Ontogenetic Expression of Aquaporins in the Kidney and Urinary Bladder of the Japanese Tree Frog, Dryophytes japonicus.

For adult anuran amphibians, the kidney and urinary bladder play important osmoregulatory roles through water reabsorption. In the present study, we have examined ontogenetic expression of aquaporins, i.e., AQP2, AQPamU (AQP6ub, AQPa2U), and AQP3, in these organs using the Japanese tree frog, Dryophytes japonicus. Immunohistochemistry using the metamorphosing larvae at stages 40-43 localized AQP2 protein to the collecting ducts in the dorsal zone of the mesonephric kidney. At prometamorphic stages 40 and 41, labelling of AQP2 protein was observed in the apical/ subapical regions of the collecting duct cells. At climax stages 42 and 43, labels for AQP2 and AQP3 became observed in the apical/subapical regions and basolateral membrane of the collecting duct cells, respectively, as seen in the adults. As for the urinary bladder, immuno-positive labels for AQPamU were localized to the apical/subapical regions of granular cells in the mucosal epithelium at stages 40-43. On the other hand, AQP3 immunoreactivity was hardly observed in the urinary bladder at stage 40, and weakly appeared in many granular cells at stage 41. Thereafter, labels for AQP3 became evident along the basolateral membrane of granular cells at stages 42 and 43, together with AQPamU in the apical/subapical regions. These results suggest that the kidney and urinary bladder might be capable of water reabsorption, via AQP2, AQPamU, and AQP3, at stage 42, contributing to the acclimation of the tree frogs to terrestrial environments.

Influence of etching mode on bonding performance of self-adhesive flowable resin composites to bovine teeth.

This study aimed to evaluate the bonding performance of self-adhesive flowable resin composites (SARs) to bovine teeth. Three SARs, one experimental, and two commercially available products, were used. The study parameters were shear bond strength (SBS), microleakage, and scanning electron microscopy (SEM) evaluation of bonding interfaces. The SBS of the materials was 14.1-15.1 MPa to enamel, 22.2-23.2 MPa to etched enamel, and 7.4-10.7 MPa to dentin. Specimens with pre-etching showed lower microleakage scores than those without pre-etching. SEM images of the interfaces of the materials showed excellent adaptation regardless of the substrate or etching mode. The study results indicate that enamel pre-etching can improve the bonding performance of SARs.

Scanning electron microscopy observation of dentin bond interfaces in different types of resin luting cements.

This study aimed to observe and compare the resin luting cement (RLC)/dentin interfaces of different types of RLC systems with scanning electron microscopy (SEM). This study evaluated six self-adhesive resin luting cement systems (SARLCs), four systems combining a SARLC with a tooth primer (SARLCPs), and six conventional resin luting cement systems (CVRLCs). Cured resin composite rods were bonded to bovine dentin using RLCs in different etching modes. The morphological features at the interfaces were observed using SEM. Although all RLCs in etch-&-rinse (ER) mode showed a clear hybrid layer, most SARLCs had a thinner and more porous hybrid layer than the SARLCPs and CVRLCs. All SARLCPs with primer and CVRLCs showed a thin high-density layer below the primer layer in both etching modes. CVRLCs and SARLCPs with primer treatment systems may be more versatile and reliable when compared to simplified RLC systems.

Influence of different curing modes on the bonding effectiveness of self-adhesive resin luting cements in combination with universal adhesives.

OBJECTIVES: This study aimed to investigate the immediate dentin bond performance and bond durability of self-adhesive resin luting cements (RLCs) in combination with universal adhesives in different curing modes. METHODS: Two self-adhesive RLCs were used with universal adhesives as primers. They were also used alone as self-adhesive RLCs. Two multiple-step RLC systems were used as comparison materials. To measure the shear bond strength (SBS) in different curing modes, 12 specimens were prepared for each group. Stainless-steel rods were bonded to bovine dentin, and the bonded specimens were assigned to the baseline group (stored for 24 h) and artificially aged group (thermal cycling [TC], 10,000 cycles). After each storage period, the SBS of the bonded specimens was measured. The Knoop hardness number (KHN) of the cured RLCs was measured with or without primer application in different curing modes at 24 h and after 10,000 TC. The representative RLC/dentin interfaces were observed using scanning electron microscopy (SEM). RESULTS: Dentin SBS was significantly influenced by the RLC system but not by the curing mode. Self-adhesive RLCs alone showed significantly lower SBS values than self-adhesive RLCs with primer regardless of the curing mode or storage period. The storage period, curing mode, and RLC system significantly influenced the KHN. SIGNIFICANCE: The use of universal adhesives as a primer may help enhance the immediate dentin bond performance and bond durability of self-adhesive RLCs.

Comparing the outcomes of laparoscopic proximal and laparoscopic total gastrectomy: A retrospective analysis of a single center in Japan.

INTRODUCTION: Despite the increasing performance of laparoscopic proximal gastrectomy (LPG) for proximal gastric cancer and esophagogastric junction cancer, the benefit of LPG over laparoscopic total gastrectomy (LTG) remains to be established. Therefore, this study was conducted to compare postoperative outcomes between LPG and LTG. METHODS: Data from 141 patients who underwent LPG or LTG for gastric neoplasm with curative intent between 2016 and 2022 were retrospectively reviewed. Clinicopathological findings, body weight changes, and serological nutritional markers during the postoperative course were evaluated. RESULTS: LPG and LTG were performed in 78 patients and 63 patients, respectively. Patients' characteristics did not differ; however, tumor stages in patients who underwent LTG were more advanced than those who underwent LPG. The mean (± standard deviation) weight loss rate after 1 year was -13.5 (±6.9)% and -18.7 (±6.6)% for LPG and LTG, respectively (p < .01). LTG (OR: 3.326, p < .01), pT disease (OR: 3.000, p = .01), pN disease (OR: 2.708, p = .02), and postoperative chemotherapy (OR: 2.488, p = .05) were correlated with severe weight loss (16% or more) 1 year after surgery, then multivariate analysis identified LTG as an independent factor (p = .01). The mean (± standard deviation) serum total protein level of LPG was significantly higher than that of LTG at 3 months (6.8 ± 0.5 vs. 6.6 ± 0.4 g/dL, p = .02) and 1 year (6.9 ± 0.4 vs. 6.7 ± 0.5 g/dL, p = .01) postoperatively. No difference was observed in postoperative serum hemoglobin and albumin levels. CONCLUSION: LPG more improved postoperative weight loss than LTG.

Treatment of saliva contamination of resin core foundation before adhesive luting.

This study aimed to evaluate the influence of surface pretreatment on the shear bond strength of resin luting cement to saliva-contaminated resin core foundation. The surface free energy (γS) of the adherent surfaces was examined. The two-way analysis of variance revealed that the surface pretreatment and storage conditions had a significant effect on the strength of the bond to resin core foundation. The γS values of the saliva-contaminated group were significantly lower than those of the other groups, and they tended to improve after surface pretreatment. The tendency of improvement in γS values differed depending on the type of pretreatment agents. Surface treatment with solutions containing functional monomers is effective in removing saliva contaminants from the resin core foundation surfaces and in creating an effective bonding surface for the resin luting cement.

Evaluation of New and Preexisting Epiretinal Membranes Following Glaucoma Filtration Surgery.

Secondary epiretinal membranes (ERMs) can develop from various causes, including those associated with glaucoma treatments such as trabeculectomy (TLE) and EX-PRESS (EXP) insertion surgery. This study aimed to investigate the occurrence of new ERMs and changes in preexisting ERMs following TLE or EXP insertion. Between April 2018 and March 2019, 102 and 74 eyes that underwent primary and standalone TLE and EXP insertion, respectively, were evaluated. Of these, 48 eyes were included in the TLE group and 32 eyes were included in the EXP group. Optical coherence tomography (OCT) was used to assess preoperative and postoperative ERMs. In the TLE group, postoperative ERMs were observed in one (case 1) (3%) out of 34 eyes without preexisting ERMs and in one (case 2) (7%) out of 14 eyes with preexisting ERMs, showing an increase in ERM stage. In the EXP group, postoperative ERMs were observed in one (case 3) (5%) out of 22 eyes without preexisting ERMs and in one (case 4) (10%) out of 10 eyes with preexisting ERMs, showing a decrease in the ERM stage. Case 1 was a 58-year-old man with primary open-angle glaucoma (POAG) in the left eye who underwent TLE. Although no preoperative ERMs were observed, postoperative ERM was noted at the three-month follow-up. Case 2 was a 49-year-old man with POAG in the right eye who underwent TLE. Although ERM was observed preoperatively, ERM progressed at six months postoperatively. Case 3 was a 59-year-old woman with POAG in the right eye who underwent EXP insertion. No preoperative ERMs were observed, but an ERM was noted at the 15-month follow-up. Case 4 was a 72-year-old woman with steroid-induced glaucoma in the right eye who underwent EXP insertion surgery. A preoperative ERM was present, and the foveal pit was absent; however, the foveal pit was observed at the 12-month follow-up. Despite the low incidence of ERMs, filtration surgery may be associated with ERM development and the progression or regression of preexisting ERMs.

Randomized Multicenter Clinical Trial Comparing 0.1% Brimonidine/0.5% Timolol Versus 1% Dorzolamide/0.5% Timolol as Adjuncts to Prostaglandin Analogues: Aibeta Crossover Study.

INTRODUCTION: This multicenter, randomized, comparative, and investigator-masked crossover clinical trial sought to compare the efficacy and tolerability of fixed combinations of 0.1% brimonidine/0.5% timolol (BTFC) versus 1% dorzolamide/0.5% timolol (DTFC) as adjunctive therapies to prostaglandin analogues. METHODS: A total of 110 patients with open-angle glaucoma or ocular hypertension previously treated with prostaglandin analogue monotherapy were randomized to receive either BTFC or DTFC as adjunctive therapy for 8 weeks. These patients were then crossed over to the alternative treatment arm for another 8 weeks. The reduction in intraocular pressure (IOP) (primary outcome), occurrence of adverse events, ocular discomfort after instillation, and patient preference (secondary outcomes) were recorded through patient interviews. RESULTS: BTFC instillation for 8 weeks reduced IOP by 3.55 mmHg, demonstrating non-inferiority to DTFC instillation (3.60 mmHg; P < 0.0001, mixed-effects model). Although adverse events were rare with both combinations, patients reported greater discomfort with DTFC than with BTFC (P < 0.0001). More patients preferred BTFC (P < 0.0001) over DTFC, as BTFC caused minimal or no eye irritation. CONCLUSION: As BTFC offered better tolerability than DTFC with comparable reduction in IOP, we recommend it as an alternative for patients who experience ocular discomfort with DTFC-prostaglandin analogue combination therapy. TRIAL REGISTRATION NUMBER: jRCTs051190125.

Patients with glaucoma who require further reduction in intraocular pressure while undergoing monotherapy with prostaglandin analogue ophthalmic solution have been prescribed two enhanced treatment options: 0.1% brimonidine/0.5% timolol fixed combination ophthalmic solution (BTFC) and 1% dorzolamide/0.5% timolol fixed combination ophthalmic solution (DTFC). The Aibeta Crossover Study Group in Japan compared the efficacy and tolerability of fixed combinations of BTFC versus DTFC when an additional fixed combination ophthalmic solution was prescribed in patients with open-angle glaucoma or ocular hypertension who had been treated with prostaglandin analogue monotherapy. We recruited 110 patients previously treated with prostaglandin analogue monotherapy at 20 clinical centers in Japan, then randomly assigned them to two alternative treatment groups: the BTFC to DTFC group or the DTFC to BTFC group, as an adjunctive therapy to prostaglandin analogues for total of 16 weeks. We compared the reduction in intraocular pressure, occurrence of side effects, eye discomfort after instillation, and patient preference between BTFC versus DTFC instillations. The intraocular pressure reduction of BTFC instillation was comparable to that of DTFC instillation, showing non-inferiority to DTFC (3.55 mmHg vs. 3.60 mmHg; P < 0.0001, mixed-effects model). Both eye drops caused few side effects; however, patients felt greater eye discomfort with DTFC than with BTFC (P < 0.0001). Because of less eye irritation, more patients preferred BTFC (P < 0.0001) over DTFC. We can recommend using BTFC for patients who feel eye discomfort with DTFC­prostaglandin analogue combination therapy.

Influence of surface roughness of universal shade resin composites on color adjustment potential.

This study aimed to determine the influence of surface roughness of the color adjustment potential restoration of universal resin composites. A structural colored resin composite (Omnichroma, OC) and a pigment-employed universal shade resin composite (Beautifil Unishade, BU) were used. Each resin composite was placed in a cavity to determine its ability to match the color of artificial teeth. The surface of the resin composites was polished with #800- or #2000-grit SiC paper before performing color measurements. One-way analysis of variance and Tukey post hoc tests were performed (α=0.05). The color difference (ΔE*ab) ranged from 2.5-3.9 for OC and 1.8-8.7 for BU. OC has a more stable color adjustment than BU. The color adjustment potential of universal resin composites was affected by the surface roughness of the restorations.

Whitening efficacy and tooth sensitivity in a combined in-office and at-home whitening protocol: A randomized controlled clinical trial.

OBJECTIVE: This controlled randomized clinical trial determined the whitening efficacy and the intensity and absolute risk of tooth sensitivity in dual whitening when prefilled at-home whitening trays were used between in-office whitening intervals. MATERIALS AND METHODS: An in-office whitening agent containing 35% hydrogen peroxide was used. A prefilled tray with a whitening agent containing 6% hydrogen peroxide was used for at-home whitening. Sixty-six subjects were randomly assigned to three groups. Group I: at-home whitening was performed 10 times between the in-office whitening treatments. Group II: at-home whitening was performed five times between the in-office whitening treatments. Group III: only in-office whitening was performed. The tooth color changes were evaluated using a spectrophotometer. A visual analog scale was used to express the pain intensity. RESULTS: All the groups showed increased ΔE*ab, ΔE00 , and ΔWID with increased whitening sessions. Group I at the 3rd whitening session showed significantly higher ΔE*ab, ΔE00 , and ΔWID than group III. Tooth sensitivity showed higher values up to 24 h after whitening. CONCLUSIONS: Although dual whitening with the prefilled tray and in-office whitening had higher whitening ability than in-office whitening alone, the intensity and absolute risk of tooth sensitivity was similar. CLINICAL RELEVANCE: The dual whitening might produce faster and stronger whitening effects than in-office whitening alone.

Right Coronary Artery with an Intramural and Interarterial Course as a Unique Cause of Myocardial Ischemia: The Unroofing Method Might Still Be the Best Solution.

A 39-year-old man was admitted because of cardiac arrest. Emergent coronary angiography revealed a preserved coronary blood flow; however, multiple-row detector computed tomography (MDCT) revealed that the proximal right coronary artery (RCA) was running inside the aortic wall, creating proximal stenosis without atherosclerotic changes. Surgical intervention with unroofing was performed; however, postoperative stenosis of the proximal RCA required additional coronary artery bypass grafting (CABG). Intraoperative findings during CABG did not reveal hematoma or coronary dissection. However, MDCT one year after CABG depicted improvement of the RCA and graft stenoses, suggesting that the post-unroof stenosis may have been caused by an inflammatory reaction after surgical intervention.

Bond durability of a two-step adhesive with a universal-adhesive-derived primer in different etching modes under different degradation conditions.

This study investigated the enamel and dentin bond durability of a two-step adhesive system, using a universal adhesive-derived primer (G2-Bond Universal [GU]), and compared it with the two conventional, two-step, self-etch adhesive systems (Clearfil SE Bond 2 [CS] and OptiBond XTR [OX]) under thermal cycling (TC) and long-term water storage (WS). The shear bond strengths to bovine enamel and dentin were determined using the etch-and-rinse and self-etch modes. Twelve specimens per test group were prepared and further divided into the following subgroups: 1) subjected to TC, 2) long-term WS, and 3) WS for 24 h (baseline). The enamel and dentin bond durability of GU was superior to those of CS and OX in different etching modes and under different degradation conditions. The latest two-step adhesive system, which utilizes universal adhesives' benefits in its primer, might offer durable clinical bonding performances and can be widely used in a clinical setting.

Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma.

Background/objectives: Co-existing idiopathic epiretinal membrane (ERM) and glaucoma complicate the estimation of glaucoma severity via optical coherence tomography (OCT). We investigated the effect of ERM and a new associated parameter, SUKIMA (space between the ERM and retinal surface), on ganglion cell complex (GCC) thickness in eyes with glaucoma, based on a matched comparison of visual field defects. Subjects/methods: We retrospectively recruited 41 eyes from 34 glaucoma patients with idiopathic ERM and 41 eyes from 41 glaucoma patients without ERM as controls (matched by age, axial length, and mean visual field deviation). The thicknesses of GCC layers [retinal nerve fiber layer (RNFL), ganglion cell layer + inner plexiform layer (GCIPL), and GCC (RNFL + GCIPL)] were measured with swept-source OCT. We investigated the presence of SUKIMA and its effect on GCC measurements. Results: RNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control eyes (31.0 ± 12.3 µm vs. 22.7 ± 10.8 µm, 62.6 ± 12.2 µm vs. 53.8 ± 5.9 µm, and 91.8 ± 16.6 µm vs. 76.8 ± 13.3 µm, respectively; P < 0.01). Eyes in the ERM-associated SUKIMA (+) group had thicker GCIPL and GCC than those in the ERM-associated SUKIMA (-) and control groups (P < 0.01). Conclusion: ERM-associated SUKIMA affects GCC thickness and can result in underestimations of glaucoma severity. We should check for the presence of ERM using a B mode scan as well as check for the SKIMA sign.

Persistent corneal blood staining after microhook trabeculotomy: A case report.

INTRODUCTION: Hyphema, that is, massive anterior chamber hemorrhage, is one of the major complications after a recent minimally invasive glaucoma surgery. Hyphema along with high intraocular pressure increases the risk of corneal bloodstaining. PATIENT CONCERNS: A 71-year-old female was receiving 0.1% fluorometholone drops in both eyes for severe dry eye. She was also receiving antiplatelet agents for platelet aggregation hyperactivity and prednisolone for interstitial pneumonia internally. Her right eye was suffering from increased intraocular pressure. DIAGNOSIS: We diagnosed her right eye as steroid-induced glaucoma. INTERVENTIONS: We performed microhook trabeculotomy. OUTCOMES: At postoperative day 10, she had total anterior chamber hemorrhage and high intraocular pressure, and subsequently developed corneal blood staining at postoperative day 15, for which we performed anterior chamber cleaning. After that, we did not perform additional anterior chamber cleaning, and during the 1-year follow-up, a gradual improvement was noted in the entire cornea with reddish-brown opacity, from the periphery to the center. However, almost the entire pupil was still covered with opacity, and her visual acuity was at the light perception at the final visit. LESSONS: Corneal bloodstaining takes a considerable time to resolve and causes severe vision loss. Special attention should be given to persistent corneal blood staining when hyphema and high intraocular pressure are observed after minimally invasive glaucoma surgeries.

Efficacy and safety of a fixed combination of 1% brinzolamide and 0.1% brimonidine as treatment for glaucoma: a retrospective study focusing on the number of ingredients.

OBJECTIVE: To evaluate the intraocular pressure (IOP)-lowering effect based on the number of ingredients and survival rate due to adverse reactions of brinzolamide (1%)/brimonidine (0.1%) fixed combination (BBFC). METHODS AND ANALYSIS: Among 424 patients newly administered BBFC from June 2020 to May 2021, 406 were retrospectively evaluated for adverse reactions and 299 were evaluated for the IOP-lowering effect of BBFC. Among those evaluated for IOP, group A (n=86) included patients whose treatment was changed to BBFC from other two ingredients, Group B (n=90) included patients who added one ingredient by switching to BBFC, and group C (n=123) included patients who added BBFC in addition to other drugs. RESULTS: The mean IOP (mm Hg) at BBFC initiation and at 3, 6 and 12 months after BBFC initiation was 14.1, 14.0, 14.3 and 13.8 in group A, 15.9, 14.4, 13.8 and 14.5 in group B and 17.2, 14.0, 14.1 and 14.9 in group C, respectively. Group A showed no significant difference in mean IOP from baseline to any time point after BBFC initiation, whereas groups B and C showed significant IOP reductions at all time points. Seventy-three (18%) patients discontinued treatment due to adverse reactions. The survival rate was 72% at 12 months after the start of BBFC when discontinuation due to adverse reactions was defined as failure. CONCLUSION: Using BBFC, sustained IOP or decreasing IOP were observed depending on the number of ingredients. Drop-outs due to the adverse reactions should also be given attention.

Comparison of Surgical Outcomes Between Microhook Ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade in Combination with Phacoemulsification: A Retrospective, Comparative Case Series.

PURPOSE: To study surgical outcomes of patients with a minimum of 6 months of follow-up after undergoing combined phacoemulsification with either microhook ab interno trabeculotomy (µLOT-Phaco) or goniotomy using the Kahook Dual Blade (KDB-Phaco). METHODS: This retrospective comparative case series examined 22 µLOT-Phaco eyes and 81 KDB-Phaco eyes that underwent surgery between December 2016 and October 2018. Data collected from medical records included pre- and postoperative intraocular pressure (IOP), number of IOP-lowering medications and complication occurrence. Potential risk factors for failure were determined by Cox proportional hazards regression analysis. Surgical failure was defined as an IOP of > 20 mmHg, < 20% reduction in preoperative IOP or additional glaucoma surgery. Kaplan-Meier survival analysis was used to assess success rates. Score matching used a genetic algorithm consisting of type of glaucoma. RESULTS: Of 81 KDB-Phaco eyes, 22 eyes were matched to 22 µLOT-Phaco eyes. Mean IOP in the µLOT-Phaco group decreased from 24.7 ± 6.4 mmHg at baseline to 14.4 ± 3.0 mmHg (P < 0.01) and 13.0 ± 2.5 mmHg (P < 0.01) at 6 and 12 months, respectively. Mean IOP in the KDB-Phaco group decreased from 23.2 ± 5.4 mmHg to 15.8 ± 3.3 mmHg (P < 0.001) and 16.7 ± 2.1 mmHg (P < 0.001), respectively. Mean number of preoperative IOP-lowering medications in the µLOT-Phaco group at baseline was 3.7 ± 1.0, which decreased to 1.4 ± 1.5 (P < 0.01) at 12 months, while in the KDB-Phaco group it decreased from a baseline value of 3.3 ± 1.2 to 1.1 ± 1.4 (P < 0.01). Probability of qualified success at 12 months in the µLOT-Phaco and KDB-Phaco groups was 71.8% and 62.2%, respectively (P = 0.75). Similar postoperative complications were found between the groups. CONCLUSIONS: Use of µLOT-Phaco and KDB-Phaco resulted in comparable IOPs and reductions in the number of medications.

Evaluation of Automatic Monitoring of Instillation Adherence Using Eye Dropper Bottle Sensor and Deep Learning in Patients With Glaucoma.

PURPOSE: We developed and evaluated an eye dropper bottle sensor system comprising motion sensor with automatic motion waveform analysis using deep learning (DL) to accurately measure adherence of patients with antiglaucoma ophthalmic solution therapy. METHODS: We enrolled 20 patients with open-angle glaucoma who were treated with either latanoprost ophthalmic solution 0.005% or latanoprost-timolol maleate fixed combination ophthalmic solution in both eyes. An eye dropper bottle sensor was installed at patients' homes, and they were asked to instill the medication and manually record each instillation time for 3 days. Waveform data were automatically collected from the eye dropper bottle sensor and judged as a complete instillation by the DL instillation assessment model. We compared the instillation times captured on the waveform data with those on each patient's record form. In addition, we also calculated instillation movement duration from Waveform data. RESULTS: The developed eye bottle sensor detected all 60 instillation events (100%). Mean difference between patient and eye bottle sensor recorded time was 1 ± 1.22 (range, 0-3) minutes. Additionally, mean instillation movement duration was 16.1 ± 14.4 (range, 4-43) seconds. Two-way ANOVA revealed a significant difference in instillation movement duration among patients (P < 0.001) and across days (P < 0.001). CONCLUSION: The eye dropper bottle sensor system developed by us can be used for automatic monitoring of instillation adherence in patients with glaucoma. TRANSLATIONAL RELEVANCE: We believe that our eye dropper bottle sensor system will accurately measure adherence of all glaucoma patients as well as help glaucoma treatment.

Radiofrequency catheter ablation of premature ventricular contractions from near the His-bundle.

OBJECTIVE: This study aimed to investigate the effects of radiofrequency catheter ablation (RFCA) and clinical and electrophysiological characteristics in symptomatic patients with premature ventricular contractions (PVCs) from near the His-bundle (His-PVCs). METHODS: The patient characteristics, prevalence of complications with any life style related disease (ALSRD) including hypertension, dyslipidemia, or diabetes mellitus, and/or cardiovascular disease (CVD) including coronary artery disease, cerebrovascular disease, renal dysfunction, or cardiomyopathy, clinical status, frequency of PVCs evaluated by 24hour Holter monitoring, echocardiography including the left ventricular diastolic dysfunction (LVDD) parameters, and electrophysiological findings were evaluated in 14 consecutive symptomatic patients with His-PVCs. RESULTS: The prevalence of males, being elderly and/or slightly obese, current and/or history of smoking, ALSRD or CVD related complications, and LVDD probably resulting from ALSRD and/or CVD complications were higher in patients with His-PVCs. RFCA of His-PVCs steadily decreased the PVC frequency and improved the systolic function, LV dilation, and clinical status, but not the LVDD. There was a significant relationship between the accordance rate of the QRS polarity between sinus rhythm and His-PVCs and the distance between the successful ablation site and His-bundle. CONCLUSION: The analysis of the QRS duration and accordance rate of the QRS polarity between sinus rhythm and His-PVCs before the RFCA may help to determine the distance between the origin of the PVCs and His-bundle. Further, the appropriate ablation catheter may be selected during the RFCA procedure. Finally, RFCA may be one of the most effective, feasible, and safest therapies for symptomatic patients with His-PVCs.

Paroxysmal Atrial Fibrillation in Patients Successfully Treated by Radiofrequency Catheter Ablation with Severely Compression, Lateral Displacement, and Clockwise Rotation of Their Hearts due to Severe Pectus Excavatum.

Two cases with severe pectus excavatum and symptomatic atrial fibrillation (AF) underwent radiofrequency catheter ablation (RFCA). Their chest X-ray and computed tomography (CT) findings revealed lateral displacement and clockwise rotation of their hearts, and severe right atrial and mild right ventricular compression against the sternum, but no left atrium compression against the spinal column. The procedure was therefore carefully performed under guidance with CT, intra-cardiac echography, atriography, and a three-dimensions mapping system. Finally, the AF was successfully treated by RFCA without any complications. These findings underscore the importance of understanding cases of abnormal anatomy and carefully designing a strategy before performing any procedure.

A case of paroxysmal atrial fibrillation in a patient successfully treated by radiofrequency catheter ablation with a severely right-sided dislocation of the heart after a total right lung excision.

A 72-year-old woman with symptomatic and drug-refractory paroxysmal atrial fibrillation (AF) underwent radiofrequency catheter ablation (RFCA). She had a history of a total right lung excision. Her chest X-ray and computed tomography (CT) revealed a severely sight-sided dislocation of the heart. Thus, the procedure was carefully performed under guidance of a CT, intracardiac echogram, atriography, and 3D mapping system. Finally, the AF was successfully treated by RFCA without any complications.