Unipolar voltage electroanatomic mapping detects structural atrial remodeling identified by LGE-MRI.

Background: In atrial fibrillation (AF) management, understanding left atrial (LA) substrate is crucial. While both electroanatomic mapping (EAM) and late gadolinium enhancement magnetic resonance imaging (LGE-MRI) are accepted methods for assessing the atrial substrate and are associated with ablation outcome, recent findings have highlighted discrepancies between low-voltage areas (LVAs) in EAM and LGE areas.

Objective: The purpose of this study was to explore the relationship between LGE regions and unipolar and bipolar LVAs using multipolar high-density mapping.

Optimizing the Distribution of Ablation Lesions to Prevent Postablation Atrial Tachycardia: A Personalized Digital-Twin Study.

Background: Although targeting atrial fibrillation (AF) drivers and substrates has been used as an effective adjunctive ablation strategy for patients with persistent AF (PsAF), it can result in iatrogenic scar-related atrial tachycardia (iAT) requiring additional ablation. Personalized atrial digital twins (DTs) have been used preprocedurally to devise ablation targeting that eliminate the fibrotic substrate arrhythmogenic propensity and could potentially be used to predict and prevent postablation iAT.

Objectives: In this study, the authors sought to explore possible alternative configurations of ablation lesions that could prevent iAT occurrence with the use of biatrial DTs of prospectively enrolled PsAF patients.

Assessing the arrhythmogenic propensity of fibrotic substrate using digital twins to inform a mechanisms-based atrial fibrillation ablation strategy.

Atrial fibrillation (AF), the most common heart rhythm disorder, may cause stroke and heart failure. For patients with persistent AF with fibrosis proliferation, the standard AF treatment-pulmonary vein isolation-has poor outcomes, necessitating redo procedures, owing to insufficient understanding of what constitutes good targets in fibrotic substrates. Here we present a prospective clinical and personalized digital twin study that characterizes the arrhythmogenic properties of persistent AF substrates and uncovers locations possessing rotor-attracting capabilities.

A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data.

Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations.

A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data.

Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the CHADS-VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations.

Arterial spin labeling image findings in the acute phase in paediatric patients with acute encephalopathy with biphasic seizures and late reduced diffusion.

Introduction: Diagnosing acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) after the first seizure (early seizure/seizures, ES/ESs) is challenging because a reduced apparent diffusion coefficient (ADC) in the cortical or subcortical white matter, often described as having a "bright-tree appearance (BTA)," is usually not observed until secondary seizures (late seizures, LSs) occur. Previous studies have reported hypoperfusion on arterial spin labeling (ASL) within 24 h after ES/ESs in patients with AESD and hyperperfusion within 24 h after LS onset. This study aimed to investigate cerebral blood flow in the hyperacute phase (between ES/ESs and LSs) using ASL in patients with AESD.

The spatiotemporal electrogram dispersion ablation targeting rotors is more effective for elderly patients than non-elderly population.

Background: Modulating atrial fibrillation (AF) drivers has been proposed as one of the effective ablation strategies for non-paroxysmal AF (non-PAF). However, the optimal non-PAF ablation strategy is still under debate because the exact mechanisms of AF persistence including focal activity and/or rotational activity, are not well-understood. Recently, spatiotemporal electrogram dispersion (STED) assumed to indicate rotors in the form of rotational activity is proposed as an effective target for non-PAF ablation.

The Role of Genetically Modified Human Feeder Cells in Maintaining the Integrity of Primary Cultured Human Deciduous Dental Pulp Cells.

Tissue-specific stem cells exist in tissues and organs, such as skin and bone marrow. However, their pluripotency is limited compared to embryonic stem cells. Culturing primary cells on plastic tissue culture dishes can result in the loss of multipotency, because of the inability of tissue-specific stem cells to survive in feeder-less dishes.

Factors related to mouth breathing syndrome in preschool children and the effects of incompetent lip seal: An exploratory study.

Objectives: A set of orofacial signs and symptoms completely or partially present in individuals who replace the correct pattern of nasal breathing with an oral or mixed pattern is defined as mouth breathing syndrome (MBS). In a previous report, it was clarified that an incompetent lip seal (ILS) affected the occurrence of MBS among primary school children. However, the factors related to MBS and the effect of ILS in preschool children remain unclear.

Truncal Instability and Titubation in Patients With Acute Encephalopathy With Reduced Subcortical Diffusion.

The present retrospective study aimed to investigate the presence of truncal instability or titubation after the first seizure and second phase in patients with acute encephalopathy with reduced subcortical diffusion (AED). Of the 15 patients with AED who were admitted to our hospital for 3 years and 2 months and had reached developmental milestones for sitting before disease onset, six experienced moderate-to-severe truncal instability while sitting after the first seizure. These patients had a significantly longer first seizure duration and significantly lower GCS scores 12-24 h after the first seizure, as well as significantly higher Tada score and Creatinine and blood glucose levels than those with mild or no truncal instability while in a seated position after the first seizure.

Application of Neck Lift Technique for Corrections of Concave Deformity and Scar Contracture After Tracheal Fenestration.

Following a tracheostomy or tracheal fenestration procedure, neck concave deformity, and contracture after spontaneous closure are common problems. Since the neck is an exposed part of the body, its concave deformity can cause cosmetic problems and functional problems such as difficulty in neck extension and swallowing due to contracture. We report the case of a 63-year-old man who underwent tracheal fenestration for worsening respiratory status due to sepsis after aspiration pneumonia.

Midterm Outcomes of Endovascular Aortic Aneurysm Repair with Carbon Dioxide-Guided Angiography.

Background: Although iodinated contrast (IC) agents are commonly used in endovascular aneurysm repair (EVAR), perioperative use in patients with renal dysfunction or IC allergies is avoided. Carbon dioxide (CO)-guided angiography is a promising alternative. We aimed to evaluate short-term and midterm outcomes of EVAR using CO-guided angiography.

Not all rotors, effective ablation targets for nonparoxysmal atrial fibrillation, are included in areas suggested by conventional indirect indicators of atrial fibrillation drivers: ExTRa Mapping project.

Background: Effects of nonparoxysmal atrial fibrillation (non-PAF) ablation targeting complex fractionated atrial electrogram (CFAE) areas and/or low voltage areas (LVAs) are still controversial.

Methods And Results: A recently developed online real-time phase mapping system (ExTRa Mapping) was used to conduct LVA mapping and simultaneous ExTRa and CFAE mapping in 28 non-PAF patients after pulmonary vein isolation (PVI). Nonpassively activated areas, in the form of meandering rotors and/or multiple wavelets assumed to contain non-PAF drivers, partly overlapped with CFAE/LVAs but not always coincided with them.

A new modified Pudendal Thigh Flap of vaginoplasty including reconstruction of vaginal vestibule.

We modified the conventional Pudendal Thigh Flap (PTF) on the vaginoplasty including reconstruction of vaginal vestibule. After the operation, no stenosis of the vaginal vestibule and opening of the vagina was observed. It is believed that our technique is cosmetically and functionally possible and a useful method.

Influence of aging on the quantity and quality of human cardiac stem cells.

Advanced age affects various tissue-specific stem cells and decreases their regenerative ability. We therefore examined whether aging affected the quantity and quality of cardiac stem cells using cells obtained from 26 patients of various ages (from 2 to 83 years old). We collected fresh right atria and cultured cardiosphere-derived cells (CDCs), which are a type of cardiac stem cell.

The Efficacy of Continuous Negative Pressure and Irrigation Treatment Inside the Wound by a Closed System in Reconstruction of All Layers of the Cranium Accompanying Infection and Cerebrospinal Fluid Leakage.

There have been many reports to date with respect to treatments on reconstruction of the cranium without accompanying infections following trauma and tumor resection. The morality is, however, high in patients observed with generation of cranial bone defect of all layers accompanying infection and cerebrospinal fluid leakage, and moreover, there are barely any reports on such cases because of the reconstruction thereof being very difficult. In this study, the authors were able to cure such 2 cases by carrying out continuous negative pressure and irrigation treatment inside the wound by a closed system following transplant of free latissimus dorsi muscle flap.

Bilateral axillary artery aneurysms after Bentall procedure in Marfan syndrome.

A man with Marfan syndrome underwent a Bentall procedure for annuloaortic ectasia and severe aortic regurgitation at 43 years of age. Twenty-eight years after the Bentall procedure, he developed bilateral axillary artery aneurysms (length × diameter: right: 80 × 39 mm; left: 103 × 45 mm). Aneurysmectomy and reconstruction of the axillary artery were performed using an artificial vascular graft.

Rapidly progressing left atrial hemangiopericytoma.

Cardiac hemangiopericytoma is a rare soft tissue tumor. We describe a case of hemangiopericytoma in the left atrium, which was diagnosed as myxoma preoperatively. A 70-year-old woman was admitted with heart failure.

Structural valve deterioration of a mitral Carpentier-Edwards pericardial bioprosthesis in an 87-year-old woman 16 years after its implantation.

The second-generation pericardial valve, the Carpentier-Edwards perimount bioprosthetic (CEP) valve, shows dramatically improved durability as compared to the first-generation pericardial valve, and excellent performance has been obtained, in both the aortic and mitral positions. Especially in elderly patients with an implanted CEP valve, reoperation due to structural valve deterioration (SVD) is rarely required. Here, we report the case of an 87-year-old woman with an explanted CEP valve in the mitral position due to SVD, 16 years after its implantation.

Successful surgical treatment of right subclavian artery aneurysm with a hypoplastic left vertebral artery using temporary cerebral perfusion to prevent cerebral ischemia.

A 71-year-old man had a right subclavian artery aneurysm (dimension, 30 × 38 mm) that was adjacent to the right common carotid artery and exceedingly close to the right vertebral artery. The patient had a marked hypoplastic left vertebral artery, dominant right vertebral artery, and an incompletely formed and underdeveloped circle of Willis in the skull. While performing a median sternotomy and supraclavicular incision during the operation, we used temporal shunting for the cerebral perfusion.

Tricuspid valve incompetence caused by an intracardiac needle-like foreign body.

We report a rare case of tricuspid valve incompetence caused by a needle-like foreign body with an unknown route of invasion. A 55-year-old woman who had suffered from chronic heart failure for more than 25 years was diagnosed as having Ebstein's anomaly after a transthoracic echocardiogram with Doppler imaging showed severe tricuspid regurgitation and displacement of the septal leaflet toward the right ventricle inlet. Surgery revealed a foreign body attached to the tricuspid valve, causing regurgitation.