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

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

CXCL13-producing CD4⁺ T cells accumulate in the early phase of tertiary lymphoid structures in ovarian cancer

卵巣がんにおける新たな免疫の仕組みを発見 --三次リンパ様構造の形成メカニズムと予後への影響を解明--. 京都大学プレスリリース. 2022-08-05.Tertiary lymphoid structures (TLSs) are transient ectopic lymphoid aggregates whose formation might be caused by chronic inflammation states, such as cancer. However, how TLSs are induced in the tumor microenvironment (TME) and how they affect patient survival are not well understood. We investigated TLS distribution in relation to tumor infiltrating lymphocytes (TILs) and related gene expression in high grade serous ovarian cancer (HGSC) specimens. CXCL13 gene expression correlated with TLS presence and the infiltration of T cells and B cells, and was a favorable prognostic factor for HGSC patients. Coexistence of CD8⁺ T cells and B-cell lineages in the TME significantly improved the prognosis of HGSC and was correlated with the presence of TLSs. CXCL13 expression was predominantly coincident with CD4⁺ T cells in TLSs and CD8⁺ T cells in TILs, and shifted from CD4⁺ T cells to CD21⁺ follicular dendritic cells as TLS matured. In a mouse ovarian cancer model, recombinant CXCL13 induced TLSs and enhanced survival by the infiltration of CD8⁺ T cells. These results suggest that TLS formation was associated with CXCL13-producing CD4⁺ T cells and that TLSs facilitated the coordinated antitumor response of cellular and humoral immunity in ovarian cancer