of adult golden hamsters treated with anti-hamster thymocyte serum. In eleven cell lines, transplantation tests with 3.5 X 10(6) to 6.8 X 10(6) cells resulted in neoplastic growth within 4 weeks. In other two cell lines including one from neuroblastoma and another from Burkitt's lymphoma, the inoculum size had to be raised to 11.8 X 10(6) and 12.2 X 10(6) cells to get tumor growth, respectively. The histological appearance of those tumors was consistent with that of the individual primary neoplasms despite of their long in vitro histories. Anaplasia grading of the tumors appeared not to be correlated with the frequency of take.

Metastasis formation of Yoshida sarcoma heterotransplanted in adult golden hamsters treated with anti-hamster thymocyte serum

Growth of Yoshida sarcoma cells heterotransplanted in adult golden hamsters treated with antithymocyte serum was investigated. Control animals were grafted with or without hydrocoritisone conditioning. In the antithymocyte serum-treated group, tumors were produced in cheek pouches and grew progressively in size until Day 21 with no sign of regression. Little host reaction was noticed histologically around the tumor grafts throughout the course. Distant metastases were revealed at autopsy in 9 of 12 animals from Day 14 of inoculation on, and all the experimental animals died by Day 23. Six of the 9 hamsters with metastases died of tumor. By means of the back-transplantation test, the metastatic tumor cells were shown to be consistent with Yoshida sarcoma cells. In hydrocortisone-treated and untreated groups, the tumor size reached a maximum on Day 21 and Day 5, respectively, and then regression followed. No metastasis was detected in either control group.