Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins

Aims: To compare the procedural outcomes of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in atrial fibrillation (AF) patients with the common ostium of inferior pulmonary veins (COIPV) and to explore the effect of COIPV on CBA performance through the assessment of anatomical factors.Methods: A total of 18 AF patients with COIPV were included. Pulmonary vein isolation (PVI) was performed with second-generation CBA or RFA. The anatomical characteristics of COIPV and procedural outcomes were collected.Results: The prevalence of COIPV was 0.82% in the enrolled population. PVI was achieved in all pulmonary veins (PVs) without any complications. The “tricircle” strategy was applied for RFA, and the segmental freeze strategy was performed for CBA. Compared with RFA, CBA had shorter procedural time (median: 53.0 vs. 78.0 min, p < 0.001) and longer fluoroscopy time (median: 13.5 vs. 6.0 min, p < 0.001). Higher ovality index of the ostium was seen in patients with ≥4 freezes in inferior PVs [IPVs; 0.95 (0.78–1.05) vs. 0.49 (0.21–0.83), p = 0.047]. During a median of 23.5 months of follow-up, the atrial arrhythmias-free survival after the procedure was comparable between CBA and RFA (p = 0.729).Conclusion: The second-generation CBA is an efficient and safe alternative for RFA in AF patients with COIPV. Anatomical characteristics of COIPV bring the challenge to the procedure performance of RFA and CBA.

A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms

Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs).Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use.Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P < 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P < 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P > 0.05).Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.

Effect of heavy metals on stem anatomical characteristics of Trapa natans L. from Skadar Lake (Montenegro)

This study aimed to analyze stem anatomical characteristics of Trapa natans from five Skadar Lake locations (L1 - Milovića bay, L2 – inflow of the Morača river, L3 - Kamenik, L4 - Grmožur, L5 - Lipovik) with different concentrations of Cu, Mn, Zn, Co and Pb, during the summer period of the year 2012. Cross sections of stem were made using cryotechnic procedure. For all analyzed quantitative anatomical parameters, the minimum values at the location L2 were recorded, with the presence of maximum content for all investigated metals in stem of Trapa natans. On the other hand, except for cobalt, at the location L4 the minimum concentration for all investigated metals were recorded. Plants collected from this location have the largest average values of the most measured anatomical parameters. The results of Discriminant Analysis showed that plants from different location could be clearly classified into three groups according to their stem quantitative anatomical characteristics which corresponds with heavy metals content. Our research also showed that there is no statistically significant correlation between the content of most investigated metals (Co, Cu, Pb and Zn) and the values of anatomical parameters. Statistically significant negative correlation was found between Mn content in stem and values of two anatomical characters (stem cross-sectional area and Mn content, r = - 0.88; p < 0.05; number of hypodermal cell layers and Mn content, r = - 0.90; p < 0.05).

Anatomical Characteristics and Potential Gene Mutation Sites of a Familial Recurrent Patellar Dislocation

Background Recurrent patellar dislocation is the result of anatomical alignment and imbalance of restraint of bone and soft tissue. To investigate the anatomical characteristics of the knee joint in a family of patients with recurrent patella dislocation, and to screen the possible pathogenic genes in this family by whole exon sequencing in 4 patients and 4 healthy subjects, so as to provide theoretical basis for the pathogenesis of this disease. Methods The data related to patella dislocation were measured by imaging data. The peripheral blood DNA of related family members was extracted for full exon sequencing, and then the sequencing results were compared with the human database. By filtering out synonymous mutations and high-frequency mutations, and then integrating single nucleotide non-synonymous mutations of family members, disease-causing genes were found. Results All patients in this family have different degree of abnormal knee anatomy, which is closely related to patella dislocation. The sequencing results of patients and normal persons in this patella dislocation family were compared and analyzed, and the data were filtered through multiple biological databases. Find HOXB9(NM_024017.4:p.Glu135Gly/c.404A>G),COL1A1(NM_000088.3:p.Ala1256 Thr/c.3766G>A),GNPAT(NM_014236.3:p.Asp519Gly/c1556A>G),NANS(NM_018946.3:p.Glu68Asp/c.204G>C),SLC26A2(NM_000112.3:p.Thr689Ser/c.2065A>T) are not synonymous mutations (MISSENSE). Through Sanger sequencing, HOXB9 and SLC26A2 genes were found to be the pathogenic genes of this family with recurrent patella dislocation. Conclusions The anatomical structure of the knee joint of patients with recurrent patellar dislocation in this family is obviously abnormal. HOXB9 mutation may be the high frequency pathogenic gene of recurrent patella dislocation in this family, while COL1A1, GNPAT, NAans, SLC26A2 gene may be the sporadical pathogenic gene.

Diversification of Stem Morphological and Anatomical Characteristics in Eleocharis and Related Genera (Cyperaceae, Monocotyledoneae)

Abstract— The genus Eleocharis (Cyperaceae, monocotyledons) is characterized by bladeless leaves, which are leaves having only leaf-sheaths. To study the evolutionary process through which Eleocharis species lost their leaf blades, we analyzed the outer morphological and anatomical characters of the representative Eleocharis species, plus species from nine phylogenetically related genera. From the analysis, we recognized eight characters and we optimized their character states on a recent molecular phylogenetic tree. As a result, we recognized five characteristics shared by Eleocharis species as follows: (1) the most apical internode is more than seven times longer than the next apical internode; (2) bladeless leaves having only leaf sheaths; (3) transversely septate aerenchyma in culms; (4) densely and peripherally located, slender, and square timber-shaped fiber bundles in culms; and (5) palisade chlorenchyma in culms. In these characteristics, (2) and (4) are synapomorphies of Eleocharis. These two apomorphic characteristics seemed to be adaptations for inhabiting running waters.

178 Catheter inversion during cavotricuspid isthmus catheter ablation: the new shaft visualization catheter reduces fluoroscopy use

Aims Catheter ablation (CA) is the choice therapy of cavotricuspid isthmus (CTI) atrial flutter. The aim of this study was to describe our approach to improve the CTI ablation using a zero-fluoroscopy (ZF). The procedural difficulties could be related to anatomical characteristics of the CTI. Methods and results One hundred eighty-eight patients that performed CA of CTI were retrospectively and consecutively evaluated between 2017 and 2019. The studied population was divided into two groups. Eighty-eight patients who were undergone CA using ablation catheter without shaft visualization catheter (NSV) were Group 1. One hundred patients were undergone CA using ablation catheter with a shaft visualization (SV); they were Group 2. The catheter was looped at the Eustachian ridge after 200 s of radiofrequencies (RF) without elimination of local electrogram. A conduction line block of CTI was obtained in all patients of Group 2 using a ZF approach. In 16 patients of Group 1, the catheter inversion was obtained using fluoroscopy to avoid damages during its loop. In Group 2, a complete CTI block was obtained with a catheter inversion approach in 10 patients without fluoroscopy, visualizing the shaft and the tip of the ablation catheter on the electroanatomic (EAM) map. In the overall population studied the use of SV had a linear correlation with the ZF approach (r = 0.629; P &lt; 0.001). The duration of RF was lower in Group 2 than in Group 1 (Group 1: 27.8 ± 6.3 vs. Group 2: 15.6 ± 7.2 min; P &lt; 0.01). The procedure time between two groups was lower in Group 2 than in Group 1 (Group 1: 58.4 ± 22.4 vs. Group 2: 42.2 ± 15.7 min; P &lt; 0.01). No differences between two groups were documented regarding success and complications. Conclusions The visualization of the shaft’s catheter on the EAM permitted the catheter inversion safely in order to overcome some complex CTI anatomy and obtain bidirectional block. The SV reduced procedure time, RF applications, and fluoroscopy exposition during CTI ablation.

Taxonomical and Anatomical Study of the Species Nonea echioides (L.) Roem. & Sehult (Boraginceae) in Northern Iraq

The present study deals with some morphological and anatomical characteristics of the Nonea echioides(L.) Roem. & Sehult species belonging to Boraginaceae, which is recorded to have spread recently in Kurdistan region of Iraq. This research focused on some of the important morphological characteristics of the stems, leaves, flowers, and fruits and comparing them with other studies of neighboring countries to Iraq. These morphological characteristics were found to be important in isolating the species of the filed. The anatomical features of the epidermis, stomata, and trichomes were also investigated. The study shows that Nonea echioides belongs to C3 plants based on the anatomical features of the leaf. In conclusion, the present study provided means for field identification and taxonomy of the plant.

Topographic and anatomical characteristics of the bladder neck in early fetuses

Aim. To determine macro-and microscopic anatomical characteristics and the dynamics in topographic and anatomical interactions of the bladder neck with adjacent organs and structures at the beginning of the fetal period. Material and methods. The study was carried out on 70 fetal specimens. The age of subjects included in the study was determined according to the tables of B.M. Patten, B.P. Khvatova, Yu.N. Shapovalov based on measurements of the parietal-calcaneal length (PCL), taking into account the Instructions for determining the perinatal period, live birth, and stillbirth criteria, approved by Order of the Ministry of Health of Ukraine No. 179 dated March 29, 2006. To achieve this goal, the following methods of anatomical research were used: anthropometry - to determine the age of the studied subjects; injection of arterial vessels with subsequent dissection under the control of a microscope – to study the peculiarities of the blood supply to the vesicoureteral segment; radiography - to determine the skeletotopy of the vesicoureteral segment; macro-microscopy – to explore the anatomical relationships of the components of the vesicoureteral segment, their structure, shape, position; histological – to study the structure of the wall of the vesicoureteral segment; morphometry – to determine the morphometric parameters of the vesicoureteral segment; 3-D reconstruction method – to study the spatial structure of the vesicoureteral segment; statistical – to analyze and establish the reliability of differences in organometric parameters.Results. Skeletopically, the projection of the vesicoureteral junction of early fetuses is located at the level of the upper third of the pubic symphysis. At the beginning of the perinatal period in female fetuses, the bladder neck (6.9 ± 2.6 mm) is longer than in male fetuses (6.4 ± 2.4 mm). Based on the analysis and generalization of the research results, it is substantiated that at the beginning of the fetal period, the internal urethral sphincter can be formed: a) by two loops of the outer longitudinal layer; b) the ring of the circular layer and the front bundles of the outer longitudinal layer; c) anterior bundles of the outer longitudinal layer and transverse bundles of the inner longitudinal layer within the trigone of urinary bladder; d) a ring of the circular layer, thickened in the anterolateral sections.Conclusions. Considering the topographic and anatomical characteristics of the angio- and myoarchitectonics of the vesicoureteral segment, we believe that its role as a physiological sphincter of the lower urinary tract is provided by the interaction of the vascular and muscle components. The vascular component of the sphincter apparatus of the vesicoureteral segment is provided by veins located in three layers: 1) cavernous-like veins of the submucosa; 2) veins of the muscular membrane; 3) veins of tunica adventitia. The second anatomical component of the sphincter function of the vesicoureteral segment is the muscular one, represented by the internal urethral sphincter.