Extensive Preferential Pathway Ablation for the Elimination of Premature Ventricular Contractions Arising from the Right Ventricular Outflow Tract

A 76 y/o women presented with 2 different types of premature ventricular contractions (VPCs 1 and 2) arising from the right ventricular outflow tract (RVOT). Catheter ablation (CA) eliminated PVC1 at the earliest activation site (EAS), but thereafter another PVC morphology (PVC3) appeared. Small potentials preceding the local potential were broadly exhibited from the RVOT’s supero-anterior region to the EAS during PVC3. Point CA targeting such prepotentials failed. Transverse-linear CA with a line connecting sites with such pre-potentials eliminated both PVCs 3 and 2. In cases with broadly spreading preferential pathways, extensive CA might be needed to eliminate the PVCs

Risk Factors for the Progression of Varus Ankle Osteoarthritis

Background: With the increase in life expectancy, the prevalence of ankle osteoarthritis (OA) is also expected to increase in the future. Functional disability and diminished quality of life associated with end-stage ankle OA are comparable to those associated with end-stage hip or knee OA. However, there are few reports on the natural history and progression of patients with ankle OA. Hence, this study aimed to evaluate the risk factors for progression in patients with varus ankle OA. Methods: We evaluated 68 ankles from 58 patients diagnosed with varus ankle OA using radiography performed at intervals over at least 60 months. The mean follow-up period was 99 ± 40 months. Narrowing of the joint space and increasing osteophyte formation were defined as ankle OA progression. Multivariate analysis was performed using logistic regression to predict the odds of progression; the model included 2 clinical variables and 7 radiographic variables. Results: Of the 68 ankles, 39 (57%) progressed. In multivariable logistic regression analyses, patient’s age (odds ratio [OR] 0.92, 95% CI 0.85-0.99, P  < .03), and the talar tilt (TT; OR 2.2, 95% CI 1.39-3.42, P  = .001) were found to be independent factors for progression. The area under the curve (AUC) of the receiver operating characteristic curve for TT was 0.844, and the cutoff value was 2.0 degrees. Conclusion: TT was found to be a primary factor associated with varus ankle OA progression. The risk appeared higher in patients with a TT more than 2.0 degrees. Level of Evidence: Level III, retrospective case control study

Postoperative Medial Tilting of the Joint Line and Preoperative Kinematics Influence Postoperative Medial Pivot Pattern Reproduction in Total Knee Arthroplasty

Background: Reproducing the medial pivot pattern after total knee arthroplasty (TKA) is known to improve patient satisfaction. However, the factors affecting the postoperative medial pivot pattern in TKA are controversial. The purpose of this study was to examine the factors affecting the postoperative medial pivot pattern in posterior-stabilized TKA. Methods: This study involved 30 cases with knee osteoarthritis who underwent primary posterior-stabilized TKA. The preoperative and postoperative kinematics were measured using a computed tomography–free navigation system, and the patients were divided into the following 2 groups: the medial pivot pattern (MP) group and non–medial pivot pattern (non-MP) group. In addition, we measured each of the following angles on X-ray films (preoperative and postoperative femorotibial angle, hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle). We examine the factors affecting the postoperative medial pivot pattern. Results: There were 14 cases in the MP group and 16 cases in the non-MP group at the preoperative knee kinematic assessment and 17 cases in the MP group and 13 cases in the non-MP group at the postoperative knee kinematic assessment. The preoperative kinematic pattern was conserved after the surgery at a rate of 76.7%. The postoperative MP-group showed a significantly smaller preoperative femorotibial angle and hip-knee-ankle and a significantly smaller postoperative mechanical lateral distal femoral angle and medial proximal tibial angle in comparison to the postoperative non-MP group. Conclusions: Preoperative kinematics and postoperative mechanical lateral distal femoral angle and medial proximal tibial angle may be important factors that affect the postoperative medial pivot pattern

Efficacy of Electroanatomical Mapping for Radiofrequency Ablation of Right-sided Accessory Pathways

Introduction: Due to the difficulty in performing detailed mapping around the tricuspid annulus and the high occurrence of mechanical trauma during the procedure, the outcome of right-sided accessory pathway (AP) ablation still has a relatively high primary failure and recurrence rate. Methods and Results: Six patients with right free-wall APs underwent electroanatomical mapping. The AP had retrograde unidirectional conduction in 3 patients, anterograde unidirectional conduction in 1 patient, and bidirectional conduction in 2 patients. The right atrial (RA) activation map was constructed during right ventricular (RV) pacing (n = 5), and the RV activation map was constructed during RA pacing (n = 3). During mapping, the AP conduction was interrupted by catheter mechanical trauma in 3 patients. The first RF application successfully eliminated the AP conduction within 2 seconds in 3 patients with concealed pathways. In the remaining 3 patients, rescue RF energy was delivered at the tagged bump site on the map. The mean procedure time was 214 ± 77 minutes, and mean fluoroscopy time 63 ± 23 minutes. No recurrence occurred during 12 ± 3.2 months of followup in any of the patients. Conclusions: With the guidance of an electroanatomical mapping system, right-sided accessory pathways can be satisfactorily eliminated without later recurrence

A newly developed upper limb single-joint HAL in a patient with elbow flexion reconstruction after traumatic brachial plexus injury: A case report

We report a case in which elbow flexion exercises using the upper limb single-joint Hybrid Assistive Limb (upper limb HAL-SJ) were implemented in a patient 13 months postoperatively following elbow flexion reconstruction with intercostal nerve transfer after a traumatic brachial plexus injury. Treatment using the upper limb HAL-SJ was administered once a week for 10 sessions from 13 to 16 months after surgery. Exercises using the upper limb HAL-SJ supported elbow motion by detecting bioelectric signals through surface electrodes on the biceps and triceps brachii. No adverse events were observed during treatment with the upper limb HAL-SJ. Improvements in elbow flexion strength were observed during treatment. Treatment with the upper limb HAL-SJ can be performed safely and effectively following elbow flexion reconstruction by intercostal nerve transfer after a traumatic brachial plexus injury

Designed abscisic acid analogs as antagonists of PYL-PP2C receptor interactions

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Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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