Surgical Treatment of Chronic Atrial Fibrillation—Unipolar Radiofrequency Ablation versus Cryoablation, and Left Atrial versus Bi-atrial Maze Procedures

AbstractThis study evaluated the efficacy of the left atrial Maze procedure (Lt-maze) and unipolar radiofrequency (RF) ablation as an additional procedure for the surgical treatment of atrial fibrillation (AF) in patient with other cardiac disease.Methods and Results: The Maze procedure was performed in 100 consecutive patients with AF: Lt-maze, 71 patients; bi-atrial Maze (Bi-maze), 29 patients. Cryoablation and RF ablation were used in 82 and 18 patients, respectively. There were no in-hospital or early deaths. Fourteen patients (14%) experienced postoperative complications. Seventy-five patients (75%) were in sinus rhythm (SR) at discharge, 4 patients were in junctional rhythm, and 21 patients had AF. Two patients (2%) required permanent pacemaker implantation. The AF-free rate at discharge was 79%, and the AF-free rate at hospital discharge did not differ significantly between cryoablation and unipolar RF ablation (78% and 82%, respectively). There were no significant differences between these two groups in operative results, in terms of the aortic cross-clamp time, cardiopulmonary bypass time, and AF-free rate, with the AFfree rate not differing significantly in those who received single valve surgery (73% and 75% in the cryoablation and unipolar RF ablation groups, respectively). The equipment cost of the two procedures differed greatly: 14,000 yen/patient for cryoablation and 250,000 yen/patient for RF ablation. The AF-free rate did not differ significantly between Lt-maze (76%) and Bi-maze (86%), including in those who received single valve surgery (72% and 79%, respectively). The significant predictors of AF recurrence in a univariate analysis were left atrial diameter (p = 0.03), duration of AF (p < 0.01), fibrillation amplitude on ECG (p = 0.02), and cardiothoracic ratio (p < 0.01), with the duration of preoperative AF being the only significant predictor of AF in a multivariate analysis.Conclusion: In this series, unipolar RF ablation for the Maze procedure was as effective as cryoablation at eliminating AF, and Lt-maze and Bi-maze were equipotent at restoring SR at discharge

The effect of celecoxib for treatment of preterm labor on fetuses during the second trimester of pregnancy: A pilot case series

OBJECTIVE: Although cyclooxygenase inhibitors effectively suppress uterine contraction, constriction of the fetal ductus arteriosus (DA) and oligohydramnios are major concerns. Celecoxib, a selective cyclooxygenase 2 inhibitor, is a potential potent tocolytic agent, but there are no studies that have evaluated the beneficial or adverse effects of celecoxib use on fetuses for more than 48 hours in pregnant women. We therefore aimed to evaluate the effect of middle-long-term celecoxib administration on the fetus during the second trimester of pregnancy, particularly in terms of fetal DA and amniotic fluid volume. MATERIALS AND METHODS: We retrospectively extracted and reviewed data from patients with preterm labor who received celecoxib for tocolysis for more than 48 hours between 2016 and 2020. Celecoxib was used for tocolysis only when treatment of patients with conventional tocolytic agents was ineffective. Data on the peak systolic velocity in ductus arteriosus (PSV-DA) and the maximum vertical pocket (MVP) were collected. RESULTS: A total of 15 patients were eligible. The median gestational age at celecoxib introduction was 22.6 weeks, and the median period of administration was 9 days (range 3-40 days). The median gestational age at delivery was 27.1 weeks, and the median duration from initial celecoxib administration to delivery was 40 days. The Z scores of PSV-DA and MVP did not change significantly after celecoxib administration. During administration, PSV-DA exceeded the 95th percentile of the corresponding normal reference range in three cases, but the levels returned to normal after reduction or discontinuation of treatment. There was no oligohydramnios during the treatment. CONCLUSION: Celecoxib administration for more than 48 hours in the second trimester of pregnancy might be safe and tolerable in terms of fetal PSV-DA and amniotic fluid volume as long as careful ultrasound monitoring is performed. Celecoxib could be an alternative for preterm labor when conventional tocolysis is not effective

Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study

BACKGROUND: The Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan. METHODS: A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated. RESULTS: Women with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013-2015) to 6.4% (2016-2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013-2015) to 14.1% (2016-2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001). CONCLUSIONS: The efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage

Incidence of gastrointestinal perforation associated with bevacizumab in combination with neoadjuvant chemotherapy as first-line treatment of advanced ovarian, fallopian tube, or peritoneal cancer: analysis of a Japanese healthcare claims database

[Objective] To assess the incidence of bevacizumab-associated gastrointestinal (GI) perforation during first-line treatment of patients with ovarian, fallopian tube, or peritoneal cancer receiving neoadjuvant chemotherapy (NAC) in Japanese real-world clinical practice. [Methods] A retrospective study was conducted using a healthcare claims database owned by Medical Data Vision Co., Ltd. (study period, 2008–2020). Patients who initiated first-line treatment of ovarian, fallopian tube, or peritoneal cancer were identified and divided into NAC and primary debulking surgery (PDS) groups. The incidence of bevacizumab-associated GI perforation was compared within the NAC group and between the groups. [Results] Paclitaxel + carboplatin (TC) was most commonly used as first-line treatment (39.5% and 59.6% in the NAC and PDS groups, respectively). TC + bevacizumab was used in 9.3% and 11.6% of patients in the NAC and PDS groups, respectively. In the NAC group receiving TC, the proportion of patients with risk factors for GI perforation was lower among patients with versus without concomitant bevacizumab. The incidence of GI perforation in the NAC group was 0.38% (1/266 patients) in patients receiving TC + bevacizumab and 0.18% (2/1, 131 patients) in patients receiving TC without bevacizumab (risk ratio=2.13; 95% confidence interval [CI]=0.19 to 23.36; risk difference=0.20; 95% CI=−0.58 to 0.97). None of the 319 patients in the PDS group receiving TC + bevacizumab had GI perforation. [Conclusion] No notable increase was observed in GI perforation associated with NAC containing bevacizumab. We conclude that bevacizumab is prescribed with sufficient care in Japan to avoid GI perforation

Development of a glue-free bimorph mirror for use in vacuum chambers

PZT (lead zirconate titanate)-glued bimorph deformable mirrors are widely used in hard X-ray regimes; however, they have not yet been used in soft X-ray regimes because they are less compatible for usage under high vacuum. In this study, we developed a glue-free bimorph deformable mirror, in which silver nano-particles were employed to bond PZT actuators to mirror substrates. Under an appropriate bonding condition, the bonding layer was confirmed to be uniform and the mirror's bending characteristics were demonstrated to be sufficiently stable; its gas emission rate was also shown to be acceptable. Piezo responses before and after additional heating at 200 °C showed the thermal stability of its bonding and bending properties.Yoshio Ichii, Hiromi Okada, Hiroki Nakamori, Akihiko Ueda, Hiroyuki Yamaguchi, Satoshi Matsuyama, and Kazuto Yamauchi, "Development of a glue-free bimorph mirror for use in vacuum chambers", Review of Scientific Instruments 90, 021702 (2019), https://doi.org/10.1063/1.5066105

Cerebral amyloid angiopathy-related inflammation presenting with steroid-responsive higher brain dysfunction: case report and review of the literature

A 56-year-old man noticed discomfort in his left lower limb, followed by convulsion and numbness in the same area. Magnetic resonance imaging (MRI) showed white matter lesions in the right parietal lobe accompanied by leptomeningeal or leptomeningeal and cortical post-contrast enhancement along the parietal sulci. The patient also exhibited higher brain dysfunction corresponding with the lesions on MRI. Histological pathology disclosed β-amyloid in the blood vessels and perivascular inflammation, which highlights the diagnosis of cerebral amyloid angiopathy (CAA)-related inflammation. Pulse steroid therapy was so effective that clinical and radiological findings immediately improved

OCT で検出された冠動脈のlipid-richプラークに対する至適薬物療法施行後の臨床経過

Background: The aim of this study was to evaluate optical coherence tomography (OCT)-detected lipid-rich coronary plaques (LRCPs) with coronary computed tomography angiography (CCTA) 10 months after optimal medical therapy (OMT). Methods and Results: Baseline OCT detected 28 LRCPs in non-culprit lesions. High-risk plaque features (HRPFs), such as positive remodeling, very low attenuation plaques, napkin-ring sign, and spotty calcification, were observed in 67.9%, 67.9%, 21.4%, and 64.3% of LRCPs, respectively, at the 10-month follow-up CCTA. Lesions with ≥3 HRPFs were defined as high-risk LRCPs (n=12); the remaining were defined as low-risk LRCPs (n=16). The maximum lipid arc on baseline OCT was larger in high- than low-risk LRCPs (221±62° vs. 179±44°, respectively; P=0.04). Receiver operating characteristic curve analysis indicated that a maximum lipid arc >154° on baseline OCT was the optimal cut-off value to predict high-risk LRCPs 10 months after OMT. Patients with high-risk LRCPs had worse clinical outcomes, defined as a composite of cardiac death, target lesion-related myocardial infarction, and target lesion-related revascularization, during follow-up than those with low-risk LRCPs (33.3% vs. 0%; P=0.01). Conclusions: A high-risk LRCP at follow-up CCTA was correlated with a larger maximum lipid arc on baseline OCT. Further aggressive treatment for patients with large LRCPs may reduce vulnerable plaque features and prevent future cardiac events.博士（医学）・甲第869号・令和5年3月15