A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

Introduction. Little is known about the effects of volume change by hemodialysis (HD) and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT) in a patient who had left atrial (LA) scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF) on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery). Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence

An annual report 2014 on campus wide Faculty Development programs at The University of Tokushima

FD promotion programs have started from 2002, promoting systematization, organization and routinization of Faculty Development. In 2014, based on the results of 12 years of FD, we have aimed to enhance the quality of higher education of our university, building new educational system for assurance of higher education. The Center for the Enhancement of Teaching & Learning was restructured into the Center of University Education. Thus, based on the guideline for educational innovation of our university, the organization for promoting FD was strengthened. Concretely, we carried out 3 programs; 1) educational innovation FD, 2) educational development FD, 3) comprehensive FD. As to each program, we showed their outlines and considered their results and problems shown from the questionnaire to their attendants

An annual report 2015 on campus wide Faculty Development programs at The University of Tokushima

Tokushima University’s FD promotion programs have started since 2002, promoting systematization, organization and routinization of Faculty Development. In 2015, in addition to the previous FD promotion programs, we have aimed to enhance the quality of higher education of our university, supporting effective implementation of Ministry of Education’s AP (=Acceleration Program for University Education Rebuilding) & building new educational system “Numbering System” for the assurance of higher education. Concretely, we carried out 3 programs; 1) educational innovation FD, 2) educational development FD, 3) comprehensive FD. As to each program, we showed their outlines and considered their results and problems shown from the questionnaire to their attendants

2016 Annual Report on Faculty Development Programs at Tokushima University

全学FD 推進プログラムは2002 年度から開始され，FD の体系化，組織化，日常化等を推進してきた。2016 年度は，例年開催している，「授業設計ワークショップ」，「授業参観・授業研究会」，「大学教育カンファレンスin 徳島」，「ティーチング・ポートフォリオ作成ワークショップ」の他に，各学部等におけるFD の実態を把握し，成果や課題を明らかにした上で，ニーズの明確化，今後の学部等FD と総合教育センターの支援の在り方について検討するために，「質保証のための分野別ワークショップ」を開催した。また，大学教育再生加速プログラムに関連するSIH 道場FD・説明会の実施や学内でアクティブ・ラーニングを推進するためにLED カフェ等を実施した。各プログラムについて概要を記載し，アンケート結果等から成果と今後の課題について考察する。Tokushima University's FD promotion programs started in 2000. They promote the systemization, organization and routinization of faculty development activities. In 2016, in addition to the regular faculty development programs, which include a Course Design Workshop, Classroom Observation and Discussion Meeting, the University Education Conference and a Teaching Portfolio Workshop, we conducted a Quality Assurance Disciplinary Workshop to ascertain the FD needs of the departments and to foster alignment between the department faculty development and the campus-wide faculty development provided by the Center of University Education. As a program for the implementation of the Ministry of Education's Acceleration Program for University Education Rebuilding (AP), we conducted a seminar to explain SIH Dojo: Introduction to Active Learning for first year students. To promote active learning, we also conducted another seminar called the Learning, Education, Development (LED) Cafe. We provide outlines of respective programs and discuss the issues raised in the responses to the questionnaire

Integral role of receptor for advanced glycation end products (RAGE) in nondiabetic atherosclerosis

An advanced glycation end products (AGE)/a receptor for AGE (RAGE) axis plays a central role in the pathogenesis of diabetic vascular remodeling. This study was conducted to clarify the role of RAGE in nondiabetic atherosclerosis. We used the aortic and coronary atherosclerotic lesions of Watanabe heritable hyperlipidemic (WHHL) rabbits prone to myocardial infarction (WHHLMI) at 1 to 14 months. Immunohistochemistry demonstrated the significant expression of RAGE as early as at 1 month with the stronger expression at 3 and 7 months, which was remarkably diminished at 14 months. RAGE expression was concordant with AGE accumulation. The major original sources of RAGE expression were macrophages and smooth muscle cells in addition to endothelial cells, and RAGE expression was distributed in the areas of phospholipid products, a component of oxidized LDL and nitrotyrosine. The concentrations of serum AGE did not alter significantly with aging. These findings suggested the expression of RAGE was induced by hyperlipidemia and oxidative stress independent of diabetes in WHHLMI rabbits. Additionally, our in vitro study showed that silencing of RAGE tended to attenuate oxidized-LDL-triggered PAI-1 expression in human cultured macrophages, as well as oxidized-LDL-induced tissue factor expression in peritoneal macrophages, suggesting a possible role of RAGE in prothrombogenic molecular regulation. In conclusion, the present study provides in vivo evidence that RAGE plays an integral role in the initiation and progression of nondiabetic atherosclerosis, suggesting that RAGE may be a novel target for treating not only diabetic but also nondiabetic vascular complications

Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry.

BackgroundCryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.MethodsThe YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.ResultsA total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.ConclusionsThe incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article

Assessing anteroposterior basal bone discrepancy with the Dental Aesthetic Index

Objective: To investigate dental appearance and cephalometric features, using a sample of orthognathic and/or orthodontic patients. A special interest was to identify the relationship of the Dental Aesthetic Index (DAI) with anteroposterior basal bone discrepancy (APBBD) and cephalometric indicators.\ud \ud Materials and Methods: A full sample of 159 patients in two Japanese hospitals was used. Each patient was assessed with a preorthodontic dental cast and cephalometric radiography.\ud \ud Results: Malocclusion with APBBD was more prevalent among high DAI subjects (P  =  .034, OR  =  1.04, 95% CI: 1.00–1.08), Class III malocclusion patients (P  =  .048, OR  =  2.32, 95% CI: 1.01–5.34) and male patients (P  =  .008, OR  =  2.96, 95% CI: 1.33–6.61). Participants scoring 88 points (the highest score in this sample) of the DAI had 16.84 times the risk of APBBD of those who scored 17 points (the lowest score in this sample). Patients with APBBD presented with a greater adjusted ANB angle (t  =  −8.10, P < .001) and a larger adjusted A-B/NF appraisal (t  =  −9.65, P < .001). The SNA angle (P < .001), the SNB angle (P  =  .002), the adjusted ANB angle (P  =  .001), and the adjusted A-B/NF appraisal (P  =  .035) were associated with DAI scores in cubic regression models.\ud \ud Conclusion: This study has demonstrated a relationship between the DAI and APBBD. Feasibility of using the adjusted ANB angle and the adjusted A-B/NF appraisal to assess severity of APBBD has been confirmed. The DAI may provide a supportive method to evaluate orthognathic needs. Future investigations are indicated