Search

Background To clarify the influence of hypertension and blood pressure ( BP ) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐ RHYTHM Registry was performed. Methods and Results A consecutive series of outpatients with atrial fibrillation was enrolled from 158 institutions. Of 7937 patients, 7406 with nonvalvular atrial fibrillation (70.8% men, 69.8±10.0 years) were followed for 2 years or until an event occurred. Hypertension was defined as a systolic BP ≥140 mm Hg, a diastolic BP ≥90 mm Hg, a history of hypertension, and/or antihypertensive drug use. Hypertension was an independent risk factor for major hemorrhage (hazard ratio 1.52, 95% CI 1.05–2.21, P =0.027) but not for thromboembolism (hazard ratio 1.05, 95% CI 0.73–1.52, P =0.787). When patients were divided into quartiles according to their systolic BP at the time closest to the event or at the end of follow‐up (Q1, CI 1.75–4.74, P CI 1.02–2.53, P =0.041) after adjustment for components of CHA 2 DS 2 ‐ VAS c score, warfarin use, and antiplatelet use. A systolic BP of ≥136 mm Hg was an independent risk factor for thromboembolism and major hemorrhage. Conclusions BP control appears to be more important than a history of hypertension and baseline BP values at preventing thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation. Clinical Trial Registration URL : http://www.umin.ac.jp/ctr . Unique identifier: UMIN 000001569.

This paper presents a numerical analysis method for shape optimization of domains with steady-state heat-conduction fields considering the temperature dependence of the thermal conductivity coefficient. In this paper, we formulate two shape optimization problems, namely, maximization of thermal dissipation on heat transfer boundaries and minimization of heat-conduction fields. The shape gradient functions for these shape optimization problems are derived theoretically using the Lagrange multiplier method and formulae of the material derivative. Reshaping is accomplished using the traction method proposed as a solution to the shape optimization problems. The proposed method is validated from the results of two-dimensional numerical analysis. © 2011 Wiley Periodicals, Inc. Heat Trans Asian Res; Published online in Wiley Online Library (wileyonlinelibrary.com/journal/htj). DOI 10.1002/htj.20374

Back ground: Three-dimensional mapping systems such as the non-contact mapping system (EnSite) have been utilized for radiofrequency catheter ablation (RFCA) in cases with various kinds of arrhythmias. Methods: An EnSite system was utilized for RFCA in 12 patients with right-sided atrial tachycardia (AT). The patients were classified into two groups according to the focus of the AT in the right atrium (RA). The patients in whom the EnSite array was positioned near the focus of the AT were defined as group A, whereas those patients in whom the EnSite array was located less near the focus were defined as group B. RF energy was applied under the guidance of the mapping with the EnSite array. We investigated the relationship between the position of the EnSite array and the focus of the AT in terms of the mapping accuracy in both groups. Results: Even though the accuracy of the mapping of the breakout site and arrhythmia origin was comparable between groups A and B, the distance between the successful CA sites and the presumed AT focus according to the EnSite mapping was significantly shorter in group A than group B. Conclusions: As the location of the focus of the AT becomes closer to the proximal and distal ends of the ESB, the mapping accuracy deteriorates.

This paper presents a numerical analysis method for solving two shape optimization problems, namely, determining temperature distributions in subdomains and maximizing the thermal dissipation on sub-boundaries of steady-state thermal convective fields. The square-error integral between the actual temperature distributions and the prescribed temperature distributions in the prescribed subdomains is employed as the objective function for determining the temperature distribution. The shape gradients for these shape determination problems were derived theoretically using the adjoint variable method, the Lagrange multiplier method and the formulae of the material derivative. Reshaping was accomplished using a traction method that was proposed as a solution to the domain optimization problems. A new numerical procedure is proposed that applies the finite element method to the shape determination problems. The validity of this method was confirmed by 2D numerical analysis. © 2008 Wiley Periodicals, Inc. Heat Trans Asian Res, 37(5): 313–328, 2008; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/htj.20202

Background: Electrical isolation of pulmonary veins (PV) by radiofrequency (RF) ablation is often performed in patients with atrial fibrillation (AF). Current catheter technology usually requires the use of a multielectrode catheter for mapping in addition to the ablation catheter. Purpose: We evaluated the feasibility and safety of using a single, expandable electrode catheter (MESH) to map and to electrically isolate the PV. Methods and Results: Nineteen closed-chest mongrel dogs, weighing 23–35 kg, were studied under general anesthesia. Intracardiac echocardiography (ICE) was used to guide transseptal puncture and to assess PV dimensions and contact of the MESH with PV ostia. ICE and angiography of RSPV were obtained before and after ablation, and prior to sacrifice at 7–99 days. An 11.5 Fr steerable MESH was advanced and deployed at the ostium of the RSPV. Recordings were obtained via the 36 electrodes comprising the MESH. For circumferential ablation, RF current was delivered at a target temperature of 62–65°C (4 thermocouples) and maximum power of 70–100 W for 180 to 300 seconds. Each animal received 1–4 RF applications. Entrance conduction block was obtained in 13/19 treated RSPVs. Pathological examination confirmed circumferential and transmural lesions in 13 of 19 RSPV. LA mural thrombus was present in 3 animals. There was no significant PV stenosis. Conclusion: Based on this canine model, a new expandable MESH catheter may safely be used for mapping and for PV antrum isolation. This approach may decrease procedure time without compromising success rate in patients undergoing AF ablation.

Spatial Resolution of Mapping. Background: The purpose of this study was to compare the spatial resolution of activation mapping and pacemapping in patients undergoing ablation of idiopathic ventricular tachycardia (VT) arising from the right ventricular outflow tract (RVOT). A direct comparison of the two techniques has not been undertaken. Methods and Results: Electroanatomical activation maps of the RVOT were obtained during VT in 15 patients. Pacemaps were obtained from multiple sites, tagged on the activation map, and scored according the degree of concordance between the paced QRS configuration and that of VT. The site of successful ablation was considered the VT site of origin. Initial endocardial activation away from the site of origin was rapid; the mean area of myocardium activated within the first 10 msec (early activation area, EAA) was 3.0 ′ 1.6 cm 2 (range: 1.3-6.4 cm 2 ). Best pacemap scores were always obtained adjacent to the site of origin. Pacemap concordance, and the probability of an exact pacemap match significantly decreased with increasing distance of the pacing site from the site of origin (P < 0.01). All patients had more than one pacing site yielding a best pacemap score. The greatest distance between such sites in an individual patient ranged from 11 to 26 mm (mean: 18 ′ 5 mm), and was strongly correlated with the size of the EAA (r = 0.77, P < 0.001). Conclusions: Pacemapping and activation mapping provide similar localizing information. The spatial resolution of each technique is modest, varies between patients, and may be optimized by three-dimensional data display.

Electrical Remodeling and Paroxysmal AF. Introduction: Rapid atrial pacing alters atrial electrophysiology, promoting initiation and maintenance of atrial fibrillation (AF). The aim of this study was to assess differencesin the electrophysiologic properties of atrial tissue between patients with and without AF episodes and to determine whether electrophysiologic properties can predict the clinical efficacy of antiarrhythmic agents. Methods and Results: Sixty patients were studied, 33 with documented episodes of paroxysmal atrial fibrillation (PAF) and 27 control patients. Atrial effective refractory period (AERP), atrial vulnerability, and intra-atrial conduction time were measured at baseline and after rapid constant atrial pacing for 5 minutes at rates of 130, 150,170, and 190 beats/min. The clinical efficacy of antiarrhythmic agents for PAF prophylaxis was assessed over 14 months with an antiarrhythmic agent identical to that administered intravenously, and the antiarrhythmic agent effects on AERP, atrial vulnerability, and intra-atrial conduction time were assessed. AERP shortening and atrial vulnerability increase were significantly larger in the PAF group. Antiarrhythmic agents that were clinically effective in suppressing PAF significantly attenuated AERP shortening, but antiarrhythmic agents that were clinically ineffective did not. Conclusion: Changes in AERP and atrial vulnerability observed after rapid atrial pacing are considered indicative of the electrophysiologic substrate of PAF. Attenuation of AERP and atrial vulnerability by antiarrhythmic agents might be useful in predicting their clinical efficacy.

In this paper, a practical method of numerical analysis for the boundary shape design of steady-state heat-conduction fields to control the temperature distribution to a prescribed distribution is presented. Reshaping was accomplished by the traction method proposed by one of the authors as a solution to domain optimization problems in which elliptic boundary value problems were defined. In this study, we formulated a temperature square error norm minimization problem between the prescribed distribution and the actual distribution on prescribed boundaries and theoretically derived a shape gradient function for this problem. We developed a convenient numerical method using a general-purpose FEM program for the temperature prescribed problem. The successful results for the two-dimensional problems of an erosion surface on a blast furnace hearth and a coolant flow passage in a wing demonstrate the validity of the presented method. © 2001 Scripta Technica, Heat Trans Asian Res, 30(3): 245–258, 2001

Background: No technique has been reported to analyze directly the antigen expression on basophil leukocytes when using a flow cytometer; therefore, the exact phenotype of human basophils and the character of the peroxidase in basophils are not well understood. Methods: Human blood basophils were purified by using an antibody against high-affinity Fc epsilon receptor (hFcϵR) and a MACS™ magnetic cell sorting system and then cytochemically stained. The phenotype and peroxidase of the human basophils were flow cytofluorometrically analyzed directly in unseparated blood and bone marrow samples as hFcϵR+/MBP+ (major basic protein)/Hist+ (histamine) light-density cells distributed in the high side-scatter area of lymphocytes on light scattergrams. Results: The peroxidase granules of human basophils were stained by an anti-eosinophil peroxidase (EPO) antobody. The human blood basophils had common granulocyte markers plus CD25, i.e., they were CD11a/CD11b/CD11c/CD25/CD38/CD13/CD33/hFcϵR/MBP/Hist/EPO positive, CD71 dim positive, CD14/CD15 partially positive, and CD2/CD3/CD7/CD122/CD16/CD56/CD57/CD10/CD19/CD20/CD22/HLA-DR/MPO (myeloperoxidase)/CD23 negative. Further examination was done to analyze the expression of colony-stimulating factor receptors on three lineages of granulocytes, i.e., basophils, eosinophils, and neutrophils. The neutrophils were CD114 (G-CSFR)/CD116 (GM-CSFR)/CD124 [interleukin (IL)-4R]/CD126 (IL-6R) positive and CD123 (IL-3R)/CD125 (IL-5R) negative. In contrast, the eosinophils and basophils were CD116/CD123/CD125/CD126 positive and CD114/CD124 negative. Conclusions: This novel technique for directly characterizing human basophil leukocytes with flow cytometry may be a convenient way to screen the expression of surface antigens and the cytoplasmic expression of CD antigens and other proteins in human blood basophils and to analyze alterations of the character of basophils by cytokines and other biological substances in vivo and in vitro. Cytometry 35:249–259, 1999. © 1999 Wiley-Liss, Inc.

Primary familial and congenital polycythaemia (PFCP) is a rare disease characterized by congenital erythrocytosis inherited in an autosomal dominant fashion. Recently, mutations in the erythropoietin receptor (EpoR) have been identified in PFCP families. We describe a Japanese family with an autosomal dominant inheritance of PFCP. An in vitro colony assay demonstrated hypersensitivity of erythroid progenitors to erythropoietin (Epo) in affected family members. Sequence analysis of RT-PCR products amplified from the C-terminal region of EpoR transcripts in affected family members revealed that they were all heterozygous for C and T bases at position 5986, which suggested a genetic mutation (C to T) on one allele of EpoR. This mutation gave rise to a translation termination codon TAG at amino acid 435. Thus, the resulting EpoR is a truncated protein product lacking all 74 amino acids downstream of the mutation. To date, all genetic mutations affecting a family with PFCP, including this one, have been located in the cytoplasmic negative regulatory region of the EpoR. All mutations gave rise to truncated Epo receptors between Tyrosine 427 and Tyrosine 455. The phosphotyrosines in this region of EpoR have been demonstrated to be binding sites for SHP-1 phosphatase. Therefore PFCP is presumably brought about as a result of genetic mutations which cause the loss of the SHP-1 binding site in the cytoplasmic region of EpoR.

Slow AV nodal pathway ablation using RF is highly effective for patients with refractory AV nodal reentrant tachycardia (AVNRT). We report three catheter ablation cases using RF current in patients associated with persistent left superior vena cava (PLSVC). Three patients with drug refractory AVNRT of common variety were involved in this study. An electrode catheter introduced through the left subclavian vein inserted directly into the coronary sinus, a typical anatomical finding of PLSVC. The ablation procedure was initially performed at the posteroinferior region of Koch's triangle. A slow pathway potential could not be found from that area; nonsustained junctional tachycardia (NSJT) did not occur during the delivery of RF current; there was failure to eliminate slow AV nodal pathway conduction. The catheter then was moved into the bed of the proximal portion of the markedly enlarged coronary sinus. A slow AV nodal pathway potential was recorded through the ablation catheter, and the delivery of RF current caused NSJT in two patients. Complete elimination of slow AV nodal pathway conduction was accomplished in these two patients by this method. No adverse effects were provoked by this procedure. Catheter ablation of the slow AV nodal pathway guided by a slow pathway potential and the appearance of NSJT was feasible and safe in the area of the coronary sinus ostium in patients associated with PLSVC.

Six carotenoids, including carotenoid glucoside fatty acid esters, have previously been identified in Rhodococcus rhodochrous RNMS1. From its colour mutant, two carotenoids with apparently very low polarities on reversed phase HPLC were found to be carotenoid glucoside mycolic acid esters. From spectroscopic and chemical evidence, their structures were determined as 1′-[(6- O -mycoloyl-β- d -glucopyranosyl)oxy]-1′,2′-dihydro-β,ψ-caroten-4-one and 1′-[(6- O -mycoloyl-β- d -glucopyranosyl)oxy]-1′,2′-dihydro-β,ψ-carotene. Their mycolic acid residues were similar to those of the cellular mycolic acids. In all strains of R. rhodochrous tested, these carotenoid derivatives were found. Such carotenoid derivatives have never been reported in other organisms.

Backround Numerous types of arthroplasties may be used in the surgical treatment of a hip fracture ( proximal femoral fracture). The main differences between the implants are in the design of the stems, whether the stem is fixed in place with or without cement, whether a second articulating joint is included within the prosthesis ( bipolar prosthesis) or whether a partial ( hemiarthroplasty) or total whole hip replacement is used.Objectives To review all randomised controlled trials that have compared different arthroplasties for the treatment of hip fractures in adults.Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register ( December 2005), the Cochrane Central Register of Controlled Trials ( T h e Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles.Selection criteria All randomised and quasi-randomised controlled trials comparing different arthroplasties and their insertion with or without cement, for the treatment of hip fractures.Data collection and analysis Two review authors independently assessed trial quality, by use of a ten-item checklist, and extracted data.Main results Seventeen trials involving 1920 patients were included. One trial involved two comparisons. Cemented prostheses, when compared with uncemented ( six trials, 549 participants) were associated with less pain at a year or later ( 16/52 versus 28/52; RR 0.51, 95% CI 0.31 to 0.81) and a tendency to better mobility. No significant difference in surgical complications was found. Comparison of unipolar hemiarthroplasty with bipolar hemiarthroplasty ( seven trials, 857 participants, 863 fractures) showed no significant differences between the two types of implant. Two trials involving 232 patients compared uncemented hemiarthroplasty with a total hip replacement. Both studies reported increased pain for the uncemented prosthesis and one study found better mobility and a lower long-term revision rate for those treated with a THR. Two trials involving 214 participants compared cemented hemiarthroplasty versus total hip replacement. Both trials generally found little difference between prostheses. THR was associated with a slightly longer surgical time but a tendency to better functional outcome in one trial.Authors' conclusions There is limited evidence that cementing a prosthesis in place may reduce post-operative pain and lead to better mobility. There is insufficient evidence to determine the roles of bipolar prostheses and total hip replacement. Further well-conducted randomised trials are required.

Background: Short-term success does not always correlate well with long-term outcome in cases of catheter ablation (CA) for atrial fibrillation (AF). The aim of this study is to examine about the predictor which can differentiate between short- and long-term recurrence of AF after CA of AF. Methods and Results: Total of 52 patients (48; ±9 years, male; 33) were involved. The patients were divided into two groups; Group A: AF recurred earlier than 3 months after CA for AF (35 cases), Group B: AF recurred later than 1 year after CA for AF (17 cases). With multivariate analysis, following parameters were analyzed between Group A and B; diameter of left atrium (LAD) (38.7; ±5.6 vs 40.3; ±9.3 mm, NS), left ventricular ejection fraction (LVEF) (66.0; ±11.9 vs 59.8; ±9.2%, NS), the maximum diameter of pulmonary veins (MDPV) (23.1; ±3.4 vs 25.0; ±2.9 mm, NS), score of CHADS2 (SCHADS) (1.35; ±0.14 vs 1.31; ±0.21, NS), cardiothoracic ration on chest X-ray (CTR) (49.3; ±3.9 vs 51.2; ±4.3, NS) and total number of radiofrequency energy application (RFAP) (62.4; ±11.8 vs 83.9; ±13.8, P

Introduction: Complex fractionated electrogram (CFE) can identify target sites for ablation of atrial fibrillation (AF). The influence of the anti-arrhythmic agents (AAA) for CFE is not completely recognized. We investigated CFE and modified CFE with AAA by a multiple simultaneous CFE recording. Methods: A total of 13 patients (10 male, 62±8 years) of non-paroxysmal AF were enrolled. We placed a 64-electrode basket catheter in the left atrium (LA) and recorded LA electrograms with serial rapid mapping technique. CFE was recorded and defined according to the algorithm of the mapping (NavX®) system (CFE; atrial electrogram cycle length of

Introduction: We report 2 cases of ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) which required radiofrequency energy (RF) application in the great cardiac vein (GCV) and/or the epicardium for treating VAs. Case 1: Sixty-five year-old female with idiopathic VAs underwent RF-catheter ablation (CA). The earliest activation site of VAs was observed in GCV, to which left descending coronary artery (LAD) run close. Sufficient RF delivery could not be performed due to the concerns about the injury to LAD, and the procedure resulted in a transient therapeutic effect. Case 2: Fifty-one year-old male suffering from VAs associated with non-ischemic cardiomyopathy underwent RF-CA. In 1st session, the earliest activation site of VAs was recognized in GCV, however, RF-CA application in GCV failed to abolish VAs. In 2nd session with the subxiphoidal pericardial approach, the earliest site was located at LVS extremely close to LAD. Despite the multiple RF applications in the vicinity sites of that portion, we were unable to abolish VAs. Conclusion: In sporadic cases, epicardial approach is required to eliminate VAs. However, the discretion and attention have to be paid in order to avoid the serious complications for treating VAs originating from LVS.

Introduction: The benefit of additional ablation of complex fractionated electrograms (CFE) has been reported in treating patients with persistent atrial fibrillation (per-AF). However, the ideal target patients group for this strategy remains unclear. We report a series of cases with per-AF in which addition of CFE ablation to PVI resulted in successful outcome in freedom from AF. Method and Results: Three patients with symptomatic per-AF (2 with lone AF and 1 with tachycardia-induced cardiomyopathy, AF duration 4–16 months, age 56±6 yrs, 3 male, LA diameter of 43, 46 and 49 mm) under went a single ablation with PVI plus CFE ablation using NavX. The amounts of CFE region were variable (12–34 cm2). However, the distribution was similar among patients (in both the LA roof toward the appendage and LA septum anterior to the right superior PV). All CFE regions were located along area with voltage of 0.5–1.0 mV. Although termination of AF was not achieved, the mean cycle length in the LA significantly prolonged by CFE ablation. Following a single procedure, all three patients remained in sinus rhythm at >4-months follow-up. Conclusion: The details of the clinical and electrophysiological characteristics underlying these three cases will be discussed.

Treatment of ethyl 2-furoate or 5-methyl-2-furoate with metallic sodium in the presence of trimethylchlorosilane affords the trimethylsilyl enol ether of 3,5-bis(trimethylsilyl)pent-4-yn-1-al or 4,6-bis(trimethylsilyl)hex-5-yn-2-one, respectively.