Identification and Radiofrequency Catheter Ablation of a Nonsustained Atrial Tachycardia at the Septal Mitral Annulus with the Use of a Noncontact Mapping System: A Case Report

AbstractHere we report a case of a 16-year old female with symptomatic nonsustained atrial tachycardia (NSAT) originating from the septal mitral annulus. NSAT was induced by atrial burst pacing after an intravenous isoproterenol (ISP) injection. The array mode of the noncontact mapping system (NCM) allowed us to quickly identify the tachycardia focus at the septal mitral annulus, where the contact bipolar voltage map revealed no low voltage area (<0.5 mV). The NSAT was eliminated by a radiofrequency energy application to the identified tachycardia focus during sinus rhythm, and the patient has been free from any symptoms during 10 months of follow-up

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An Alternative Approach for Radiofrequency Catheter Ablation for Intra-atrial Reentrant Tachycardia Associated with Open-Heart Surgery

We present case reports of 2 patients with scar-related intra-atrial reentrant tachycardia (IART) associated with previous open-heart surgeries, in which standard ablation strategies failed to eliminate atrial tachycardia (AT). The strategies targeted a narrow conducting channel between the right atrial scars or between the scar and inferior vena cava. In these patients, an alternative approach to transect another narrow conducting pathway between the scar and crista terminalis (CT), which was revealed by a noncontact mapping system, successfully terminated and eliminated the IART. Both the cases were free of recurrent AT at the 24-and 25-month follow up visits, respectively. Transection of the corridor between the CT and the incision scar appears to be an effective technique for eliminating scar-related IART and can be considered as a second-line procedure for radiofrequency catheter ablation to eliminate IART

Transverse incision advantages for total knee arthroplasty

Background If a transverse incision can be safely used for total knee arthroplasty (TKA), decreases in scar formation, reduced injury of the infrapatellar branch of the saphenous nerve and improved kneeling motion will be observed. Methods We evaluated 95 patients (101 knees) on whom primary TKA was performed with follow-up of more than 2 years. A longitudinal incision was used for the first 40 knees and a transverse incision for the remaining 61 knees. Operation time, blood loss, complications and Knee Society Score were evaluated. Wound lengths, widths and the Manchester Scar Scale (MSS) were measured 1 year after the surgery. Further examination evaluated sensory disturbances and whether kneeling was possible. Results The complication rate in both groups was almost the same. The wound lengths measured at a 90° kneeflexed position were about 15 cm with no significant difference between the groups. The average width measured at a maximum area was significantly smaller in the transverse group than in the longitudinal group. MSS of the transverse group was also significantly lower than that of the longitudinal group. Sensory disturbance was found to be significantly smaller in the transverse group than in the longitudinal group both in subjective and objective evaluation at 1 year after surgery. When a transverse incision was used, the direction of the incision corresponded to the running direction of the saphenous nerve, and thus, we were able to reduce sensory disturbances on the distal lateral side of the knee joint. The transverse group (70.4%) performed significantly better than the longitudinal group (40.6%) at kneeling motion. Conclusions We showed that making a transverse incision is a safe method, resulting in a reduction of scar formation and less dysfunction of the infrapatellar branch of the saphenous nerve, and improvement of kneeling motion. © The Japanese Orthopaedic Association 2011

Cytoplasmic control of Rab family small GTPases through BAG6

Rab family small GTPases are master regulators of distinct steps of intracellular vesicle trafficking in eukaryotic cells. GDP‐bound cytoplasmic forms of Rab proteins are prone to aggregation due to the exposure of hydrophobic groups but the machinery that determines the fate of Rab species in the cytosol has not been elucidated in detail. In this study, we find that BAG6 (BAT3/Scythe) predominantly recognizes a cryptic portion of GDP‐associated Rab8a, while its major GTP‐bound active form is not recognized. The hydrophobic residues of the Switch I region of Rab8a are essential for its interaction with BAG6 and the degradation of GDP‐Rab8a via the ubiquitin‐proteasome system. BAG6 prevents the excess accumulation of inactive Rab8a, whose accumulation impairs intracellular membrane trafficking. BAG6 binds not only Rab8a but also a functionally distinct set of Rab family proteins, and is also required for the correct distribution of Golgi and endosomal markers. From these observations, we suggest that Rab proteins represent a novel set of substrates for BAG6, and the BAG6‐mediated pathway is associated with the regulation of membrane vesicle trafficking events in mammalian cells

精神疾患におけるマイクログリア由来ニューレグリン発現

Several studies have revealed that neuregulins (NRGs) are involved in brain function and psychiatric disorders. While NRGs have been regarded as neuron- or astrocyte-derived molecules, our research has revealed that microglia also express NRGs, levels of which are markedly increased in activated microglia. Previous studies have indicated that microglia are activated in the brains of individuals with autism spectrum disorder (ASD). Therefore, we investigated microglial NRG mRNA expression in multiple lines of mice considered models of ASD. Intriguingly, microglial NRG expression significantly increased in BTBR and socially-isolated mice, while maternal immune activation (MIA) mice exhibited identical NRG expression to controls. Furthermore, we observed a positive correlation between NRG expression in microglia and peripheral blood mononuclear cells (PBMCs) in mice, suggesting that NRG expression in human PBMCs may mirror microglia-derived NRG expression in the human brain. To translate these findings for application in clinical psychiatry, we measured levels of NRG1 splice-variant expression in clinically available PBMCs of patients with ASD. Levels of NRG1 type III expression in PBMCs were positively correlated with impairments in social interaction in children with ASD (as assessed using the Autistic Diagnostic Interview-Revised test: ADI-R). These findings suggest that immune cell-derived NRGs may be implicated in the pathobiology of psychiatric disorders such as ASD.博士（医学）・乙第1404号・平成29年6月28日Copyright © 2017 Elsevier Inc. All rights reserved