Anatomical consideration for safe pericardiocentesis assessed by three-dimensional computed tomography: Should an anterior or posterior approach be used?

AbstractBackgroundThe efficacy of epicardial catheter ablation for ventricular tachycardia has been reported. However, the safest anatomical method for pericardial puncture has not been determined.MethodsThirty patients who underwent 3-dimensional computed tomography (3D-CT) preceding catheter ablations for atrial fibrillation were enrolled in this study. We used the skin surface 1cm below the xiphisternum as the puncture site. For the anterior approach, the attainment site was the pericardium of the mid portion of right ventricular anterior site, and for the posterior approach it was the pericardium of the inferior ventricular site. The distance and the angle between the 2 sites were measured using 3D-CT.ResultsFor the anterior approach, the distance was 54±11mm and the needle angle was 37±11° toward the left scapula and 34±12° towards the back of the body. For the posterior approach, the distance was 56±10mm and the corresponding needle angles were 60±9° and 86±13°. The distance correlated with BMI for the anterior and posterior approaches (anterior approach: r2=0.43, P<0.001; posterior approach: r2=0.49, P<0.001). Liver existed along the pathway of the posterior approach in 11 (37%) of 30 patients, and through in 2 (18%) of 11 patients. The liver and lung were not located along the pathway of the anterior approach in any patients.ConclusionsPerforming subxiphoid pericardiocentesis is anatomically safer via the anterior approach than via the posterior approach

Intra-cardiac echocardiography guided catheter ablation of a right posterior accessory pathway in a patient with Ebstein׳s anomaly

AbstractWe report a case of Ebstein׳s anomaly in which radiofrequency catheter ablation of an accessory pathway was successfully performed under intra-cardiac echocardiography. A 50-year-old woman was referred to our hospital for radiofrequency catheter ablation of a paroxysmal supraventricular tachycardia. A 12-lead surface electrocardiogram revealed ventricular pre-excitation associated with type B Wolff–Parkinson–White syndrome. In the baseline electrophysiological study, an orthodromic atrioventricular reciprocating tachycardia with a right posterior accessory pathway was induced. A phased-array intra-cardiac echo probe was positioned in the right atrium to visualize the atrioventricular junction. The key structures for catheter ablation, such as the atrialized right ventricle, atrioventricular junction, and tricuspid valve, were clearly visualized on intra-cardiac echocardiography. Radiofrequency current was successfully delivered at the atrioventricular junction, where a Kent potential was recorded. During a 6-month follow-up period, the patient was free from arrhythmias. The findings in this case suggest that phased-array intra-cardiac echocardiography is useful for ablation of right-sided accessory pathways in patients with Ebstein׳s anomaly

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography

AbstractBackgroundThe radiofrequency (RF) lesions for atrial fibrillation (AF) ablation can be visualized by delayed enhancement magnetic resonance imaging (DE-MRI). However, the quality of anatomical information provided by DE-MRI is not adequate due to its spatial resolution. In contrast, magnetic resonance angiography (MRA) provides similar information regarding the left atrium (LA) and pulmonary veins (PVs) as computed tomography angiography. We hypothesized that DE-MRI fused with MRA will compensate for the inadequate image quality provided by DE-MRI.MethodsDE-MRI and MRA were performed in 18 patients who underwent AF ablation (age, 60±9 years; LA diameter, 42±6mm). Two observers independently assessed the DE-MRI and DE-MRI fused with MRA for visualization of the RF lesion (score 0–2; where 0: not visualized and 2: excellent in all 14 segments of the circular RF lesion).ResultsDE-MRI fused with MRA was successfully performed in all patients. The image quality score was significantly higher in DE-MRI fused with MRA compared to DE-MRI alone (observer 1: 22 (18, 25) vs 28 (28, 28), p<0.001; observer 2: 24 (23, 25) vs 28 (28, 28), p<0.001).ConclusionsDE-MRI fused with MRA was superior to DE-MRI for visualization of the RF lesion owing to the precise information on LA and PV anatomy provided by DE-MRI

Role of rac1 in fibronectin-induced adhesion and motility of human corneal epithelial cells. Invest Ophthalmol Vis Sci.

PURPOSE. The fibronectin-integrin system plays an important role in adhesion and migration of corneal epithelial cells and thereby contributes to epithelial wound healing. The role of Rac1, a member of the Rho family of GTPases, in the intracellular signaling responsible for regulation of the adhesion and motility of corneal epithelial cells by fibronectin was examined. METHODS. Simian virus 40 -transformed human corneal epithelial (HCE) cells were plated on fibronectin or on bovine serum albumin as a control. Cell motility was monitored by time-lapse video microscopy. The actin cytoskeleton and focal adhesions were detected by staining of cells with rhodamine-phalloidin and antibodies to phosphotyrosine, respectively. The activation of Rac1 and phosphorylation of its effector PAK were evaluated with a pull-down assay and immunoblot analysis, respectively. The effects of mutant forms of Rac1 were determined by cell transfection. RESULTS. HCE cells plated on fibronectin manifested greater levels of cell adhesion and motility than did those plated on bovine serum albumin. Fibronectin also induced the accumulation of F-actin and the formation of focal adhesions at the cell periphery as well as the activation of Rac1 and the phosphorylation of PAK. Expression of the dominant negative mutant Asn17Rac1 inhibited the effects of fibronectin on cell adhesion and motility, the actin cytoskeleton, and focal adhesions. Expression of the constitutive active mutant Val12Rac1 mimicked the effects of fibronectin on F-actin and focal adhesions. CONCLUSIONS. Rac1 is necessary for the promotion of HCE cell adhesion and motility by fibronectin. It therefore probably plays an important role in corneal wound healing. (Invest Ophthalmol Vis Sci

Stimulation of corneal epithelial migration by a synthetic peptide (PHSRN) corresponding to the second cell-binding site of fibronectin

PURPOSE. Fibronectin plays an important role in the migration of corneal epithelial cells in vivo. The Arg-Gly-Asp (RGD) sequence in the principal cell binding domain of fibronectin mediates the interaction of fibronectin with integrins, whereas the Pro-His-Ser-Arg-Asn (PHSRN) sequence of fibronectin is thought to modulate this interaction. The authors examined the effects of a PHSRN peptide on corneal epithelial migration in vitro and in vivo. METHODS. Epithelial migration in vitro was examined with the rabbit cornea in organ culture. The motility and phenotype of simian virus 40 -transformed human corneal epithelial (HCE) cells were evaluated by time-lapse and immunofluorescence microscopy, respectively. Tyrosine phosphorylation of focal adhesion kinase (FAK) and paxillin was examined by immunoprecipitation and immunoblot analysis. The healing of rabbit corneal epithelial wounds induced by 1-heptanol was evaluated by fluorescein staining. RESULTS. The PHSRN peptide stimulated corneal epithelial migration in organ culture in a concentration-dependent manner, and it increased HCE cell motility in vitro. The peptide induced the accumulation of F-actin and the formation of focal adhesions at the leading edge of HCE cells. It also upregulated the tyrosine phosphorylation of FAK and paxillin in HCE cells, but it did not affect HCE cell proliferation or attachment to a fibronectin matrix. Administration of the PHSRN peptide in eye drops promoted corneal epithelial wound closure in vivo in a dose-dependent manner. None of these effects of the PHSRN peptide were induced by a control NRSHP peptide. T he healing of corneal epithelial wounds is important for maintaining corneal transparency. Damage to the corneal epithelium induces migration of the remaining epithelial cells to cover the area of the defect. Thus, the motility of corneal epithelial cells is key to the initiation of wound healing. We and others 1,2 have shown that fibronectin, an adhesive extracellular glycoprotein, appears at the exposed surface of the stroma at corneal epithelial wound sites. Epithelial cells migrate over this provisional matrix of fibronectin and upregulate their expression of integrin chains that form the cell surface receptors for fibronectin. CONCLUSIONS. 3 The fibronectin-integrin system thus plays a central role in corneal epithelial wound healing. 5 Furthermore, a fibronectin matrix promotes the attachment of corneal epithelial cells in culture, and this effect is inhibited by the addition of an RGD (Arg-Gly-Asp) peptide corresponding to the principal cell-binding domain of fibronectin (Gly-Arg-Gly-AspSer-Pro [GRGDSP]). 6 -8 Exogenous fibronectin does not affect the proliferation of cultured corneal epithelial cells. 9 -13 The administration of fibronectin eye drops also facilitates corneal epithelial wound closure in experimental animals 14 -17 and has proven effective clinically for the treatment of persistent epithelial defects of the cornea. 5,18 -21 Fibronectin is a dimer of two almost identical polypeptides. It consists of several structural domains, including three types of repeat, that mediate the various biological functions of the protein. From the Departments o

Influence of extended depth of focus intraocular lenses on visual field sensitivity.

PurposeTo investigate the influence of EDOF IOLs, TECNIS Symfony® (Johnson & Johnson Surgical Vision, Inc.), on visual field sensitivity and to compare the IOLs with other kinds of IOLs.MethodsThe subjects included the normal fellow eyes of patients who underwent the Humphrey Field Analyzer (HFA) 30-2 with Swedish Interactive Threshold Algorithm Fast within 6 months after cataract due to glaucoma or suspected glaucoma. Each parameter of HFA was compared among eyes implanted with TENIS Symfony® (EDOF group), diffractive bifocal IOLs (bifocal group), and monofocal IOLs (monofocal group).ResultsThe total of 76 eyes, including 24 eyes in the EDOF group, 26 eyes in the bifocal group, and 26 eyes in the monofocal group, were included in this study. Mean deviation (MD) of HFA was -0.24±0.58 dB in the EDOF group, -1.38±0.58 dB in the bifocal group, and 0.02±0.44 dB in the monofocal group. Foveal threshold (FT) of HFA was 35.8±1.6 dB in the EDOF group, 33.6±1.7 dB in the bifocal group, and 36.6±1.4 dB in the monofocal group. In both MD and FT, there was significant difference between the bifocal group and the others (pConclusionTECNIS Symfony® may have little influence on visual field sensitivity, whereas diffractive bifocal IOLs decrease visual field sensitivity

SARS-CoV-2 infection status in corneal preservation solution and COVID-19 prevalence after corneal transplantation

Abstract The potential risks associated with organs from COVID-19-infected donors were unclear. To determine the SARS-CoV-2 infection status of corneas transplanted during the COVID-19 pandemic, we performed a polymerase chain reaction (PCR) using the corneal preservation solution that was used for corneal transplantation. We also examined the postoperative health status of the recipients. This study included 144 transplants in 143 eyes. Ninety-nine eyes of imported corneas and 10 of the 14 corneas donated in the prefecture were PCR tested at our hospital, and all were SARS-CoV-2 negative. All corneal transplants were performed after confirming their SARS-CoV-2 negativity by a PCR using a corneal preservation solution at our hospital or a nasopharyngeal swab at a previous facility. Despite postoperative steroid administration, no patient developed COVID-19 infection until discharge. Hence, if the donor's nasopharyngeal swab test is SARS-CoV-2 negative, COVID-19 infection in the recipient due to corneal transplantation may be prevented. Since corneal transplant recipients are susceptible to infection due to prolonged steroid administration and are at high risk for severe diseases if infection occurs, SARS-CoV-2 detection testing using nasopharyngeal swabs in donors should be performed