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Kawashima K, Hikichi T, Onizawa M, Gunji N, Watahiki Y, Sakuma C, Mochimaru T, Murakami M, Suzuki O, Hashimoto Y, Kobayakawa M, Ohira H. Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection. DEN Open 2024; 4:e300. [PMID: 37841650 PMCID: PMC10569401 DOI: 10.1002/deo2.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD. Methods Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed. Results In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; p < 0.001) and more lesions with >50% circumference than did the HM0 group (p < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group (p < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group. Conclusions The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis.
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Affiliation(s)
- Kazumasa Kawashima
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Michio Onizawa
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Yu Watahiki
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Chiharu Sakuma
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Tomoaki Mochimaru
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Mai Murakami
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Osamu Suzuki
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Yuko Hashimoto
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
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Yamaguchi J, Takigawa M, Goya M, Martin CA, Negishi M, Yamamoto T, Ikenouchi T, Goto K, Shigeta T, Kawamura I, Nishimura T, Takamiya T, Tao S, Miyazaki S, Sasano T. Impact of contact force on the lesion characteristics of very high-power short-duration ablation using a QDOT-MICRO catheter. J Arrhythm 2024; 40:247-255. [PMID: 38586837 PMCID: PMC10995585 DOI: 10.1002/joa3.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 04/09/2024] Open
Abstract
Background Lesion size is reported to become larger as contact force (CF) increases. However, this has not been systematically evaluated in temperature-guided very high-power short-duration (vHPSD) ablation, which was therefore the purpose of this study. Methods Radiofrequency applications (90 W/4 s, temperature-control mode) were performed in excised porcine myocardium with four different CFs of 5, 15, 25, and 35 g using QDOT-MICRO™ catheter. Ten lesions for each combination of settings were created, and lesion metrics and steam-pops were compared. Results A total of 320 lesions were analyzed. Lesion depth, surface area, and volume were smallest for CF of 5 g than for 15, 25, and 35 g (depth: 2.7 mm vs. 2.9 mm, 3.0 mm, 3.15 mm, p < .01; surface area: 38.4 mm2 vs. 41.8 mm2, 43.3 mm2, 41.5 mm2, p < .05; volume: 98.2 mm3 vs. 133.3 mm3, 129.4 mm3, 126.8 mm3, p < .01 for all pairs of groups compared to CF = 5 g). However, no significant differences were observed between CFs of 15-35 g. Average power was highest for CF of 5 g, followed by 15, 25, and 35 g (83.2 W vs. 82.1 W vs. 77.1 W vs. 66.1 W, p < .01 for all pairs), reflecting the higher incidence of temperature-guided power titration with greater CFs (5 g:8.8% vs. 15 g:52.5% vs. 25 g:77.5% vs. 35 g:91.2%, p < .01 for all pairs except for 25 g vs. 35 g). The incidence of steam-pops did not significantly differ between four groups (5 g:3.8% vs. 15 g:10% vs. 25 g:6.2% vs. 35 g:2.5%, not significant for all pairs). Conclusions For vHPSD ablation, lesion size does not become large once the CF reaches 15 g, and the risk of steam-pops may be mitigated through power titration even in high CFs.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Clinical and Diagnostic Laboratory ScienceTokyo Medical and Dental UniversityTokyoJapan
| | - Masateru Takigawa
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | | | - Miho Negishi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tasuku Yamamoto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takashi Ikenouchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Kentaro Goto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takatoshi Shigeta
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Iwanari Kawamura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takuro Nishimura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tomomasa Takamiya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Susumu Tao
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
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Gupta N, Bhargava A, Saigal S, Sharma S, Patel M, Prakash O. Effectiveness of Injectable Platelet-Rich Fibrin in the Treatment of Oral Lichen Planus: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51626. [PMID: 38318577 PMCID: PMC10839423 DOI: 10.7759/cureus.51626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory condition affecting the oral mucosa. The current review investigated the potential effectiveness of injectable platelet-rich fibrin (i-PRF) as a treatment for OLP when compared to other interventions. The current review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented across databases such as PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. The search utilized a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) terms to capture relevant studies. Comparative clinical studies focusing on i-PRF as a treatment for OLP and other interventions were included. Outcomes assessed were pain, surface area of lesions, and patient satisfaction. Review Manager 5.4 was used for statistical analysis. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the studies. Three studies were included for the final analysis. The findings indicated that both the i-PRF and comparison treatment groups demonstrated reductions in pain and lesion size. The post-treatment Visual Analogue Scale (VAS) scores showed a decrease in pain intensity, and there was an improvement in lesion extension in the i-PRF-treated sites. The results also revealed increased patient satisfaction with i-PRF treatment. Adverse effects were not reported or specified in the included studies. Quantitative analysis for pain (VAS) showed a mean difference of 0.38 (95% CI: 0.63-1.40), but there was no significant difference between the i-PRF and control groups at p=0.46. Though intragroup differences showed statistically significant differences between pre and post intervention, intergroup differences were not significant for any of the assessed outcomes. The findings from this study suggest that i-PRF holds promise as a potential treatment for OLP. The use of i-PRF resulted in pain reduction, lesion size improvement, and increased patient satisfaction. However, it is important to consider the limitations of the included studies, such as variability in study designs, small sample sizes, and the limited number of studies.
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Affiliation(s)
- Neha Gupta
- Oral Pathology, Microbiology, and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ankur Bhargava
- Oral Pathology and Microbiology, Hazaribag College of Dental Sciences and Hospital, Hazaribag, IND
| | - Sonal Saigal
- Oral Pathology, Microbiology, and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shilpi Sharma
- Oral Medicine, Diagnosis, and Radiology, Promotional and Medical Review (PMR) Enterprise Medical, Indegene Limited, Bengaluru, IND
| | - Mimansha Patel
- Oral Pathology and Microbiology, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, IND
| | - Om Prakash
- Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, IND
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Yamaguchi J, Takigawa M, Goya M, Yamamoto T, Ikenouchi T, Iwakawa H, Negishi M, Goto K, Shigeta T, Nishimura T, Takamiya T, Tao S, Miyazaki S, Sasano T. Safety verification of a novel irrigation catheter with flexible tip of laser-cut kerfs and contact force sensor. Pacing Clin Electrophysiol 2023; 46:1536-1545. [PMID: 37957924 DOI: 10.1111/pace.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND AIMS The safety evaluation of TactiFlex, a novel contact-force sensing catheter with a flexible 4-mm tip irrigated through laser-cut kerfs, has been ongoing. This study aimed to verify the safety of this type of catheter. METHODS Study 1: Radiofrequency (RF) applications at a range of powers (30-50 W), contact forces (10-20 g), and durations (10-60 s) using perpendicular/parallel catheter orientation with half-normal (HNS) or normal saline irrigation were compared between TactiFlex (4-mm tip) and TactiCath (3.5-mm tip) with temperature-controlled mode in excised porcine hearts. Study 2: The relation between RF applications using TactiFlex and the incidence of steam-pops in the real clinical cases were examined. RESULTS Study-1: 576 RF lesions were examined. TactiFlex demonstrated a significantly lower risk of steam-pops (5[1.7%] vs. 59[20.5%], p < .0001). Compared to 3.5-mm-tip catheter (TactiCath), 4-mm-tip catheter (TactiFlex) produced smaller lesion volume at perpendicular (193[98-554]mm3 vs. 263[139-436]mm3 , p < .0001), but relatively similar lesion volume at parallel contact (243[105-443]mm3 vs. 278[180-440]mm3 , p = .06). HNS-irrigation tended to increase the lesion volume in both catheters and to increase the incidence of steam-pops with TactiCath, but not with TactiFlex. The cut-off value of %impedance-drop ( = absolute impedance-drop/initial impedance) of 20% predicted steam-pops with a sensitivity = 100% and specificity = 89.6% in TactiFlex. Study-2: 5496 RF applications in 84 patients (51AFs/8ATs/3AVNRTs/4AVRTs/17PVCs/4VTs) using TactiFlex were analyzed. Four steam-pops (0.07%) in three patients with pericardial effusion were observed (%impedance-drop = 24%/26%/29%/35%, respectively). The cut-off value of %impedance-drop = 20%, derived from ex-vivo study, showed sensitivity = 100% and specificity = 90.1% in detecting steam-pops. CONCLUSION TactiFlex reduced the risk of steam-pops than TactiCath. %impedance-drop ≤ 20% may be reasonable for safely use with a sufficient safety margin. For 4-mm-tip catheter, parallel-contact may be recommended for larger lesion creation.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
- Department of Clinical and Diagnostic Laboratory Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Bahlke F, Wachter A, Erhard N, Englert F, Krafft H, Popa M, Risse E, Kottmaier M, Telishevska M, Lengauer S, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. The influence of electrode-tissue-coverage on RF lesion formation and local impedance: Insights from an ex vivo model. Pacing Clin Electrophysiol 2023; 46:1170-1181. [PMID: 37616376 DOI: 10.1111/pace.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model. METHODS AND RESULTS An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC. CONCLUSIONS ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Andreas Wachter
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
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Adhikari U, Brown J, Ojiambo PS, Cowger C. Effects of Host and Weather Factors on the Growth Rate of Septoria nodorum Blotch Lesions on Winter Wheat. Phytopathology 2023; 113:1898-1907. [PMID: 37147578 DOI: 10.1094/phyto-12-22-0476-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Septoria nodorum blotch (SNB), caused by Parastagonospora nodorum, is a major disease of winter wheat that occurs frequently in the central and southeastern United States. Quantitative resistance to SNB in wheat is determined by various disease resistance components and their interaction with environmental factors. A study was conducted in North Carolina from 2018 to 2020 to characterize SNB lesion size and growth rate and to quantify the effects of temperature and relative humidity on lesion expansion in winter wheat cultivars with different levels of resistance. Disease was initiated in the field by spreading P. nodorum-infected wheat straw in experimental plots. Cohorts (groups of foliar lesions arbitrarily selected and tagged as an observational unit) were sequentially selected and monitored throughout each season. Lesion area was measured at regular intervals, and weather data were collected using in-field data loggers and the nearest weather stations. Final mean lesion area was approximately seven times greater on susceptible than on moderately resistant cultivars, and lesion growth rate was approximately four times higher on susceptible than on moderately resistant cultivars. Across trials and cultivars, temperature had a strong effect of increasing lesion growth rates (P < 0.001), while relative humidity had no significant effect (P = 0.34). Lesion growth rate declined slightly and steadily over the duration of cohort assessment. Our results demonstrate that restricting lesion growth is an important component of SNB resistance in the field and suggest that the ability to limit lesion size may be a useful breeding goal.
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Affiliation(s)
- Urmila Adhikari
- Center for Integrated Fungal Research, Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, U.S.A
| | - James Brown
- John Innes Centre, Norwich Research Park, Colney, Norwich, U.K
| | - Peter S Ojiambo
- Center for Integrated Fungal Research, Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, U.S.A
| | - Christina Cowger
- Center for Integrated Fungal Research, Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC, U.S.A
- U.S. Department of Agriculture-Agricultural Research Service, Raleigh, NC, U.S.A
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Yamaguchi J, Takigawa M, Goya M, Martin CA, Yamamoto T, Ikenouchi T, Shigeta T, Nishimura T, Tao S, Miyazaki S, Sasano T. Comparison of three different approaches to very high-power short-duration ablation using the QDOT-MICRO catheter. J Cardiovasc Electrophysiol 2023; 34:888-897. [PMID: 36852902 DOI: 10.1111/jce.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND/OBJECTIVES The QDOT-MICRO™ catheter allows very high-power and short-duration (vHPSD) ablation. This study aimed to investigate lesion characteristics using different ablation settings. METHODS Radiofrequency applications (90 W/4 s, temperature-control mode with 55°C or 60°C target) were performed in excised porcine myocardium using three different approaches: single (SA), double nonrepetitive (DNRA), and double repetitive applications (DRA). Applications were performed with an interval of 1 min for DNRA, and without interval for DRA. RESULTS A total of 480 lesions were analyzed. Lesion depth and volume were largest for DRA followed by DNRA and SA regardless of catheter direction (depth: 3.8 vs. 3.3 vs. 2.6 mm, p < .001 for all comparisons; volume: 176.6 vs. 145.1 vs. 97.0 mm3 , p < .001 for all comparisons). Surface area was significantly larger for DRA than for SA (45.1 vs. 38.3 mm2 , p < .001) and larger for DNRA than for SA (44.5 vs. 38.3 mm2 , p < .001), but was similar between DRA and DNRA (45.1 vs. 44.5 mm2 , p = .54). Steam-pops more frequently occurred for DRA than for SA (15.6% vs. 4.4%, p = .004) and DNRA (15.6% vs. 6.9%, p = .061), but the incidence was similar between SA and DNRA (4.4% vs. 6.9%, p = 1). Although surface area and lesion volume were larger in lesions with steam-pops than without steam-pops (46.5 vs. 38.1 mm2 , p = .018 and 128.3 vs. 96.8 mm3 , p = .068, respectively), lesions were not deeper (pop(+): 2.5 mm vs. pop(-): 2.6 mm, p = .75). CONCLUSIONS DNRA produces larger lesions than SA without increasing the risk of steam-pops. DRA produces the largest lesions among the three groups, but with an increased risk of steam-pops. Even with steam-pops, lesions do not become deeper in vHPSD ablation.
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Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan.,Department of Clinical and Diagnostic Laboratory Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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8
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Pillai A, Robila V, Kasirajan V, Ellenbogen KA, Koneru JN. Ex-vivo histopathologic examination of irrigated radiofrequency ablation utilizing half-normal saline of the human heart. J Cardiovasc Electrophysiol 2023; 34:900-907. [PMID: 36738139 DOI: 10.1111/jce.15840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/07/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) utilizing half-normal saline (HNS) irrigation is a promising intervention to circumvent commonly encountered limitations during radiofrequency ablation of deep myocardial substrate. Few studies to date have analyzed the morphologic changes in the human myocardium following HNS RFA. METHODS AND RESULTS Three patients with symptomatic ventricular tachycardia (VT) who underwent RFA with HNS irrigation underwent pathological specimen examination at time of autopsy or following native heart explant at the time of cardiac transplantation. Gross evaluation of the heart was performed fresh and after fixation in 10% formalin. A routine examination was performed with fixation in 10% formalin. Sections of lesioned tissue were paraffin embedded and evaluated using standard hematoxylin and eosin (H&E) staining. CONCLUSION Irrigated RF ablation with HNS irrigant produces coagulative necrosis as well as several delayed histopathological changes with a deeper field of effective ablation. Transmurality may not be obtained in the ventricular myocardium with endocardial, epicardial, or sequential unipolar HNS ablation.
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Affiliation(s)
- Ajay Pillai
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Valentina Robila
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA
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9
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Wang X, Zhu J, Liu Y, Li W, Chen S, Zhang H. Assessment of ultrasound shear wave elastography: An animal ex-vivo study. J Appl Clin Med Phys 2023; 24:e13924. [PMID: 36729737 PMCID: PMC10113705 DOI: 10.1002/acm2.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To explore the influence of the surrounding environment of the target tissue, lesion size, and rectangular sampling box size on shear wave speed (SWS). METHODS The tendon SWS was acquired ex-vivo. Then the tendons were dissected and buried in the couplant (gel) and evaluated by two-dimensional shear wave elastography (2D-SWE). Finally, the tendons were placed in the isolated muscles to simulate the intramuscular lesions, and their elasticity was tested under two rectangular sampling box conditions. The isolated complete liver SWS was acquired. Similarly, the large and small pieces of livers were cut out, placed in the muscles, and assessed by SWE under two rectangular sampling box conditions. The SWS acquired under different conditions was compared. Variability was evaluated using the coefficient of variation (CV). The intraclass correlation coefficient (ICC) was used to evaluate repeatability. RESULTS The SWS of the tendons ex-vivo, buried in the couplant and placed in the isolated muscles showed significant differences (p < 0.001). The ex-vivo condition produced the highest SWS and CV values. There were significant differences in SWS of livers with different sizes placed in muscles (p < 0.001). The highest SWS value was associated with small pieces of livers. No significant difference was found in SWS acquired under different rectangular box sizes (p > 0.05). CONCLUSIONS Under the present study conditions, the surrounding environment of the target tissue makes a big difference to lesion SWS values. The lesion size will affect the assessment of its inherent elasticity. The size of the sampling frame has no significant effect on the tissue SWS.
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Affiliation(s)
- Xiuming Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China.,Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China
| | - Si Chen
- Department of Ultrasound, Peking University People's Hospital, Beijing, People's Republic of China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
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10
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Kong P, Daughtrey ML, Hong C. Differential Adaptation Has Resulted in Aggressiveness Variation of Calonectria pseudonaviculata on Hosts Buxus, Pachysandra, and Sarcococca. J Fungi (Basel) 2023; 9:jof9020181. [PMID: 36836296 PMCID: PMC9966688 DOI: 10.3390/jof9020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Calonectria pseudonaviculata (Cps) infects Buxus (boxwood), Pachysandra (pachysandra), and Sarcococca spp. (sweet box); yet, how it adapts to its hosts has been unclear. Here, we performed serial passage experiments with the three hosts and measured Cps changes in three aggressiveness components: infectibility, lesion size, and conidial production. The detached leaves of individual hosts were inoculated with isolates (P0) from the originating host, followed by nine serial inoculations of new leaves of the same host with conidia from the infected leaves of the previous inoculation. All boxwood isolates maintained their capability of infection and lesion expansion through the 10 passages, whereas most non-boxwood isolates lost these abilities during the passages. Isolates from plants of origin (*-P0) and their descendants isolated from passages 5 (*-P5) and 10 (*-P10) were used to evaluate aggressiveness changes on all three hosts with cross-inoculation. While post-passage boxwood isolates gave enlarged lesions on pachysandra, sweet box P5 and pachysandra P10 isolates showed reduced aggressiveness on all hosts. Cps appears to be most adapted to boxwood and less adapted to sweet box and pachysandra. These results suggest speciation of Cps, with its coevolutionary pace with the hosts the fastest with boxwood, intermediate with sweet box, and the slowest with pachysandra.
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Affiliation(s)
- Ping Kong
- Hampton Roads Agricultural Research and Extension Center, Virginia Tech, Virginia Beach, VA 23455, USA
- Correspondence:
| | - Margery L. Daughtrey
- Long Island Horticultural Research and Extension Center, Cornell University, Riverhead, NY 11901, USA
| | - Chuanxue Hong
- Hampton Roads Agricultural Research and Extension Center, Virginia Tech, Virginia Beach, VA 23455, USA
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11
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Tsutsui K, Mori H, Kawano D, Tanaka N, Ikeda Y, Sumitomo N, Iwanaga S, Nakano S, Muramatsu T, Matsumoto K, Kato R. Ablation characteristics and incidence of steam pops with a novel, surface temperature-controlled ablation system in an ex vivo experimental model. Pacing Clin Electrophysiol 2022; 45:1390-1400. [PMID: 36222300 DOI: 10.1111/pace.14597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/23/2022] [Accepted: 09/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND A novel irrigation catheter (QDOT MICRO™) has been introduced, which enables a surface temperature-controlled ablation combined with tip cooling. However, the detailed description of its complex behavior and effect on the incidence of pops and lesion formation remains elusive. This study aimed to systematically investigate the ablation characteristics, feedback behavior, and incidence of steam pops in a simplified ex vivo swine model. METHODS Using swine ventricular tissue perfused with saline at 37°C, we systematically created lesions with 4×3 combinations of the wattage (20, 30, 40, and 50 W) and contact force (CF, 10, 30, and 50 g). Ablation was continued for either 120 s or until a steam pop occurred and repeated 10 times with each setting. The lesion geometry, ablation index, feedback dynamics, and conditions underlying the steam pops were measured and analyzed. RESULTS Steam pops occurred particularly frequently in combinations of a low CF and high power (10 g vs. 30 g+50 g [p < .0001]; 40 W+50 W vs. 20 W+30 W [p < .0001]). Failure to activate a feedback process was associated with a 5.1 times higher incidence of steam pops (21/109 vs.11/11, [95% CI 3.499-7.716], p < .0001). The wattage feedback was particularly evident with a high CF (30 and 50 g) and high initial wattage (40 and 50 W). The average delivered wattage at 27 W predicted the occurrence of steam pops. CONCLUSION The temperature-controlled ablation with the QDOT MICRO™ demonstrated a complex feedback behavior, which contributed to a reduced incidence of steam pops and prolonged lead time to the pops.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.,Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Daisuke Kawano
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Naomichi Tanaka
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shiro Iwanaga
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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12
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Montanari E, Bokor A, Szabó G, Kondo W, Trippia CH, Malzoni M, Di Giovanni A, Tinneberg HR, Oberstein A, Rocha RM, Leonardi M, Condous G, Alsalem H, Keckstein J, Hudelist G. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study. Ultrasound Obstet Gynecol 2022; 59:385-391. [PMID: 34919760 DOI: 10.1002/uog.24833] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the preoperative detection of endometriosis using transvaginal sonography (TVS) supplemented by transabdominal sonography (TAS) with surgical assessment of disease, using the #Enzian classification for endometriosis. METHODS This was a prospective multicenter diagnostic accuracy study of women undergoing TVS/TAS and radical surgery for deep endometriosis (DE) at different tertiary referral centers. The localization and grade of severity of the endometriotic lesions and adhesions were described according to the criteria of the #Enzian classification, both at preoperative ultrasound examination and during surgery. According to the #Enzian classification, the small pelvis is divided into three compartments for DE: A (rectovaginal septum and vagina); B (uterosacral and cardinal ligaments, parametrium and pelvic sidewalls); and C (rectum). In addition, further locations (F) are classified as adenomyosis (FA), urinary bladder involvement (FB) and ureteric involvement with signs of obstruction (FU). Other intestinal locations (FI) and other extragenital locations (FO) are also included. Ovarian endometriosis and adhesions at the level of the tubo-ovarian unit are listed as O and T, respectively. The #Enzian grade of severity (Grade 1-3) was determined for #Enzian compartments O, T, A, B and C based on the size of the lesion or the severity of the adhesions. Concordance between preoperative assessment using TVS/TAS and evaluation at surgery was assessed. The sensitivity, specificity, positive and negative predictive values and accuracy of TVS/TAS in the detection of endometriotic lesions/adhesions in the different #Enzian compartments were calculated. RESULTS In total, 745 women were included in the analysis. Preoperative TVS/TAS and surgical findings showed a concordance rate ranging between 86% and 99% for the presence or absence of endometriotic lesions/adhesions, depending on the evaluated #Enzian compartment. The concordance rate between TVS and surgery ranged between 71% and 92% for different severity grades, in #Enzian compartments O, T, A, B and C. Determining the presence or absence of adhesions at the level of the tubo-ovarian unit and classifying them accurately as Grade 1, 2 or 3 on TVS was more difficult than determining the presence and severity of endometriotic lesions in #Enzian compartments O, A, B and C. The sensitivity of TVS/TAS for the detection of endometriotic lesions ranged from 50% (#Enzian compartment FI) to 95% (#Enzian compartment A), specificity from 86% (#Enzian compartment Tleft ) to 99% (#Enzian compartment FI) and 100% (#Enzian compartments FB, FU and FO), positive predictive value from 90% (#Enzian compartment Tright ) to 100% (#Enzian compartment FO), negative predictive value from 74% (#Enzian compartment Bleft ) to 99% (#Enzian compartments FB and FU) and accuracy from 88% (#Enzian compartment Bright ) to 99% (#Enzian compartment FB). CONCLUSIONS The localization and severity of endometriotic lesions/adhesions, as described and classified according to the #Enzian classification, can be diagnosed accurately and non-invasively using TVS/TAS. The #Enzian classification provides a uniform classification system for describing endometriotic lesions, which can be used both at TVS/TAS and during surgical evaluation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Montanari
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
| | - A Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Szabó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - W Kondo
- Department of Gynecology and Minimally Invasive Unit, Vita Batel Hospital, Curitiba, Brazil
| | - C H Trippia
- Department of Radiology, Roentgen Diagnóstico Institute, Curitiba, Brazil
| | - M Malzoni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - A Di Giovanni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - H R Tinneberg
- Department of Obstetrics and Gynecology, Nordwest Hospital, Frankfurt, Germany
| | - A Oberstein
- Department of Obstetrics and Gynecology, Nordwest Hospital, Frankfurt, Germany
| | - R M Rocha
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - M Leonardi
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - H Alsalem
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J Keckstein
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
- Rudolfinerhaus Private Clinic, Vienna, Austria
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13
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Matsuura G, Fukaya H, Ogawa E, Kawakami S, Mori H, Saito D, Sato T, Nakamura H, Ishizue N, Oikawa J, Kishihara J, Niwano S, Ako J. Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: Insight from a porcine experimental study with 2 different LI-sensing catheters. J Cardiovasc Electrophysiol 2022; 33:380-388. [PMID: 35018687 DOI: 10.1111/jce.15356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local impedance (LI) can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). However, data on the effects of catheter contact angle on LI parameters are scarce. This study aimed to evaluate the influence of catheter contact angle on LI changes and lesion size with 2 different LI-sensing catheters in a porcine experimental study. METHODS Lesions were created by the INTELLANAV MiFi™ OI (MiFi) and the INTELLANAV STABLEPOINT™ (STABLEPOINT). RFCA was performed with 30 watts and a duration of 30 seconds. The CF (0, 5, 10, 20, and 30 g) and catheter contact angle (30°, 45°, and 90°) were changed in each set (n=8 each). The LI rise, LI drop, and lesion size were evaluated. RESULTS The LI rise increased as CF increased. There was no angular dependence with the LI rise under all CFs in the MiFi. On the other hand, the LI rise at 90° was lower than at 30° under 5 and 10 g of CF in STABLEPOINT. The LI drop increased as CF increased. Regarding the difference in catheter contact angles, the LI drop at 90° was lower than that at 30° for both catheters. The maximum lesion widths and surface widths were smaller at 90° than at 30°, whereas there were no differences in lesion depths. CONCLUSION The LI drop and lesion widths at 90° were significantly smaller than those at 30°, although the lesion depths were not different among the 3 angles for the MiFi and STABLEPOINT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Emiyu Ogawa
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Sota Kawakami
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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14
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Aas-Eng MK, Lieng M, Dauser B, Diep LM, Leonardi M, Condous G, Hudelist G. Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis. Ultrasound Obstet Gynecol 2021; 58:933-939. [PMID: 34182605 DOI: 10.1002/uog.23728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the agreement of measurements of the three diameters of rectosigmoid deep endometriosis (DE) lesions between presurgical evaluation using transvaginal sonography (TVS) and postsurgical specimen measurement (PSM). METHODS This was a prospective observational multicenter study including symptomatic women undergoing surgical treatment for DE involving the rectosigmoid, by either discoid or segmental resection, from April 2017 to December 2019. TVS was performed presurgically to evaluate lesion size (craniocaudal-midsagittal length, anteroposterior thickness and transverse diameter), in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement, and was compared with PSM. The agreement of lesion dimensions between the two methods was assessed by Bland-Altman plots and limits of agreement and additionally by the intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. Systematic and proportional bias was assessed using the paired t-test. RESULTS A total of 207 consecutive women were eligible for inclusion. Forty-one women were excluded, leaving 166 women for final analysis. A total of 123 segmental resections and 46 discoid resections were performed (both procedures were performed in three women). The mean difference between TVS and PSM was 0.90 (95% CI, 0.85-0.95) mm for lesion length measurements, 1.03 (95% CI, 0.98-1.09) mm for lesion thickness measurements and 0.84 (95% CI, 0.79-0.89) mm for transverse diameter measurements. Bland-Altman analysis demonstrated good agreement between the two methods for measurements of lesion length. Furthermore, there was good reliability and correlation between TVS and PSM for lesion length measurements, as demonstrated by an ICC of 0.82 (95% CI, 0.75-0.87) and Pearson's correlation coefficient of 0.72 (95% CI, 0.62-0.80), moderate-to-good reliability and correlation for lesion thickness measurements, with an ICC of 0.76 (95% CI, 0.67-0.82) and Pearson's correlation coefficient of 0.61 (95% CI, 0.51-0.70), and poor-to-moderate reliability and correlation for transverse diameter measurements, with an ICC of 0.58 (95% CI, 0.39-0.71) and Pearson's correlation coefficient of 0.46 (95% CI, 0.33-0.58). CONCLUSION Preoperative TVS determines accurately rectosigmoid DE lesion length. TVS can thereby contribute to optimal planning of surgical treatment options in women with rectosigmoid DE. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M K Aas-Eng
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M Lieng
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - B Dauser
- Department of Surgery, Hospital St John of God, Vienna, Austria
| | - L M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - M Leonardi
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - G Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
- Scientific Endometriosis Foundation (SEF, Stiftung Endometriose Forschung), Westerstede, Germany
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15
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Farahani ZK, Taherianfard M, Naderi MM, Ferrero H. Possible therapeutic effect of royal jelly on endometriotic lesion size, pain sensitivity, and neurotrophic factors in a rat model of endometriosis. Physiol Rep 2021; 9:e15117. [PMID: 34806344 PMCID: PMC8606856 DOI: 10.14814/phy2.15117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/07/2023] Open
Abstract
Endometriosis is the abnormal growth of endometrial tissue. The goals of the study are: (1) Is any correlation between endometriosis pain and neurotrophins in the serum, dorsal root ganglion (DRG), and peritoneal fluid (PF) in rat models of experimental endometriosis?, (2) Possible therapeutic effects of royal jelly (RJ) on pain scores, size of endometriotic lesion, and neurotrophic factors. Forty-eight Sprague Dawley female rats weighing 205.023 ± 21.54 g were maintained in a standard condition. The rats were randomly divided into one of the six groups: Control (no intervention), Sham-1 (remove of uterine horn), RJ (administration of 200 mg/kg/day RJ for 21 days), Endometriosis (induction of endometriosis), Treatment (induction of endometriosis+administration of 200 mg/kg/day RJ for 21 days), and Sham-2 (induction of endometriosis+administration of water). Formalin test performed for pain evaluation. The levels of Brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), substance P, and calcitonin gene-related peptide (CGRP) were measured by enzyme-linked immunosorbent assay. The mean pain scores in all three phases of the formalin test were significantly increased by endometriosis induction (p < 0.05). The concentrations of BDNF, NGF, and CGRP in DRG of the endometriosis group were significantly higher than these factors in the Control, Sham-1, and RJ groups (p < 0.05). RJ could significantly (p < 0.001) decrease the mean lesion size and the mean pain score in the late phase (p < 0.05). The present results determine that endometriosis pain may be related to nervous system neurotrophic factors. Treatment with RJ could decrease the size of endometriosis lesions as well as pain scores. The findings may shed light on other complementary and alternative remedies for endometriosis.
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Affiliation(s)
- Zahra K. Farahani
- Physiology Division of Basic Sciences DepartmentSchool of Veterinary MedicineShiraz UniversityShirazIran
- Maternal, Fetal, and Neonatal Research CenterTehran University of Medical SciencesTehranIran
| | - Mahnaz Taherianfard
- Physiology Division of Basic Sciences DepartmentSchool of Veterinary MedicineShiraz UniversityShirazIran
| | - Mohamad Mehdi Naderi
- Reproductive Biotechnology Research CenterAvicenna Research InstituteACECRTehranIran
| | - Hortensia Ferrero
- Institute of Treatment and Diagnosis of Uterine DiseasesIVI FoundationValenciaSpain
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16
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Tsutsui K, Kawano D, Mori H, Kato R, Ikeda Y, Sumitomo N, Fukaya H, Iwanaga S, Nakano S, Muramatsu T, Matsumoto K. Characteristics and optimal ablation settings of a novel, contact-force sensing and local impedance-enabled catheter in an ex vivo perfused swine ventricle model. J Cardiovasc Electrophysiol 2021; 32:3187-3194. [PMID: 34559441 DOI: 10.1111/jce.15253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/25/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local impedance (LI) has emerged as a new technology that informs on electrical catheter-tissue coupling during radiofrequency (RF) ablation. Recently, IntellaNav StablePoint, a novel LI-enabled catheter that equips contact force (CF) sensing, has been introduced. Although StablePoint and its predecessor IntellaNav MiFi OI share the common technology that reports LI, distinct mechanics for LI sensing between the two products raise a concern that the LI-RF lesion formation relationship may differ. METHODS In an ex vivo swine cardiac tissue model, we investigated the initial level and range of a reduction in LI during a 60-s RF ablation and the resultant lesion characteristics at nine combinations of three energy power (30, 40, and 50 W) and CF (10, 30, and 50 g) steps. Correlations and interactions between CF, LI, wattage, and formed lesions were analyzed. Incidence of achieving LI drop plateau and that of a steam pop were also determined. RESULTS Positive correlations existed between CF and initial LI, CF and absolute/relative LI drop, CF and lesion volume, and LI drop and lesion volume. At the same LI drop, wattage-dependent gain in lesion volume was observed. Steam pops occurred in all CF steps and the prevalence was highest at 50 W. LI drop predicted a steam pop with a cutoff value at 89Ω. CONCLUSION In StablePoint, wattage crucially affects LI drop and lesion volume. Because 30 W ablation may by underpowered for intramural lesion formation and 50 W often resulted in a steam pop, 40 W appears to achieve the balance between the safety and efficacy.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
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17
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Lee J, Forrester VJ, Novicoff WM, Guffey DJ, Russell MA. Surgical delays of less than 1 year in Mohs surgery associated with tumor growth in moderately- and poorly-differentiated squamous cell carcinomas but not lower-grade squamous cell carcinomas or basal cell carcinomas: A retrospective analysis. J Am Acad Dermatol 2021; 86:131-139. [PMID: 34499990 DOI: 10.1016/j.jaad.2021.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence is controversial and limited concerning whether surgical delays are associated with tumor growth for cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas. OBJECTIVE Identify tumor subpopulations that may demonstrate an association between tumor growth and surgical delay. METHODS We retrospectively analyzed 299 SCCs and 802 basal cell carcinomas treated with Mohs surgery at a single institution. Time interval from biopsy to surgery represented surgical delay. Change in major diameter (ΔMD) from size at biopsy to postoperative defect represented tumor growth. Independent predictors of ΔMD were identified by multivariate analysis. Linear regression was then utilized to assess for whether the ΔMD from these independent predictors trended with surgical delay. RESULTS Surgical delays ranged from 0 to 331 days. Among SCCs, histologic subtype and prior treatment were identified as independent predictors of ΔMD. Significant associations between ΔMD and surgical delay were found for poorly- and moderately-differentiated SCCs, demonstrating growth rates of 0.28 cm and 0.24 cm per month of delay, respectively. The ΔMD for SCCs with prior treatment and basal cell carcinoma subgroups did not vary with surgical delay. LIMITATIONS Retrospective design, single center. CONCLUSION Surgical delays of less than a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance.
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Affiliation(s)
- Jack Lee
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia.
| | - Vernon J Forrester
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
| | - Wendy M Novicoff
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Darren J Guffey
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
| | - Mark A Russell
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
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18
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Kawano D, Mori H, Kato R, Tsutsui K, Ikeda Y, Sumitomo N, Fukaya H, Iwagana S, Nakano S, Muramatsu T, Matsumoto K. The optimal ablation setting for a local impedance guided catheter in an in vitro experimental model. J Cardiovasc Electrophysiol 2021; 32:2069-2076. [PMID: 34185348 DOI: 10.1111/jce.15136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The local impedance (LI) reflects the electrical catheter-tissue coupling and correlates with the local tissue temperature. However, there have been few clinical studies showing the recommended method for LI monitoring catheters. This study aimed to investigate the optimal ablation setting for this catheter in an in vitro experimental model. METHODS LI monitoring catheters were used in an excised swine heart experimental model. The tissue contact force (CF) was directly monitored from an external weight scale. Radiofrequency ablation was performed with a combination of various energy power settings (30, 40, and 50 W), and various CFs (10, 30, and 50 g) for 60 s. The correlation between the LI-related indexes, power, and CF with the lesion formation was statistically analyzed. RESULTS A positive correlation between the LI or lesion formation and CF was observed under all powers. Although the LI drop always correlated with the maximum lesion depth, lesion diameter, and lesion volume, the coefficient of the correlation value was lower under a high CF (lesion depth, diameter, and volume; 10 g, r = 0.8064, r = 0.8389, r = 0.8477; 30 g, r = 0.7590, r = 0.8063, r = 0.8060; 50 g r = 0.5555, r = 0.5701, and r = 0.5678, respectively). Steam pops occurred only under a 50 W ablation and the LI drop cutoff value for steam pops was 46 Ω. CONCLUSION The same LI drop did not always lead to the same lesion size when the CF differed. Monitoring the LI and not exceeding 46 Ω would be useful for a safe ablation.
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Affiliation(s)
- Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan
| | - Shiro Iwagana
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
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19
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Bourier F, Popa M, Kottmaier M, Maurer S, Bahlke F, Telishevska M, Lengauer S, Koch-Büttner K, Kornmayer M, Risse E, Brkic A, Reents T, Hessling G, Deisenhofer I. RF electrode-tissue coverage significantly influences steam pop incidence and lesion size. J Cardiovasc Electrophysiol 2021; 32:1594-1599. [PMID: 33928696 DOI: 10.1111/jce.15063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Steam pops are a rare complication associated with radiofrequency (RF) ablation and are hard to predict. The aim of this study was to assess the influence of coverage between the RF ablation electrode and cardiac tissue on steam pop incidence and lesion size. METHODS AND RESULTS An ex vivo model using porcine cardiac preparations and contact force sensing catheters was designed to perform RF ablations at different coverage levels between the RF electrode and cardiac tissue. During coverage level I, only the distal part of the ablation electrode was in contact with tissue. During coverage level II half of the ablation electrode, and during coverage level III the entire ablation electrode was embedded in tissue. RF applications (n = 60) at different coverage levels I-III were systematically performed using the same standardized ablation protocol. Ablations during coverage level III resulted in a significantly higher rate of steam pops (100%) when compared to ablations during coverage level II (10%) and coverage level I (0%), log rank p < .001. Coverage level I ablations resulted in significantly smaller lesion depths, diameters, and impedance drops when compared to higher coverage level ablations, p < .001. In the controlled ex vivo model, there was no difference in applied contact force or energy between different coverage levels. CONCLUSIONS The level of coverage between RF electrode, cardiac tissue, and the surrounding fluid significantly influenced the incidence of steam pops in an ex vivo setup. Larger coverage between RF electrode and tissue resulted in significantly larger lesion dimensions.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Susanne Maurer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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20
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Gschaidmeier A, Heimgärtner M, Schnaufer L, Hernáiz Driever P, Wilke M, Lidzba K, Staudt M. Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies. Front Pediatr 2021; 9:660096. [PMID: 34136439 PMCID: PMC8200455 DOI: 10.3389/fped.2021.660096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The risk factors for impaired cognitive development after unilateral perinatal stroke are poorly understood. Non-verbal intelligence seems to be at particular risk, since language can shift to the right hemisphere and may thereby reduce the capacity of the right hemisphere for its originary functions. Pharmaco-refractory epilepsies, a frequent complication of perinatal strokes, often lead to impaired intelligence. Yet, the role of well-controlled epilepsies is less well-understood. Here, we investigated whether well-controlled epilepsies, motor impairment, lesion size, lesion side, and lateralization of language functions influence non-verbal functions. Methods: We recruited 8 patients with well-controlled epilepsies (9-26 years), 15 patients without epilepsies (8-23 years), and 23 healthy controls (8-27 years). All underwent the Test of Non-verbal Intelligence, a motor-independent test, which excludes biased results due to motor impairment. Language lateralization was determined with functional MRI, lesion size with MRI-based volumetry, and hand motor impairment with the Jebson-Taylor Hand Function-Test. Results: Patients with epilepsies showed significantly impaired non-verbal intelligence [Md = 89.5, interquartile range (IQR) = 13.5] compared with controls (Md = 103, IQR = 17). In contrast, patients without epilepsies (Md = 97, IQR = 15.0) performed within the range of typically developing children. A multiple regression analysis revealed only epilepsy as a significant risk factor for impaired non-verbal functions. Conclusion: In patients with unilateral perinatal strokes without epilepsies, the neuroplastic potential of one healthy hemisphere is able to support the development of normal non-verbal cognitive abilities, regardless of lesion size, lesion side, or language lateralization. In contrast, epilepsy substantially reduces this neuroplastic potential; even seizure-free patients exhibit below-average non-verbal cognitive functions.
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Affiliation(s)
- Alisa Gschaidmeier
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Division of Neuropediatrics, Development, and Rehabilitation, University Children's Hospital Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
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21
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Kiouptsi K, Pontarollo G, Todorov H, Braun J, Jäckel S, Koeck T, Bayer F, Karwot C, Karpi A, Gerber S, Jansen Y, Wild P, Ruf W, Daiber A, Van Der Vorst E, Weber C, Döring Y, Reinhardt C. Germ-free housing conditions do not affect aortic root and aortic arch lesion size of late atherosclerotic low-density lipoprotein receptor-deficient mice. Gut Microbes 2020; 11:1809-1823. [PMID: 32579470 PMCID: PMC7524356 DOI: 10.1080/19490976.2020.1767463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The microbiota has been linked to the development of atherosclerosis, but the functional impact of these resident bacteria on the lesion size and cellular composition of atherosclerotic plaques in the aorta has never been experimentally addressed with the germ-free low-density lipoprotein receptor-deficient (Ldlr-/- ) mouse atherosclerosis model. Here, we report that 16 weeks of high-fat diet (HFD) feeding of hypercholesterolemic Ldlr-/- mice at germ-free (GF) housing conditions did not impact relative aortic root plaque size, macrophage content, and necrotic core area. Likewise, we did not find changes in the relative aortic arch lesion size. However, late atherosclerotic GF Ldlr-/- mice had altered inflammatory plasma protein markers and reduced smooth muscle cell content in their atherosclerotic root plaques relative to CONV-R Ldlr-/- mice. Neither absolute nor relative aortic root or aortic arch plaque size correlated with age. Our analyses on GF Ldlr-/- mice did not reveal a significant contribution of the microbiota in late aortic atherosclerosis.
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Affiliation(s)
- Klytaimnistra Kiouptsi
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Giulia Pontarollo
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Hristo Todorov
- Institute of Developmental Biology and Neurobiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Johannes Braun
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Sven Jäckel
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany
| | - Thomas Koeck
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Franziska Bayer
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Cornelia Karwot
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Angelica Karpi
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Susanne Gerber
- Institute of Developmental Biology and Neurobiology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Yvonne Jansen
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfram Ruf
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany,Department of Immunology and Microbiology, Scripps Research Institute, La Jolla, USA
| | - Andreas Daiber
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany,Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Emiel Van Der Vorst
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Interdisciplinary Center for Clinical Research (IZKF), Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
| | - Christian Weber
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Yvonne Döring
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christoph Reinhardt
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany,CONTACT Christoph Reinhardt University Medical Center Mainz, Mainz55131, Germany
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22
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Knauss S, Albrecht C, Dirnagl U, Mueller S, Harms C, Hoffmann CJ, Koch SP, Endres M, Boehm-Sturm P. A Semiquantitative Non-invasive Measurement of PcomA Patency in C57BL/6 Mice Explains Variance in Ischemic Brain Damage in Filament MCAo. Front Neurosci 2020; 14:576741. [PMID: 33071747 PMCID: PMC7538613 DOI: 10.3389/fnins.2020.576741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/21/2020] [Indexed: 12/14/2022] Open
Abstract
Numerous studies on experimental ischemic stroke use the filament middle cerebral artery occlusion (fMCAo) model in C57BL/6 mice, but lesion sizes in this strain are highly variable. A known contributor is variation in the posterior communicating artery (PcomA) patency. We therefore aimed to provide a semiquantitative non-invasive in vivo method to routinely assess PcomA patency. We included 43 male C57BL/6 mice from four independent studies using a transient 45 min fMCAo model. Edema-corrected lesion sizes were measured by magnetic resonance (MR) imaging 24 h after reperfusion. Time-of-flight MR angiography was performed 7 days before and 24 h after fMCAo. Scores of PcomA size measured 24 h after, but not scores measured 7 days before fMCAo were negatively correlated with lesion size. Variability in PcomA patency explained 30% of the variance in our cohort (p < 0.0001, coefficient of determination r2 = 0.3). In a simulation using parameters typical for experimental stroke research, the power to detect a true effect of d = 1 between two groups increased by 15% when an according covariate was included in the statistical model. We have demonstrated that in vivo measurement of PcomA size is feasible and can lead to increased accuracy in assessing the effect of treatments.
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Affiliation(s)
- Samuel Knauss
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Carolin Albrecht
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ulrich Dirnagl
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Quality, Ethics, Open Science, Translation, Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Susanne Mueller
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Harms
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Johannes Hoffmann
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Paul Koch
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Philipp Boehm-Sturm
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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23
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Yan S, Gu K, Wu X, Wang W. Computer simulation study on the effect of electrode-tissue contact force on thermal lesion size in cardiac radiofrequency ablation. Int J Hyperthermia 2020; 37:37-48. [PMID: 31918588 DOI: 10.1080/02656736.2019.1708482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: In cardiac radiofrequency (RF) ablation, RF energy is often used to create a series of transmural lesions for blocking accessory conduction pathways. Electrode-tissue contact force (CF) is one of the key determinants of lesion formation during RF ablation. Low electrode-tissue CF is associated with ineffective RF lesion formation, whereas excessive CF may increase the risk of steam pop and perforation. By using finite element analysis, we studied lesion size and features at different values of electrode-tissue CF in cardiac RF ablation.Materials and methods: A computer-model-coupled electrode-tissue CF field, RF electric field, and thermal field were developed to study temperature distribution and lesion dimensions in cardiac tissue subjected to CF of 2, 5, 10, 20, 30, and 40 g with identical RF voltage and duration.Results: Increasing CF was associated with an increase in lesion depth, width, and cross-section area. The lesion cross-section area exhibited a linear increase, and the lesion width was significantly greater than lesion depth under the identical ablation condition. The relationship between CF value and lesion size is a power function: Lesion Size = a × CFb (Lesion Depth = 3.17 × CF0.14 and Lesion Width = 5.17 × CF0.14).Conclusions: This study confirmed that CF is a major determinant of RF lesion size and that electrode-tissue CF affects the amount of power dissipated in tissue. At a constant RF voltage and application time, RF lesion size increases as CF increases.
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Affiliation(s)
- Shengjie Yan
- Electronic Engineering Department, Fudan University, Shanghai, China
| | - Kaihao Gu
- Electronic Engineering Department, Fudan University, Shanghai, China
| | - Xiaomei Wu
- Electronic Engineering Department, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Weiqi Wang
- Electronic Engineering Department, Fudan University, Shanghai, China
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24
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Jeffers MS, Touvykine B, Ripley A, Lahey G, Carter A, Dancause N, Corbett D. Poststroke Impairment and Recovery Are Predicted by Task-Specific Regionalization of Injury. J Neurosci 2020; 40:6082-97. [PMID: 32605940 DOI: 10.1523/JNEUROSCI.0057-20.2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 01/01/2023] Open
Abstract
Lesion size and location affect the magnitude of impairment and recovery following stroke, but the precise relationship between these variables and functional outcome is unknown. Herein, we systematically varied the size of strokes in motor cortex and surrounding regions to assess effects on impairment and recovery of function. Female Sprague Dawley rats (N = 64) were evaluated for skilled reaching, spontaneous limb use, and limb placement over a 7 week period after stroke. Exploration and reaching were also tested in a free ranging, more naturalistic, environment. MRI voxel-based analysis of injury volume and its likelihood of including the caudal forelimb area (CFA), rostral forelimb area (RFA), hindlimb (HL) cortex (based on intracranial microstimulation), or their bordering regions were related to both impairment and recovery. Severity of impairment on each task was best predicted by injury in unique regions: impaired reaching, by damage in voxels encompassing CFA/RFA; hindlimb placement, by damage in HL; and spontaneous forelimb use, by damage in CFA. An entirely different set of voxels predicted recovery of function: damage lateral to RFA reduced recovery of reaching, damage medial to HL reduced recovery of hindlimb placing, and damage lateral to CFA reduced recovery of spontaneous limb use. Precise lesion location is an important, but heretofore relatively neglected, prognostic factor in both preclinical and clinical stroke studies, especially those using region-specific therapies, such as transcranial magnetic stimulation.SIGNIFICANCE STATEMENT By estimating lesion location relative to cortical motor representations, we established the relationship between individualized lesion location, and functional impairment and recovery in reaching/grasping, spontaneous limb use, and hindlimb placement during walking. We confirmed that stroke results in impairments to specific motor domains linked to the damaged cortical subregion and that damage encroaching on adjacent regions reduces the ability to recover from initial lesion-induced impairments. Each motor domain encompasses unique brain regions that are most associated with recovery and likely represent targets where beneficial reorganization is taking place. Future clinical trials should use individualized therapies (e.g., transcranial magnetic stimulation, intracerebral stem/progenitor cells) that consider precise lesion location and the specific functional impairments of each subject since these variables can markedly affect therapeutic efficacy.
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Saldarriaga S, Cataño SJ, Rezaei A, Giambini H. Effect of metastatic lesion size and location on the load-bearing capacity of vertebrae using an optimized ash density-modulus equation. Comput Methods Biomech Biomed Engin 2020; 23:601-610. [PMID: 32310687 DOI: 10.1080/10255842.2020.1754808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
About 1.8 million new cancer cases are estimated in the US in 2019 from which 50-85% might metastasize to the thoracic and lumbar spines. Subject-specific quantitative computed tomography-based finite element analysis (QCT/FEA) is a promising used tool to predict vertebral fracture properties. The aims of this study were twofold: First, to develop an optimized equation for the elastic modulus accounting for all input parameters in FE modeling of fracture properties. Second, to assess the effect of lesion size and location on the predicted fracture loads. An inverse QCT/FEA method was implemented to determine optimal coefficients for the modulus equation as a function of ash density. Lesions of 16 and 20 mm were then virtually located at the center, off-centered, anterior, and posterior regions of the vertebrae. A total of 6426 QCT/FEA models were run to optimize the coefficients and evaluate the effect of lesions on fracture properties. QCT/FEA predicted stiffness showed high correlations (50%) with the experimentally measured values. Compared to a 16 mm lesion size, a 20 mm lesion had a reduction in failure load of 55%, 57%, 52%, and 44% at the center, off-centered, anterior cortex, and pedicle, respectively (p < 0.001). Lesions affecting mostly trabecular bone showed the largest reduction in predicted failure loads (about 55%), and females presented weaker outcomes than males. An optimal elastic modulus equation resulted in accurate vertebral stiffness predictions. A deterioration of the trabecular bone due to the presence of a lesion highly affected the predicted fracture loads, and this reduction was significantly higher in females compared to males.
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Affiliation(s)
- Sebastian Saldarriaga
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Simon Jimenez Cataño
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
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Abstract
New endoscopic resection techniques are constantly being developed for gastric adenoma, which can be classified as low or high grade according to the Vienna classification. However, long-term data on gastric adenoma (e.g., removal or follow-up after resection via endoscopy) remain lacking.We retrospectively analyzed 133 cases with gastric adenoma that underwent endoscopic resection from January 2010 to November 2018. We analyzed the risk factors and frequency of patients with synchronous and metachronous lesions after endoscopic resection for gastric adenoma and followed them for more than 2 years.One hundred six (79.7%) and 27 patients (20.3%) received endoscopic resection (ER) once and more than twice, respectively. Compared with the initial endoscopic biopsy pathological results, the upgraded and downgraded histological discrepancy rates were 10.5% (n = 14) and 3.0% (n = 4) after resection, respectively. The mean time to synchronous/metachronous recurrence was 2.23 years. The average lesion size at first procedure was larger in the multiple ER group than in the single ER group (2.00 vs 1.10 cm; P = .040). Eleven (8.3%) and 16 patients (12.0%) had recurred synchronous and metachronous lesions, respectively. In the multivariate Cox analysis of the recurrence group, intestinal metaplasia (hazard ratio, 2.761; 95% confidence interval, 1.117-6.820; P = .028) and lesion size (hazard ratio, 1.607; 95% confidence interval, 1.082-2.385; P = .019) were independent factors for receiving endoscopic resection more than twice.If patients have severe intestinal metaplasia or large size of lesion at endoscopic resection for gastric adenoma, periodic observation is necessary.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Department of Internal Medicine, Maryknoll Hospital
| | - Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Tae Hyung Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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Zhou Y. Dose and blending fraction quantification for adaptive statistical iterative reconstruction based on low-contrast detectability in abdomen CT. J Appl Clin Med Phys 2020; 21:128-135. [PMID: 31898865 PMCID: PMC7021010 DOI: 10.1002/acm2.12813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The utilization of iterative reconstruction makes it difficult to identify the dose‐noise relationship, resulting in empirical design of scan protocols and inconsistent conclusions on dose reduction for consistent image quality. This study was to quantitatively determine the dose and the blending fraction of adaptive statistical iterative reconstruction (ASIR) based on the specified low‐contrast detectability (LCD). Methods A tissue equivalent abdomen phantom and a GE discovery 750 HD computed tomography (CT) were utilized. The normality of the noise distribution was tested at various spatial scales (2.1–9.8 mm) in the presence of ASIR (10–100%) with a wide range of doses (2.24–38 mGy). The statically defined minimum detectable contrast (MDC) was used as the image quality metric. The parametric model decomposed the MDC into two terms: one with and the other without ASIR, each was related to the dose in the form of power law with factors and indices dependent on spatial scales. The parameters were identified by least‐square fitting to the experimental data. By considering the constraint of the blending fraction in the range of [0, 1], the dose and ASIR blending fraction were determined for any specified low‐contrast detectability (LCD), quantified by the MDC at the concerned lesion size. Results It was verified that noise distribution is normal in the presence of ASIR. It was also found that the noises obtained from the subtractions of adjacent slices had an underestimate of 20% as compared to the ground truth noises, regardless of the spatial scale, pitch, or ASIR blending fraction. The least‐square fitting for the parametric model resulted in correlation coefficients from 0.905 to 0.996. The root‐mean‐square errors ranged from 1.27% to 7.15%. Conclusion The parametric model can be used to form a look‐up‐table for dose and ASIR blending fraction. The dose choices may be substantially limited in some cases depending on the required LCD.
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Affiliation(s)
- Yifang Zhou
- Department of ImagingImaging Physics DivisionS. Mark Taper Foundation Imaging CenterCedars‐Sinai Medical Center8700 Beverly Blvd.Los AngelesCalifornia90048USA
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Mori H, Kato R, Sumitomo N, Ikeda Y, Goto K, Tanaka S, Asano S, Tahara M, Nagase T, Iwanaga S, Muramatsu T, Matsumoto K. Relationship between the ablation index, lesion formation, and incidence of steam pops. J Arrhythm 2019; 35:636-644. [PMID: 31410234 PMCID: PMC6686293 DOI: 10.1002/joa3.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ablation index (AI) is reported to be useful for a durable pulmonary vein isolation (PVI). However, there have been no studies investigating the relationship between the power, contact force (CF), AI, and steam pops. METHODS Using an in vitro model, ablation energy was delivered until a steam pop occurred and the time to the steam pop and AI when the steam pop occurred were measured. The experiment was performed with a combination of various powers (20, 30, 40, and 50 W) and contact forces (CFs) (10, 30, and 50 g) 20 times for each setting. The analysis consisted of two protocols. The first protocol was a comparison between the ablation power and several parameters under the same CF (10, 30, and 50 g). The second protocol was a comparison between the CF and several parameters under the same power (20, 30, 40, and 50 W). The correlation between the lesion formation and ablation parameters was evaluated. RESULTS The AI value when steam pops occurred varied depending on the ablation settings. All AI median values were <500 under an ablation power of 50 W. On other hand, the median ablation time up to the steam pop was more than 46 seconds, but all median values of the AI were more than 550 under an ablation with 20 W. CONCLUSIONS The AI cannot predict steam pops. A low power and long duration ablation could obtain a high AI value. However, high-power ablation could not obtain a high AI value because of an early occurrence of steam pops.
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Affiliation(s)
- Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Koji Goto
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Sayaka Tanaka
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - So Asano
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Mai Tahara
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Takahiko Nagase
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Shiro Iwanaga
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Toshihiro Muramatsu
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Kazuo Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
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Ho A, Kurdziel MD, Koueiter DM, Wiater JM. Three-dimensional computed tomography measurement accuracy of varying Hill-Sachs lesion size. J Shoulder Elbow Surg 2018; 27:350-356. [PMID: 29198939 DOI: 10.1016/j.jse.2017.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The glenoid track concept has been proposed to correlate shoulder stability with bone loss. Accurate assessment of Hill-Sachs lesion size preoperatively may affect surgical planning and postoperative outcomes; however, no measurement method has been universally accepted. This study aimed to assess the accuracy and reliability of measuring Hill-Sachs lesion sizes using 3-dimensional (3D) computed tomography (CT). METHODS Nine polyurethane humerus bone substitutes were used to create Hill-Sachs lesions of varying sizes with a combination of lesion depth (shallow, intermediate, and deep) and width (small, medium, and large). Specimens were scanned with a clinical CT scanner for size measurements and a micro-CT scanner for measurement of true lesion size. Six evaluators repeated measurements twice in a 2-week interval. Scans were measured by use of 3D CT reconstructions for length, width, and Hill-Sachs interval and with use of 2D CT for depth. The interclass correlation coefficient evaluated interobserver and intraobserver variability and percentage error, and Student t-tests assessed measurement accuracy. RESULTS Interclass correlation coefficient reliability demonstrated strong agreement for all variables measured (0.856-0.975). Percentage error between measured length and measured depth and the true measurement significantly varied with respect to both lesion depth (P = .003 and P = .005, respectively) and lesion size (P = .049 and P = .004, respectively). DISCUSSION AND CONCLUSIONS The 3D CT imaging is effective and reproducible in determining lesion size. Determination of Hill-Sachs interval width is also reliable when it is applied to the glenoid track concept. Measured values on 3D and 2-dimensional imaging using a conventional CT scanner may slightly underestimate true measurements.
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Affiliation(s)
- Anthony Ho
- Department of Orthopedics, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA; Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - Denise M Koueiter
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA; Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - J Michael Wiater
- Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA; Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA.
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Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med 2017; 45:1698-1705. [PMID: 27852595 DOI: 10.1177/0363546516668292] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. PURPOSE To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. STUDY DESIGN Systematic review. METHODS A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. RESULTS Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. CONCLUSION An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
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Affiliation(s)
| | - Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, New York, New York, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Amsterdam, the Netherlands
| | | | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | | | - Woo Jin Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - James Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Munro A, Codde J, Spilsbury K, Steel N, Stewart CJ, Salfinger SG, Tan J, Mohan GR, Leung Y, Semmens JB, O'Leary P, Williams V, Cohen PA. Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ. Am J Obstet Gynecol 2017; 216:272.e1-272.e7. [PMID: 27908632 DOI: 10.1016/j.ajog.2016.11.1044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. OBJECTIVE We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. STUDY DESIGN We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, and invasive adenocarcinoma during follow-up (<12 months) and surveillance (≥12 months) periods. RESULTS The cohort comprised 298 patients, with 228 (76.5%) treated initially by loop electrosurgical excision procedure and 70 (23.5%) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7%) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. CONCLUSION Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.
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Zhou Y, Nute J, Scott A, Lee C. Consistent low-contrast detectability for variable patient sizes and corresponding dose in abdominal CT. Med Phys 2017; 44:861-872. [PMID: 28039857 DOI: 10.1002/mp.12085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/04/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE For CT dose optimization, one needs to address two important questions. The first is how various lesion-specific detection tasks demand different patient doses for the same patient. The second is how the variation of the patient size requires different patient doses for the same lesion detection task. In this study, we attempted to find quantitative solutions to these questions by utilizing a wide range of abdomen phantoms. METHODS A simplified model with a monochromatic fan beam passing through a bowtie-filter and an elliptical object was proposed. The model relates the minimum detectable contrast (MDC) to the size-specific dose by power index of -1/2 and to the lesion size by power index of -1 with a patient size dependence function (PSDF) as the proportionality factor. The experimental validation was performed using seven abdomen phantoms (lateral ranges: 10 cm-39 cm) scanned with helical modes at various dose levels on two 64-slice scanners (Siemens mCT and GE HD 750). Noise images were obtained using subtractions among adjacent slices in the images reconstructed with filtered backprojection. It was verified that the mean pixel value distributions from various small regions (1.8 mm-10 mm) are Gaussian, thus the concept of the statistically defined minimum detectable contrast (SD-MDC), defined as distribution's standard deviation multiplied by 3.29, can be applied. The impact of the helical pitch and the high-definition (HD) acquisition was also studied. RESULTS The experimental data from all phantoms were found to fit the power law well (R2 ≥ 0.983). The PSDF was found to be scanner dependent - modeled with a Gaussian amplifier (R2 = 0.983) for one manufacturer and with an exponential function for the other (R2 = 0.990). The MDC relationship was not found to be impacted by different pitches or by HD acquisition. The results were used to find the size-specific doses and corresponding acquisition techniques required by consistent low-contrast detectability for variable patient sizes. Visual comparisons on the low-contrast insert images demonstrated that the derived techniques delivered consistent low-contrast detectability. CONCLUSIONS We have modeled and verified the relationship of the minimum detectable contrast to the patient size, the patient dose, and the lesion size from the images reconstructed with filtered backprojection. The findings can be useful for task-specific dose modulation on abdomen CT studies.
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Affiliation(s)
- Yifang Zhou
- Departments of Radiation Safety & Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Jessica Nute
- Departments of Radiation Safety & Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Alexander Scott
- Departments of Radiation Safety & Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Christina Lee
- Departments of Radiation Safety & Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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Abstract
Quasi-static ultrasound elastography is an emerging diagnostic imaging modality for determining the stiffness of pathologically changed soft tissues, which do not show significant differences in acoustic impedance for B-mode imaging. Although some methods were applied to improve the signal-to-noise ratio (SNRe) and contrast-to-noise ratio (CNRe) of the constructed elastogram, nonuniform strain distribution at the internal boundary of a hard inclusion, even with the uniform displacement on the surface, is an inherent mechanical effect and results in distortion at the detected lesion boundary. To overcome such stress concentrations, a new elastographic modality was proposed, where the elastograms from different angles throughout 360° were compounded. The strain field and subsequent ultrasound images were calculated using the finite element method (FEM) and Field II, respectively, from which the elastograms were constructed. The performance of complete angular compound elastography with varied interval angles, lesion sizes, and ratios of Young's moduli of the lesion to the background was simulated and compared with that of conventional axial strain elastography. It is found that viewing the lesion from only about 10 angles (interval of 36°) would significantly improve the image quality of elastogram (increasing SNRe by at least 13% and CNRe by at least 5.8 dB), reduce the lesion distortion in the lateral direction, and enhance the sensitivity, resolution, and accuracy of lesion detection. A preliminary phantom study showed similar improvements. Altogether, complete angular compound elastography improves the elastogram quality and reduces the mechanical effects in lesion detection.
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Affiliation(s)
- Chenhui Liu
- 1 School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - Yufeng Zhou
- 1 School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
- 2 Key Laboratory of Modern Acoustics, Nanjing University, Nanjing, China
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Munmany M, Marimon L, Cardona M, Nonell R, Juiz M, Astudillo R, Ordi J, Torné A, Del Pino M. Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen. BJOG 2016; 124:495-502. [PMID: 27506510 DOI: 10.1111/1471-0528.14247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN). DESIGN Prospective observational study. SETTING Tertiary university hospital. POPULATION A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC). METHODS After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%). MAIN OUTCOME MEASURES The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women. RESULTS The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm2 ; P < 0.001). A lesion size of ≤12 mm2 and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm2 predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6-30.6; P < 0.001). A lesion size of ≤12 mm2 had a specificity of 90.9% (95% CI 83.0-95.3%) and a negative predictive value of 86.0% (95% CI 77.5-91.6%) to predict the absence of SIL/CIN in the surgical specimen. CONCLUSIONS Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment. TWEETABLE ABSTRACT Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.
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Affiliation(s)
- M Munmany
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - L Marimon
- Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - M Cardona
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Nonell
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Juiz
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Astudillo
- Gynaecological Department, MANSO Primary Assistance Centre, Barcelona, Spain
| | - J Ordi
- Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - A Torné
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Del Pino
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Touvykine B, Mansoori BK, Jean-Charles L, Deffeyes J, Quessy S, Dancause N. The Effect of Lesion Size on the Organization of the Ipsilesional and Contralesional Motor Cortex. Neurorehabil Neural Repair 2015; 30:280-92. [PMID: 25967757 PMCID: PMC4766967 DOI: 10.1177/1545968315585356] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recovery of hand function following lesions in the primary motor cortex (M1) is associated with a reorganization of premotor areas in the ipsilesional hemisphere, and this reorganization depends on the size of the lesion. It is not clear how lesion size affects motor representations in the contralesional hemisphere and how the effects in the 2 hemispheres compare. Our goal was to study how lesion size affects motor representations in the ipsilesional and contralesional hemispheres. In rats, we induced lesions of different sizes in the caudal forelimb area (CFA), the equivalent of M1. The effective lesion volume in each animal was quantified histologically. Behavioral recovery was evaluated with the Montoya Staircase task for 28 days after the lesion. Then, the organization of the CFA and the rostral forelimb area (RFA)—the putative premotor area in rats—in the 2 cerebral hemispheres was studied with intracortical microstimulation mapping techniques. The distal forelimb representation in the RFA of both the ipsilesional and contralesional hemispheres was positively correlated with the size of the lesion. In contrast, lesion size had no effect on the contralesional CFA, and there was no relationship between movement representations in the 2 hemispheres. Finally, only the contralesional RFA was negatively correlated with chronic motor deficits of the paretic forelimb. Our data show that lesion size has comparable effects on motor representations in premotor areas of both hemispheres and suggest that the contralesional premotor cortex may play a greater role in the recovery of the paretic forelimb following large lesions.
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Affiliation(s)
- Boris Touvykine
- Département de Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Babak K Mansoori
- Département de Biologie moléculaire, Biochimie médicale et pathologie, Université Laval, Québec, QC, Canada
| | - Loyda Jean-Charles
- Département de Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Joan Deffeyes
- Département de Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Stephan Quessy
- Département de Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Numa Dancause
- Département de Neurosciences, Université de Montréal, Montréal, QC, Canada Groupe de Recherche sur le Système Nerveux Central (GRSNC), Université de Montréal, Montréal, QC, Canada
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Nguyen DT, Barham W, Zheng L, Shillinglaw B, Tzou WS, Neltner B, Mestroni L, Bosi S, Ballerini L, Prato M, Sauer WH. Carbon nanotube facilitation of myocardial ablation with radiofrequency energy. J Cardiovasc Electrophysiol 2014; 25:1385-90. [PMID: 25091811 DOI: 10.1111/jce.12509] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/24/2014] [Accepted: 07/22/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of carbon nanotubes (CNTs) in oncology has been proposed for the purpose of sensitizing tumors to radiofrequency (RF) ablation. We hypothesize that myocardial tissue infiltrated with CNTs will improve thermal conductivity of RF heating and lead to altered ablation lesion characteristics. METHODS An ex vivo model consisting of viable bovine myocardium, a circulating saline bath at 37 °C, a submersible load cell, and a deflectable sheath was assembled. A 4-mm nonirrigated ablation catheter was positioned with 10 gm of force over bovine myocardium infiltrated with CNTs, 0.9% saline, or sham injections. A series of ablation lesions were delivered at 20 and 50 W, and lesion volumes were acquired by analyzing tissue sections with a digital micrometer. Tissue temperature analyses at 3 and 5 mm depths were also performed. RESULTS Myocardial tissue treated with CNTs resulted in significantly larger lesions at both low and high power settings. The electrical impedance was increased in CNT treated tissue with a greater impedance change observed in the CNT infiltrated myocardium. The thermal conductivity of heat generated by application of RF in the tissue was altered by the presence of CNTs, resulting in higher temperatures at 3 and 5 mm depths for both 20 and 50 W. CONCLUSIONS Myocardial tissue treated with CNTs resulted in significantly larger lesions at both low and high power settings. The electrical and thermal conductivity of heat generated by application of RF in myocardial tissue was altered by the presence of CNTs. Further research is needed to assess the in vivo applicability for this concept of facilitated ablation with CNTs.
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Affiliation(s)
- Duy T Nguyen
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
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Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, Wilson EL. Treatment of osteochondral lesions of the talus with particulated juvenile cartilage. Foot Ankle Int 2013; 34:1205-11. [PMID: 23576118 DOI: 10.1177/1071100713485739] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous modalities are used today to treat symptomatic osteochondral lesions in the ankle. However, there are ongoing challenges with the treatment of certain lesions, and concerns exist regarding long-term effectiveness. METHODS The purpose of the study was to collect clinical outcomes of pain and function in retrospectively and prospectively enrolled patients treated with particulated juvenile cartilage for symptomatic osteochondral lesions in the ankle. This study collected outcomes and incidence of reoperations in standard clinic patients. The analysis presented here includes final follow-up to date for 12 males and 11 females representing 24 ankles. Subjects had an average age at surgery of 35.0 years and an average body mass index of 28 ± 5.8. Fourteen ankles had failed at least 1 prior bone marrow stimulation procedure. The average lesion size was 125 ± 75 mm(2), and the average depth was 7 ± 5 mm. In conjunction with the treatment, 9 (38%) ankles had 1 concomitant procedure and 9 (38%) had more than 1 concomitant procedure. Clinical evaluations were performed with an average follow-up of 16.2 months. RESULTS Average outcome scores at final follow-up were American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale 85 ± 18 with 18 (78%) ankles demonstrating good to excellent scores, Short-Form 12 Health Survey (SF12) physical composite score 46 ± 10, SF12 mental health composite score 55 ± 7.1, Foot and Ankle Ability Measure (FAAM) activities of daily living 82 ± 14, FAAM Sports 63 ± 27, and 100-mm visual analog scale for pain 24 ± 25. Outcomes data divided by lesion size demonstrated 92% (12/13) good to excellent results in lesions 10 mm or larger and those smaller than 15 mm. To date, 1 partial graft delamination has been reported at 16 months. CONCLUSIONS Preliminary data from a challenging clinical population with large, symptomatic osteochondral lesions in the ankle suggest that treatment with particulated juvenile cartilage could improve function and decrease pain. Longer follow-up and additional subjects are needed to evaluate improvement level and ideal patient indications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- J Chris Coetzee
- Minnesota Orthopedic Sports Medicine Institute (MOSMI) at Twin Cities Orthopedics, and Fairview/MOSMI Medicine Fellowship Faculty, Edina, MN, USA
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Stahl R, Jain SK, Lutz J, Wyman BT, Le Graverand-Gastineau MP, Vignon E, Majumdar S, Link TM. Osteoarthritis of the knee at 3.0 T: comparison of a quantitative and a semi-quantitative score for the assessment of the extent of cartilage lesion and bone marrow edema pattern in a 24-month longitudinal study. Skeletal Radiol 2011; 40:1315-27. [PMID: 21479518 DOI: 10.1007/s00256-011-1156-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/29/2011] [Accepted: 03/13/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare a semi-quantitative and a quantitative morphological score for assessment of early osteoarthritis (OA) evolution. MATERIALS AND METHODS 3.0 T MRI of the knee was performed in 60 women, 30 with early OA (each 15 with Kellgren-Lawrence grade 2 and 3) and 30 age-matched controls at baseline and at 12 and 24 months. Pathological condition was assessed with the whole-organ magnetic resonance imaging score (WORMS). Cartilage abnormalities and bone marrow edema pattern (BMEP) were also quantified using a previously introduced morphological quantitative score. These data were correlated with changes in clinical parameters and joint space width using generalized estimation equations (GEE). RESULTS At baseline, OA patients had significantly (p < 0.05) more and larger cartilage lesions and BMEP. During follow-up, cartilage lesions increased significantly (p < 0.05) in the patients compared with controls: WORMS showed progression only at the lateral patella, whereas the quantitative score revealed progression additionally at the trochlea and at the medial compartment. Both scores showed a significant (p < 0.05) increase in BMEP at the lateral femur in OA patients. In addition, quantitative scores of BMEP of the whole knee decreased significantly (p < 0.05) after 12 months and increased after 24 months in the patients, but showed an increase in controls at all follow-up examinations. Only weak correlations between structural imaging findings and clinical parameters were observed. CONCLUSION Quantitative assessment of cartilage lesions and BMEP is more sensitive to changes during the course of the disease than semi-quantitative scoring. However, structural imaging findings do not correlate well with the clinical progression of OA.
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Sood RR, Taheri S, Candelario-Jalil E, Estrada EY, Rosenberg GA. Early beneficial effect of matrix metalloproteinase inhibition on blood-brain barrier permeability as measured by magnetic resonance imaging countered by impaired long-term recovery after stroke in rat brain. J Cereb Blood Flow Metab 2008; 28:431-8. [PMID: 17700631 PMCID: PMC2330167 DOI: 10.1038/sj.jcbfm.9600534] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Proteolytic disruption of the extracellular matrix with opening of the blood-brain barrier (BBB) because of matrix metalloproteinases (MMPs) occurs in reperfusion injury after stroke. Matrix metalloproteinase inhibition blocks the early disruption of the BBB, but the long-term consequences of short-term MMP inhibition are not known. Recently, a method to quantify BBB permeability by graphical methods was described, which provides a way to study both early disruption of the BBB and long-term effects on recovery in the same animal. We used a broad-spectrum MMP inhibitor, BB1101, to determine both the usefulness of the Magnetic resonance imaging (MRI) method for treatment studies and the long-term effects on recovery. Magnetic resonance imaging studies were performed in control (N=6) and drug-treated (N=8) groups on a dedicated 4.7-T MRI scanner. Adult Wistar-Kyoto underwent a 2-h middle cerebral artery occlusion followed by an MRI study after 3 h of reperfusion, which consisted of T2- and diffusion-weighted techniques. Additionally, a rapid T1 mapping protocol was also implemented to acquire one pre-gadolinium-diethylenetriaminepentaacetic acid baseline data set followed by postinjection data sets at 3-min intervals for 45 mins. The same animal was imaged again at 48 h for lesion size estimation. Data was postprocessed pixel-wise to generate apparent diffusion coefficient and permeability coefficient maps. Treatment with BB-1101 significantly reduced BBB permeability at 3 h, but failed to reduce lesion size at 48 h. Behavioral studies showed impairment in recovery in treated rats. Magnetic resonance imaging allowed for the monitoring of multiple parameters in the same animal. Our studies showed that BB-1101 was an excellent inhibitor of the BBB damage. However, results show that BB-1101 may be responsible for significant deterioration in neurologic status of treated animals. Although these preliminary results suggest that BB-1101 is useful in reducing early BBB leakage owing to reperfusion injury in stroke, further studies will be needed to determine whether the later detrimental effects can be eliminated by shorter time course of drug delivery.
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Affiliation(s)
- Rohit R Sood
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico 87131, USA.
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Doi A, Takagi M, Toda I, Teragaki M, Yoshiyama M, Takeuchi K, Yoshikawa J. Real time quantification of low temperature radiofrequency ablation lesion size using phased array intracardiac echocardiography in the canine model: comparison of two dimensional images with pathological lesion characteristics. Heart 2003; 89:923-7. [PMID: 12860873 PMCID: PMC1767768 DOI: 10.1136/heart.89.8.923] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of quantifying low temperature radiofrequency catheter ablation (RFCA) lesions using a phased array intracardiac echocardiography (ICE) catheter--with better tissue penetration and in a deflectable device-in the canine model. INTERVENTION Low temperature radiofrequency (RF) energy (50-60 degrees C at up to 40 W) was delivered to the left ventricle in 11 beagles for 60 seconds, using an 8 French catheter with a deflectable tip and a 4 mm distal electrode. MAIN OUTCOME MEASURES Comparison of the width and depth of RFCA lesions measured by ICE with pathological findings. RESULTS 33 RF energies were delivered in 11 dogs. 31 lesions (94%) were confirmed at necropsy. 27 of 31 ablation lesions (87%) were detected by ICE. The mean (SD) width and depth of the ICE detected lesions were 10.4 (2.6) mm and 5.7 (1.9) mm, respectively. Pathological findings showed that RFCA lesions consisted of inner and outer layers. Macroscopically, the mean (SD) width and depth of the inner layers were 7.6 (2.3) mm and 3.6 (1.2) mm and those for the whole layers were 10.0 (2.8) mm and 5.3 (1.5) mm, respectively. Microscopically, the inner and outer layers corresponded to necrotic and oedematous areas, respectively. The ICE detected lesion size had better correlation with the pathological measurements of the whole layers in width (r = 0.911) and in depth (r = 0.756). CONCLUSION The real time evaluation of RFCA lesion size using the phased array ICE is feasible, even with a low temperature RF application. However, ICE slightly overestimates RFCA lesion size compared with pathological necrotic lesion size.
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Affiliation(s)
- A Doi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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