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

A study was conducted to investigate changes in muscle soreness, serum creatine kinase (CK) activity and white blood cell (WBC) count following exercise bouts spaced three weeks apart.
The subjects were six male students (aged 23-25 yr), who had not participated in any training program for over 18 months. They performed muscular exercise of the nondominant arm using elbow flexors. Twenty percent of maximum voluntary contraction was used as the exercise intensity. After three weeks, the subjects repeated the same exercise bout. Perceived muscle soreness, CK activity and WBC count were assessed before, immediately after, 6h after and over 9 days after each exercise bout.
After the first exercise bout (1 st Ex), the subjects experienced muscle sorenss for 3-7 days. Also, a large increase of CK was found in five subjects (266-763%) . When the peak CK efflux was observed (day 3-4 after exercise), soreness had almost disappeared. WBC count was increased immediately and 6 h after exercise, then returned to the resting level. However, a significant increase (p<0.05) in WBC count was observed again on day 7 after exercise when CK had returned to the resting level. After the second exercise (2 nd Ex), a significant decrease of muscle soreness and the CK response was found in comparison with the 1 st Ex (p<0.41) . One interesting feature was that the CK efflux of subjects who had shown a large increase of CK after the 1 st Ex was not increased after the 2 nd Ex.
The initial exercise bout may have induced some damage to the muscle fibers or mem. bran. This damage would induce a process of repair in the damaged tissue, which in turn would adapt the muscle to the next stimulus. However, the subjects who showed a slight increase of CK after the 1 st Ex did not show this adaptation. Therefore an adaptive threshold for fiber or membrane damage may exist.

A study was conducted to investigate the relationship between energy systems and running performance, especially during the last spurt in an 800-m race. The subjects were separated into good 800-m runners (group A n=5: best record, 1′54″3±1.4) and a second group of slower 800-m runners (group B n=4: best record, 2′02″1±1.3) . Each group executed two types of running test (600m test and 800m test) . To simulate an 800-m race, the running speed up to 600m was set by means of a lamp pace maker system. The last spurt was running 200m at maximal voluntary running speed. Plasma lactate, plasma ammonia, serum glucose and blood pH were assayed at rest, after warming up, and 6 and 10min after the running test.
The following results were obtained:
1) The last spurt time of group A was significantly faster than that of group B (p<0.01) . 2) In group A, plasma lactate and plasma ammonia concentrations increased significantly during the last spurt (p<0.05) . In group B, however, plasma lactate and plasma ammonia concentrations before the last spurt (600m test values) were very close to the values after the last spurt (800m test values), 3) Last spurt times were significantly related to changes in plasma lactate concentration (r=-0.870, p<0.01) and O² debt (r=-0.799, p<0.01) during the last spurt.
These results suggest that running performance during the last spurt in an 800-m race depends on anaerobic energy ability, as reflected by plasma lactate, plasma ammonia and O² debt before the last spurt.

A study was conducted to investigate the changes in human urinary proteins caused by physical exercise. Nine subjects (male middle-distance runners, 19-21 years) were loaded physical exercise with a 10km-run, and quantitative and qualitative changes in urinary proteins were examined using various techniques including polyacrylamide gel electrophoresis, immunoelectrophoresis and two-dimensional electrophoresis. Total protein concentrations in urine from all subjects before exercise were very low (0.68-2.56mg/dl), but those were increased remarkably after exercise. Few proteins except for albumin were detected in urine before run by polyacrylamide gel electrophoresis and immunoelectrophoresis, however, a few proteins were observed after exercise in addition to a marked increase of albumin. Several proteins which were not observed in serum could also be detected in urine after exercise by two-dimensional electrophoresis under non-denaturing condition. It is considered that two-dimensional electrophoresis is a very powerful technique for analyzing dilute and complicated protein mixture in biological fluids such as urine.

Topical cardiac hypothermia has unequivocal preservation effects during ischemia, but it has some disadvantages. Topical cooling, especially with ice slush, can injure the phrenic nerve, disturb the equal distribution of the cardioplegic solution due to coronary artery spasm and damage the epicardium. It is easy to prevent cooling injury without topical hypothermia, but the myocardial oxygen demands are increased. In order to supply the myocardium with oxygen for the increased oxygen demands during ischemia, isolated rat hearts were immersed in perfluorochemicals (PFC) which have excellent transportation of oxygen. The effects of immersion in PFC during mild hypothermic ischemia (at 20°C without cardioplegia and at 30°C cardioplegic arrest) on the cardiac function on reperfusion were evaluated. Under 20°C hypothermic ischemia without cardioplegia, cardiac beating was maintained for 20±4 minutes in the hearts were immersed in PFC, and for 10±2 minutes in the hearts that were not immersed in any solution. In the recovery of cardiac function (LVDP and LV_max dp/dt) after mild hypothermic (30°C) cardioplegic arrest, the hearts immersed in PFC showed better results than hearts that were not immersed.

Infected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.

It was reported that nerve fibers were present in the inner part of lumbar intervertebral discs from patients with discogenic pain. Because there are no nerve fibers in the inner part of annulus fibrosus in normal condition, this finding suggests nerve ingrowth into the disc may be a cause of discogenic pain. Disc degeneration is often asymptomatic, thus, to understand the differences between symptomatic and asymptomatic disc, it is necessary to understand the pathogenesis of discogenic pain. We recently revealed that over 90% of the nociceptive dorsal root ganglion (DRG) neurons innervating the disc are sensitive to nerve growth factor (NGF), which is related to inflammatory pain. This indicates that discogenic pain is closely related to inflammation and NGF may play a key role. The increase of inflammatory mediators in symptomatic discs has been reported; we therefore studied the effects of disc inflammation and found that it induces sensitization of disc-innervating neurons and nerve ingrowth into the disc. More recently, it was shown that annular rupture induces nerve ingrowth, an increase of inflammatory mediators in the disc, and upregulation of calcitonin gene-related peptide, a pain-related molecule in DRGs. These findings led us to believe that annular rupture triggers inflammation and nerve ingrowth, inflammatory mediators then further promote nerve ingrowth into the disc and sensitization of disc-innervating neurons, and discogenic pain finally becomes chronic. NGF, found in symptomatic discs, may act as a key factor in generating chronic discogenic pain by sensitizing disc-innervating neurons and stimulating nerve ingrowth into the disc.
Calcitonin Gene-Related Peptide ; Diagnosis-Related Groups ; Ganglia, Spinal ; Humans ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Nerve Fibers ; Nerve Growth Factor ; Neurons ; Rupture ; Up-Regulation

BACKGROUND: Dexmedetomidine is a highly selective central α₂-agonist used as a sedative in pediatric intensive care unit (PICU). However, little is known about the relationship between dexmedetomidine dose and its plasma concentration during long-term infusion. We have previously demonstrated that the sedative plasma dexmedetomidine concentration is moderately correlated with the administered dose in adults (r = 0.653, P = 0.001). We hypothesized that there would be a similar relationship between the sedative dexmedetomidine concentration and administered dose in infants. METHODS: All patients admitted to the PICU at Nagoya City University Hospital, Japan, between November 2012 and March 2013 were eligible for inclusion in the study. Plasma dexmedetomidine concentration was measured by ultra-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS: We measured the plasma dexmedetomidine concentration in 203 samples from 45 patients. Of these, 96 samples collected from 27 patients < 2 years old were included in this study. All patients received dexmedetomidine at 0.12–1.40 µg/kg/h. The median administration duration was 87.6 hours (range: 6–540 hours). Plasma dexmedetomidine concentration ranged from 0.07 to 3.17 ng/ml. Plasma dexmedetomidine concentration was not correlated with the administered dose (r = 0.273, P = 0.007). The approximate linear equation was y = 0.690x + 0.423. CONCLUSIONS: In infants, plasma dexmedetomidine concentration did not exhibit any correlation with administered dose, which is not a reliable means of obtaining optimal plasma concentration.
Adult ; Chromatography, Liquid ; Cohort Studies* ; Critical Illness* ; Dexmedetomidine* ; Humans ; Infant* ; Intensive Care Units ; Japan ; Plasma* ; Prospective Studies* ; Tandem Mass Spectrometry

STUDY DESIGN: Retrospective analysis. PURPOSE: The present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS). OVERVIEW OF LITERATURE: The SCN is derived from the cutaneous branches of the dorsal rami of T11–L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder. METHODS: The present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19–89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35–84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ. RESULTS: The duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p=0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8–15 points) than in the LSS group (7 points; interquartile range, 4–9 points; p<0.001). For seven items (question number 1, 8, 11, and 20–23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group. CONCLUSIONS: Patients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.