Catheter ablation for atrial fibrillation is based on pulmonary vein (PV) isolation, but this procedure is thought to be demanding. The visualization of 3-dimensional information that is provided by CartoMerge® (BioSense Webster Inc., Diamond Bar, CA, USA) makes the ablation procedure easier. The SoundStar® catheter (BioSense Webster Inc., Diamond Bar, CA, USA)became available in Korea in September 2016. CartoMerge® using a SoundStar® catheter, which we termed as SoundMerge, is a simple way to obtain good CartoMerge® results. In addition, information on catheter stability and ablation intensity at each site are provided by a new ablation annotation system (CARTO® 3 System, VisiTag™ Module [BioSense Webster Inc., Diamond Bar, CA, USA]), which would be helpful for accomplishing durable PV isolation. In this article, we introduce the methodology of SoundMerge and the setting of the VisiTag™ module that we are performing currently. Effective practical use of these new technologies would improve the quality of ablation procedures.
Atrial Fibrillation* ; Catheter Ablation ; Catheters* ; Diamond ; Korea ; Pulmonary Veins

Background : Since 2002, Keio University Hospital's Kampo Clinic has promoted itself actively through the media, public presentations, faculty outreach and an internet home page. However, the relative value of these promotions is unknown. Additionally, the range and prevalence of presenting concerns, and the ages and the gender ratio of the patients served at Keio is unknown.Objective and Methods : To better understand and better serve the patients, the medical charts of every new patient who presented to Keio University Hospital's Kampo Clinic from November 2004 to November 2005 (n=791) were retrospectively analyzed for 1) referral source, 2) age, 3) gender, and, 4) disease category.Results : The internet webpage was by far the best source of new patient referrals. The out-of-hospital referral rate to the clinic was remarkably low. Women exceeded men by a 3 : 1 ratio. Most women were in their thirties but male patients were fairly evenly distributed across the age spectrum. Patients under 16 and over 70 were gender-balanced. The vast majority of patients presented with general medicine/pediatric, dermatological or gynecological problems.Conclusion : A patient-oriented internet home page provides a good source of new patient referrals. Given the low rate of referrals from outside hospitals and physicians, additional outreach directed at internal medicine, dermatology or obstetrics/gynecology physicians appears warranted.
Clinic ; Hospitals ; Medicine, Kampo ; seconds ; Universities

The present study was conducted to obtain basic information about blood glucose fluctuation and relation with race performance during 100 km marathon. Subcutaneous glucose of one well-trained runner was measured by continuous glucose monitoring system (CGMS) at 5 min interval and blood samples for biochemical analysis were drawn at pre, middle and post of the race. Energy balance during one week prior to the 100 km race was recorded, and the whole energy and fluid intake during the race was analyzed. Blood glucose fluctuated reflecting duration of exercise and energy supply during the race. During the latter part of the race (65–70 km), abrupt declines in blood glucose level, which reflected insufficient carbohydrate intake before the race (119 g), were accompanied by decrease in running speed. The present report suggests that continuous glucose monitoring supplemented with standard nutritional and physiological measurement provides precise and valuable information on runner’s energy state during the ultra-endurance race, and that athletes need to reassess their preparation for the race and planning of energy intake during the race.

The purpose of this study was to investigate the relation between alterations of salivary secretory immunoglobulin A (SIgA) and the occurrence of upper respiratory tract infections (URTI) in rugby football players.We examined the relationship between the onset of URTI and the daily alterations of SIgA levels in 32 male collegiate rugby football players (20.5±1.3 years) during summer training camp for 36 days.Total of 6 in 32 subjects had the appearance of URTI symptoms (18 %). SIgA secretion rate decreased significantly in the middle of training camp compared to the baseline (P＜0.05). Furthermore, SIgA secretion rate during the appearance of URTI (13.7±1.1μg/min) were significantly lower than that without symptoms (19.2±1.4 μg/min, P＜0.01). These results suggest that serial monitoring of SIgA may be useful to assess the risk status of URTI affection in athletes.

The present study was conducted to obtain basic information about blood glucose fluctuation and relation with race performance during 100 km marathon. Subcutaneous glucose of one well-trained runner was measured by continuous glucose monitoring system (CGMS) at 5 min interval and blood samples for biochemical analysis were drawn at pre, middle and post of the race. Energy balance during one week prior to the 100 km race was recorded, and the whole energy and fluid intake during the race was analyzed. Blood glucose fluctuated reflecting duration of exercise and energy supply during the race. During the latter part of the race (65–70 km), abrupt declines in blood glucose level, which reflected insufficient carbohydrate intake before the race (119 g), were accompanied by decrease in running speed. The present report suggests that continuous glucose monitoring supplemented with standard nutritional and physiological measurement provides precise and valuable information on runner’s energy state during the ultra-endurance race, and that athletes need to reassess their preparation for the race and planning of energy intake during the race.

    Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.

A 66-year-old woman complained of dyspnea due to congestive heart failure, and was given a diagnosis of severe aortic insufficiency. Antiphospholipid syndrome and idiopathic thrombocytopenic purpura (ITP) had been diagnosed with 9 years previously. We planned preoperative plasma exchange and steroid pulse infusion to reduce the level of auto-antibodies for phospholipids. The aortic valve replacement was performed safely. Anticoagulant therapy with low molecular weight heparin and oral steroid therapy was administered after the operation to avoid thrombosis or bleeding. The patient's postoperative course was stable. She was discharged without any complication. In conclusion, preoperative plasma exchange and steroid pulse infusion, postoperative anticoagulant therapy and oral steroids resulted in a favorable outcome in a case of heart surgery for a patient with antiphospholipid syndrome.

Though preoperative autologous donation is not acceptable for all cases partly because some are preoperatively in a severe condition, intraoperative predonation is possible in almost all cases. We retrospectively evaluated the major factors related to the prevention of homologous blood transfusion by intraoperative predonation in 25 cases following valvular surgery without preoperative autologous donation. Homologous blood was not transfused in 18 cases {Group-(-)} but in 7 cases only after CPB {Group-(+)}. The male/female ratio, type of operation, body weight, CPB dilution, CPB duration, and perioperative change in hematocrit were comparable in the 2 groups. However, the autologous blood pooled before CPB in Group-(-) was significantly more than in Group-(+) (11.3±2.5 vs 7.3±1.8ml/kg, p<0.001). In conclusion, homologous blood transfusion may be prevented by appropriate intraoperative predonation during surgery for valvular disease.

The purpose of this study was to investigate the effects of Lactobacillus gasseri OLL2809 (MG2809) intake on salivary secretory immunoglobulin A (SIgA) secretion and incidence of upper-respiratory tract infection (URTI) symptoms among college rugby athletes. Sixty-seven subjects were assigned to a MG2809 group (n = 33) or a placebo group (n = 34) using a double-blind procedure. Each subject took MG2809 or placebo tablets for 9 weeks. Resting saliva samples were collected before (0 week) and after 2, 4, 6, 8, and 9 weeks of the MG2809 intakes. A log of URTI symptoms was kept every day during the study period. Our results showed that salivary SIgA level was significantly increased at 6 weeks in the MG2809 group (p < 0.05), although the placebo group did not show significant change. The duration of URTI symptoms episode in the MG2809 group was significantly shorter than that in the placebo (p < 0.05). These results suggest that regular intake of MG2809 may enhance oral immune function mediated by SIgA and reduce the risk of URTI in athletes.

Ossification of parts of the intracranial dura mater is common and is generally accepted as an age-related finding. Additionally, duplication of the abducens nerve along its course to the lateral rectus muscle is a known, although uncommon anatomical variant. During routine cadaveric dissection, an ossified portion of dura mater traveling over the trigeminal nerve's entrance (porus trigeminus) into the middle cranial fossa was observed unilaterally. Ipsilaterally, a duplicated abducens nerve was also observed, with a unique foramen superolateral to the entrance of Dorello's canal. To our knowledge, there has been no existing report of a simultaneous ossified roof of the porus trigeminus with an ipsilateral duplicated abducens nerve. Herein, we discuss this case and the potential clinical and surgical applications. We believe this case report will be informative for the skull base surgeon in the diagnosis of neuralgic pain in the frontomaxillary, andibular, orbital, and external and middle ear regions.
Abducens Nerve ; Cadaver ; Cranial Fossa, Middle ; Diagnosis ; Dura Mater ; Ear, Middle ; Orbit ; Skull Base ; Trigeminal Neuralgia