Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

AbstractAT caused by SVC fibrillationHere, we report a case of a 62-year-old man with a history of incessant atrial tachycardia (AT) for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC), but the surface 12-lead electrocardiogram (ECG) exhibited a relatively regular AT (atrial cycle length=240ms). CARTO mapping of the right atrium (RA) demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC–RA junction). Intravenous administration of 20mg adenosine triphosphate (ATP) led to an acceleration of the SVC–RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF). Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC–RA junction was the cause of this AT

Satellite glial cell P2Y12 receptor in the trigeminal ganglion is involved in lingual neuropathic pain mechanisms in rats

<p>Abstract</p> <p>Background</p> <p>It has been reported that the P2Y₁₂receptor (P2Y₁₂R) is involved in satellite glial cells (SGCs) activation, indicating that P2Y₁₂R expressed in SGCs may play functional roles in orofacial neuropathic pain mechanisms. However, the involvement of P2Y₁₂R in orofacial neuropathic pain mechanisms is still unknown. We therefore studied the reflex to noxious mechanical or heat stimulation of the tongue, P2Y₁₂R and glial fibrillary acidic protein (GFAP) immunohistochemistries in the trigeminal ganglion (TG) in a rat model of unilateral lingual nerve crush (LNC) to evaluate role of P2Y₁₂R in SGC in lingual neuropathic pain.</p> <p>Results</p> <p>The head-withdrawal reflex thresholds to mechanical and heat stimulation of the lateral tongue were significantly decreased in LNC-rats compared to sham-rats. These nocifensive effects were apparent on day 1 after LNC and lasted for 17 days. On days 3, 9, 15 and 21 after LNC, the mean relative number of TG neurons encircled with GFAP-immunoreactive (IR) cells significantly increased in the ophthalmic, maxillary and mandibular branch regions of TG. On day 3 after LNC, P2Y₁₂R expression occurred in GFAP-IR cells but not neuronal nuclei (NeuN)-IR cells (i.e. neurons) in TG. After 3 days of successive administration of the P2Y₁₂R antagonist MRS2395 into TG in LNC-rats, the mean relative number of TG neurons encircled with GFAP-IR cells was significantly decreased coincident with a significant reversal of the lowered head-withdrawal reflex thresholds to mechanical and heat stimulation of the tongue compared to vehicle-injected rats. Furthermore, after 3 days of successive administration of the P2YR agonist 2-MeSADP into the TG in naïve rats, the mean relative number of TG neurons encircled with GFAP-IR cells was significantly increased and head-withdrawal reflex thresholds to mechanical and heat stimulation of the tongue were significantly decreased in a dose-dependent manner compared to vehicle-injected rats.</p> <p>Conclusions</p> <p>The present findings provide the first evidence that the activation of P2Y₁₂R in SGCs of TG following lingual nerve injury is involved in the enhancement of TG neuron activity and nocifensive reflex behavior, resulting in neuropathic pain in the tongue.</p

Mechanisms involved in an increment of multimodal excitability of medullary and upper cervical dorsal horn neurons following cutaneous capsaicin treatment

<p>Abstract</p> <p>Background</p> <p>In order to evaluate mechanisms that may underlie the sensitization of trigeminal spinal subnucleus caudalis (Vc; the medullary dorsal horn) and upper cervical spinal cord (C1-C2) nociceptive neurons to heat, cold and mechanical stimuli following topical capsaicin treatment of the facial skin, nocifensive behaviors as well as phosphorylation of extracellular regulated-kinase (pERK) in Vc and C1-C2 neurons were studied in rats.</p> <p>Results</p> <p>Compared to vehicle application, capsaicin application to the lateral facial skin produced 1 hour later a flare in the skin, and also induced significantly greater nocifensive behaviors to heat, cold or mechanical stimulus of the lateral facial skin. The intrathecal (i.t.) injection of the MEK inhibitor PD98059 markedly attenuated the nocifensive behaviors to these stimuli in capsaicin-treated rats. Moreover, the number of pERK-like immunoreactive (pERK-LI) cells in Vc and C1-C2 was significantly larger following the heat, cold and mechanical stimuli in capsaicin-treated rats compared with vehicle-treated rats. The number of pERK-LI cells gradually increased following progressive increases in the heat or mechanical stimulus intensity and following progressive decrease in the cold stimulus. The ERK phosphorylation in Vc and C1-C2 neurons was strongly inhibited after subcutaneous injection of the capsaicin antagonist capsazepine in capsaicin-treated rats.</p> <p>Conclusion</p> <p>The present findings revealed that capsaicin treatment of the lateral facial skin causes an enhancement of ERK phosphorylation in Vc and C1-C2 neurons as well as induces nocifensive behavior to heat, cold and mechanical simulation of the capsaicin-treated skin. The findings suggest that TRPV1 receptor mechanisms in rat facial skin influence nociceptive responses to noxious cutaneous thermal and mechanical stimuli by inducing neuroplastic changes in Vc and C1-C2 neurons that involve in the MAP kinase cascade.</p

現像温度および時間のマンモフイルム特性に与える影響

The influence for developing temperature and processing time within film processing conditions was investigated using four mammographic films, Konica New CM, Fuji UM-MA HC, Kodak Min-R M and Kodak EB/RA (for rapid system). And Fuji UR-2, a double-emulsion film, was used as a control. Those sensitometric strips exposed by a sensitometer were processed in the different combinations of developing temperatures ranging from 28 to 36℃, processing times from 45 to 210 sec. Average gradient, relative speed and base plus fog obtained from the measured film characteristic curves were evaluated for the different developing temperatures and times. Fuji UR-2 was scarcely affected and mammographic films were greatly affected in the different combinations without an increase in base plus fog except EB/RA. In New CM, UM-MA HC and Min-R M, the average gradients and the relative speeds increased as the developing temperature was higher and the developing time was longer, but the increases were limit on the combination of 36℃ and 210 sec in New CM and UM-MA HC. In EB/RA, the average gradients were almost constant and the relative speeds increased slightly like the double-emulsion film. These results suggested that it would be possible to contribute to dose reduction and advancement of contrast in New CM, UM-MA HC and Min-R M by changing these processing parameters.フィルム処理条件において,現像温度と処理時間に対する影響を4種類のマンモグラフィ用フィルムKonica New CM, Fuji UM-MA HC,Kodak Min-R M,迅速処理用Kodak EB/RAについて調べた｡そして,比較基準用として両面乳剤フィルムFuji UR-2を用いた｡感光計で露光したフィルムを現像温度28～36℃,処理時間45～210秒で処理した｡特性曲線から得られたフィルム特性（平均階調度,相対感度,カブリ濃度）を異なる現像温度,現像時間に対して評価した｡UR-2はほとんど影響を受けず,マンモグラフィ用フィルムは,カブリ濃度が上昇することなく,現像条件の影響を大きく受けた。New CM, UM-MA HC,Min-R Mは現像温度の上昇,処理時間の延長に伴い,平均階調度と相対感度は増加した｡しかし,New CM, UM-MA HCの36℃,210秒で増加は限度に達した｡EB/RAの平均階調度は一定で,相対感度は両面乳剤フイルムと同 様にわずかな増加であった｡これらの結果は,New CM, UM-MA HC, Min-R Mにおいて,処理条件を変化させることにより,被曝低減,コントラスト向上に貢献できる可能性を示唆していた

Pathological Vascular Invasion and Tumor Differentiation Predict Cancer Recurrence in Stage ia Non–Small-Cell Lung Cancer After Complete Surgical Resection

Introduction:The appropriate therapeutic strategy and postoperative management for patients with stage IA non–small-cell lung cancer (NSCLC) still remain a matter of debate because of the prognostic heterogeneity of this population, including the risk of cancer recurrence. The objective of the current study was to identify the clinicopathological factors that affect overall prognosis and cancer recurrence of stage IA NSCLC.Methods:We reviewed the data of 532 patients in whom complete resection of stage IA NSCLC had been performed. Overall survival and recurrence-free proportion (RFP) were estimated using the Kaplan–Meier method. RFP was estimated from the date of the primary tumor resection to the date of the first recurrence or last follow-up. We performed univariate and multivariate analyses to determine the independent prognostic factors.Results:On multivariate analyses, three variables were shown to be independently significant recurrence risk factors: histological differentiation (hazard ratio [HR] = 1.925), blood-vessel invasion (HR = 1.712), and lymph-vessel invasion (HR = 1.751). On subgroup analyses combining these risk factors, the 5-year RFP was 91.3% for patients with no risk factors, 79.5% for those with either poorly differentiated carcinoma or vascular invasion, (p < 0.001 for both), and 62.9% for those with both poorly differentiated carcinoma and vascular invasion (p = 0.068).Conclusion:These results indicated that vascular invasion and tumor differentiation have a significant impact on the prediction of cancer recurrence in patients with stage IA NSCLC. Patients with these predictive factors of recurrence may be good candidates for adjuvant chemotherapy